Steiner Naama, Wainstock Tamar, Sheiner Eyal, Segal Idit, Landau Daniela, Walfisch Asnat
a Department of Obstetrics and Gynecology , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel.
b Department of Public Health, Faculty of Health Sciences , Ben-Gurion University of the Negev , Beer-Sheva , Israel.
J Matern Fetal Neonatal Med. 2019 May;32(9):1407-1411. doi: 10.1080/14767058.2017.1406473. Epub 2017 Dec 4.
The concept of neonatal programming has begun to emerge as an important component of adult health. Scarce data exist regarding perinatal risk factors for long-term gastrointestinal (GI) morbidity of the offspring. We aimed to evaluate the association between birthweight (BW) at term and long-term pediatric GI morbidity.
A population-based cohort analysis was performed, comparing the risk of long-term GI morbidity (up to the age of 18 years) in children delivered at term according to their BW. The study included all term deliveries occurring between 1991 and 2014 at a single regional tertiary medical center. Multiple gestations and fetuses with congenital malformations were excluded. BW was subdivided into: small for gestational age (small for gestational age (SGA) - BW ≤ 5th centile), appropriate for gestational age (AGA -5th centile < BW < 95th centile), and large for gestational age (LGA - BW ≥95th centile). Hospitalizations up to the age of 18 years involving GI morbidity were evaluated, using a predefined set of ICD-9 codes, as recorded in the hospital files. A Kaplan-Meier survival curve was used to compare cumulative GI morbidity incidence. A Cox proportional hazards model was constructed to control for confounders.
During the study period, 225,600 term singleton deliveries met the inclusion criteria. Of them, 4.6% (n = 10,415) were SGA and 4.3% (n = 9796) were LGA. During the 18-years follow-up period, 11,791 (5.2%) children were hospitalized with GI morbidity. Hospitalizations were significantly more common in the SGA group, as compared with the AGA and LGA groups (6.6 versus 5.2 versus 4.5%, respectively, p < .001) Specifically, inflammatory bowel disease, celiac, hernia, hepatitis, and cholecystitis, were more common in the SGA group. The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of gastrointestinal morbidity in the SGA group (log rank p < .001). In the Cox proportional hazards model, controlled for relevant clinical confounders, SGA BW was found to be an independent risk factor for long-term GI morbidity (adjusted HR = 1.23, 95%CI 1.14-1.33, p < .001).
SGA offspring are at an increased and independent risk for long-term pediatric GI morbidity.
新生儿编程的概念已开始成为成人健康的一个重要组成部分。关于后代长期胃肠道（GI）发病的围产期危险因素的数据稀缺。我们旨在评估足月出生体重（BW）与儿童长期GI发病之间的关联。
进行了一项基于人群的队列分析，比较根据BW足月出生儿童发生长期GI发病（至18岁）的风险。该研究纳入了1991年至2014年在一个单一的地区三级医疗中心发生的所有足月分娩。排除多胎妊娠和有先天性畸形的胎儿。BW被细分为：小于胎龄儿（小于胎龄儿（SGA） - BW≤第5百分位数）、适于胎龄儿（AGA - 第5百分位数＜BW＜第95百分位数）和大于胎龄儿（LGA - BW≥第95百分位数）。使用医院文件中记录的一组预定义的ICD - 9编码评估至18岁涉及GI发病的住院情况。采用Kaplan - Meier生存曲线比较累积GI发病发生率。构建Cox比例风险模型以控制混杂因素。
在研究期间，225,600例足月单胎分娩符合纳入标准。其中，4.6%（n = 10,415）为SGA，4.3%（n = 9796）为LGA。在18年的随访期内，11,791例（5.2%）儿童因GI发病住院。与AGA和LGA组相比，SGA组的住院情况明显更常见（分别为6.6%、5.2%和4.5%，p＜0.001）。具体而言，炎症性肠病、乳糜泻、疝气、肝炎和胆囊炎在SGA组中更常见。Kaplan - Meier生存曲线显示SGA组胃肠道发病的累积发生率显著更高（对数秩检验p＜0.001）。在Cox比例风险模型中，在控制了相关临床混杂因素后，发现SGA BW是长期GI发病的独立危险因素（调整后HR = 1.23，95%CI 1.14 - 1.33，p＜0.001）。
SGA后代发生儿童长期GI发病的风险增加且独立。
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