Kozuki Naoko, Katz Joanne, Lee Anne C C, Vogel Joshua P, Silveira Mariangela F, Sania Ayesha, Stevens Gretchen A, Cousens Simon, Caulfield Laura E, Christian Parul, Huybregts Lieven, Roberfroid Dominique, Schmiegelow Christentze, Adair Linda S, Barros Fernando C, Cowan Melanie, Fawzi Wafaie, Kolsteren Patrick, Merialdi Mario, Mongkolchati Aroonsri, Saville Naomi, Victora Cesar G, Bhutta Zulfiqar A, Blencowe Hannah, Ezzati Majid, Lawn Joy E, Black Robert E
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA;
J Nutr. 2015 Nov;145(11):2542-50. doi: 10.3945/jn.115.216374. Epub 2015 Sep 30.
Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease.
The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature.
We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed.
All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated with maternal short stature.
Approximately 6.5 million SGA and/or preterm births in LMIC may be associated with short maternal stature annually. A reduction in this burden requires primary prevention of SGA, improvement in postnatal growth through early childhood, and possibly further intervention in late childhood and adolescence. It is vital for researchers to broaden the evidence base for addressing chronic malnutrition through multiple life stages, and for program implementers to explore effective, sustainable ways of reaching the most vulnerable populations.
小于胎龄儿（SGA）和早产与不良健康后果相关，包括新生儿和婴儿死亡、儿童期营养不良以及成年期慢性病。
本研究的具体目标是估计母亲身材矮小与单纯SGA、单纯早产或两者结局之间的关联，并计算与母亲身材矮小相关的SGA和早产的人群归因分数。
我们利用来自12项基于人群的队列研究和世界卫生组织全球孕产妇和围产期健康调查（使用了24个可用数据集中的13个）的数据集，对低收入和中等收入国家（LMIC）的个体参与者数据进行了荟萃分析。我们纳入了出生后72小时内测量的体重、孕周和母亲身高数据的人群（n = 177,000）。对于每项研究，我们分别计算身高暴露类别<145 cm、145至<150 cm和150至<155 cm（参考：≥155 cm）与SGA、早产及其组合类别结局之间的相对风险（RR）。SGA使用21世纪国际胎儿和新生儿生长联盟（INTERGROWTH - 21st）出生体重标准和1991年美国出生体重参考标准进行定义。然后对这些关联进行荟萃分析。
所有身材矮小类别与足月SGA、早产适于胎龄儿（AGA）和早产SGA出生均有统计学显著关联（参考：足月AGA）。使用INTERGROWTH - 21st标准定义SGA时，身高<145 cm的女性调整后风险比（aRR）最高（足月SGA - aRR：2.03；95%置信区间：1.76, 2.35；早产AGA - aRR：1.45；95%置信区间：1.26, 1.66；早产SGA - aRR：2.13；95%置信区间：1.42, 3.21）。使用美国参考标准定义SGA时也观察到类似的关联。每年，550万例足月SGA（占全球总数的18.6%）、550,800例早产AGA（占全球总数的5.0%）和458,000例早产SGA（占全球总数的16.5%）出生可能与母亲身材矮小有关。
在低收入和中等收入国家，每年约650万例SGA和/或早产可能与母亲身材矮小有关。减轻这一负担需要对SGA进行一级预防，通过幼儿期改善出生后生长，并可能在儿童晚期和青春期进行进一步干预。对于研究人员来说，拓宽通过多个生命阶段解决慢性营养不良问题的证据基础至关重要，对于项目实施者来说，探索有效、可持续的方式来覆盖最脆弱人群也至关重要。
