Zhu Zhonghai, Perumal Nandita, Fawzi Wafaie W, Cheng Yue, Elhoumed Mohamed, Qi Qi, Wang Liang, Dibley Michael J, Zeng Lingxia, Sudfeld Christopher R
Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
J Nutr. 2022 Jan 11;152(1):302-309. doi: 10.1093/jn/nxab335.
Preterm birth and fetal growth restriction are associated with linear growth faltering and suboptimal cognitive development in childhood.
We aimed to investigate whether and to what extent the associations between adverse birth outcomes and cognitive development in mid-childhood and early adolescence are mediated by postnatal stature.
We used data from a prospective birth cohort of children born to women who participated in a large cluster-randomized trial of antenatal micronutrient supplementation in rural western China. Children were followed up for anthropometric assessments at 6, 12, and 24 mo of age and in mid-childhood (7-9 y). Cognitive development was assessed in mid-childhood (n = 669) and early adolescence (n = 735; 10-12 y) using the Wechsler Intelligence Scale for Children-IV. We conducted a causal mediation analysis to evaluate the proportion of the association of low birth weight (LBW; <2500 g), small-for-gestational age (SGA; <10th percentile), and preterm birth (<37 weeks of gestation) with cognitive development in mid-childhood and early adolescence that was mediated by postnatal length/height-for-age and -sex z score (LAZ/HAZ) during the first 2 y of life and in mid-childhood.
LBW and SGA, but not preterm birth, were associated with lower cognitive test scores in mid-childhood and early adolescence. The proportion of the total association of SGA with adolescent cognitive development that was mediated by LAZ/HAZ at 6, 12, and 24 mo of age and in mid-childhood was 25%, 32%, 32%, and 27%, respectively. The corresponding proportions for LBW were 25%, 32%, 16%, and 24%, respectively.
The association of LBW and SGA with cognitive development in mid-childhood and adolescence is not largely mediated by postnatal stature during the first 2 y of life. Postnatal interventions that address the antecedent causes of poor child growth and development, rather than early childhood growth alone, are more likely to mitigate the risk of suboptimal development among SGA and LBW children. This trial was registered at www.isrctn.com as ISRCTN08850194.
早产和胎儿生长受限与儿童期线性生长发育迟缓及认知发育欠佳有关。
我们旨在研究不良出生结局与儿童中期和青春期早期认知发育之间的关联是否以及在多大程度上由出生后身高介导。
我们使用了来自一个前瞻性出生队列的数据，该队列中的儿童母亲参与了中国西部农村一项大型产前微量营养素补充剂集群随机试验。对儿童在6、12和24月龄以及儿童中期（7 - 9岁）进行人体测量评估随访。在儿童中期（n = 669）和青春期早期（n = 735；10 - 12岁）使用韦氏儿童智力量表第四版评估认知发育。我们进行了因果中介分析，以评估低出生体重（<2500 g）、小于胎龄儿（<第10百分位数）和早产（<37孕周）与儿童中期和青春期早期认知发育之间的关联中，在生命最初2年以及儿童中期由出生后年龄和性别的身长/身高z评分（LAZ/HAZ）介导的比例。
低出生体重和小于胎龄儿，但不是早产，与儿童中期和青春期早期较低的认知测试分数有关。小于胎龄儿与青少年认知发育的总关联中，在6、12和24月龄以及儿童中期由LAZ/HAZ介导的比例分别为25%、32%、32%和27%。低出生体重的相应比例分别为25%、32%、16%和24%。
低出生体重和小于胎龄儿与儿童中期和青春期认知发育之间的关联在很大程度上并非由生命最初2年的出生后身高介导。针对儿童生长发育不良的先前原因而非仅针对幼儿期生长的出生后干预措施，更有可能降低小于胎龄儿和低出生体重儿童发育欠佳的风险。本试验在www.isrctn.com注册，注册号为ISRCTN08850194。
