Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
Arch Dis Child. 2023 Dec;108(12):956-969. doi: 10.1136/archdischild-2022-324884. Epub 2023 Jun 20.
Size at birth, an indicator of intrauterine growth, has been studied extensively in relation to subsequent health, growth and developmental outcomes. Our umbrella review synthesises evidence from systematic reviews and meta-analyses on the effects of size at birth on subsequent health, growth and development in children and adolescents up to age 18, and identifies gaps.
We searched five databases from inception to mid-July 2021 to identify eligible systematic reviews and meta-analyses. For each meta-analysis, we extracted data on the exposures and outcomes measured and the strength of the association.
We screened 16 641 articles and identified 302 systematic reviews. The literature operationalised size at birth (birth weight and/or gestation) in 12 ways. There were 1041 meta-analyses of associations between size at birth and 67 outcomes. Thirteen outcomes had no meta-analysis.Small size at birth was examined for 50 outcomes and was associated with over half of these (32 of 50); continuous/post-term/large size at birth was examined for 35 outcomes and was consistently associated with 11 of the 35 outcomes. Seventy-three meta-analyses (in 11 reviews) compared risks by size for gestational age (GA), stratified by preterm and term. Prematurity mechanisms were the key aetiologies linked to mortality and cognitive development, while intrauterine growth restriction (IUGR), manifesting as small for GA, was primarily linked to underweight and stunting.
Future reviews should use methodologically sound comparators to further understand aetiological mechanisms linking IUGR and prematurity to subsequent outcomes. Future research should focus on understudied exposures (large size at birth and size at birth stratified by gestation), gaps in outcomes (specifically those without reviews or meta-analysis and stratified by age group of children) and neglected populations.
CRD42021268843.
出生体重作为宫内生长的指标，与随后的健康、生长和发育结果有广泛的关联。我们的综述汇总了关于出生体重对 18 岁以下儿童和青少年随后健康、生长和发育影响的系统评价和荟萃分析的证据，并确定了其中的空白。
我们从建库到 2021 年 7 月中旬，在五个数据库中搜索了合格的系统评价和荟萃分析。对于每一个荟萃分析，我们提取了所测量的暴露和结局以及关联强度的数据。
我们筛选了 16641 篇文章，确定了 302 篇系统评价。文献以 12 种方式对出生体重（出生体重和/或胎龄）进行了操作化处理。有 1041 项关于出生体重与 67 种结局关联的荟萃分析。有 13 种结局没有荟萃分析。对 50 种出生体重较小的结局进行了研究，其中超过一半（50 种中的 32 种）与出生体重相关；对 35 种连续/过期/较大的出生体重进行了研究，与 35 种结局中的 11 种始终相关。73 项荟萃分析（11 项综述中）比较了按胎龄（GA）划分的大小风险，分为早产和足月。早产机制是与死亡率和认知发育相关的关键病因，而宫内生长受限（IUGR），表现为胎龄小，主要与体重不足和发育迟缓相关。
未来的综述应使用方法上合理的对照物来进一步了解将 IUGR 和早产与随后的结局联系起来的病因机制。未来的研究应侧重于研究较少的暴露（出生体重较大和按胎龄分层的出生体重）、结局的空白（特别是那些没有综述或荟萃分析以及按儿童年龄组分层的结局）和被忽视的人群。
CRD42021268843。
