Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Women and Children Medical and Healthcare Center of Wuhan, Wuhan, 430015, People's Republic of China.
BMC Med. 2024 Apr 29;22(1):181. doi: 10.1186/s12916-024-03390-3.
Early pregnancy is a critical window for neural system programming; however, the association of first-trimester fetal size with children's neurodevelopment remains to be assessed. This study aimed to explore the association between first-trimester fetal size and children's neurodevelopment and to examine whether intrauterine accelerated growth could compensate for the detrimental effects of first-trimester restricted growth on childhood neurodevelopment.
The participants were from a birth cohort enrolled from March 2014 to March 2019 in Wuhan, China. A total of 2058 fetuses with crown to rump length (CRL) (a proxy of first-trimester fetal size) measurements in the first trimester and neurodevelopmental assessment at age 2 years were included. We measured the first-trimester CRL and defined three fetal growth patterns based on the growth rate of estimated fetal weight from mid to late pregnancy. The neurodevelopment was assessed using the Bayley Scales of Infant Development of China Revision at 2 years.
Each unit (a Z score) increase of first-trimester CRL was associated with increased scores in mental developmental index (MDI) (adjusted beta estimate = 1.19, (95% CI: 0.42, 1.95), P = 0.03) and psychomotor developmental index (PDI) (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at age 2 years, respectively. No significant association was observed between fetal growth rate and PDI. For children with restricted first-trimester fetal size (the lowest tertile of first-trimester CRL), those with "intrauterine accelerated growth" pattern (higher growth rates) had significantly higher MDI (adjusted beta estimate = 6.14, (95% CI: 3.80, 8.49), P < 0.001) but indistinguishable PDI compared to those with "intrauterine faltering growth" pattern (lower growth rates). Main limitations of this study included potential misclassification of gestational age due to recall bias of the last menstrual period and residual confounding.
The current study suggests that restricted first-trimester fetal size is associated with mental and psychomotor developmental delay in childhood. However, in children with restricted first-trimester fetal size, intrauterine accelerated growth was associated with improved mental development but had little effect on psychomotor development. Additional studies are needed to validate the results in diverse populations.
早期妊娠是神经系统发育编程的关键窗口；然而，第一孕期胎儿大小与儿童神经发育的关系仍有待评估。本研究旨在探讨第一孕期胎儿大小与儿童神经发育的关系，并研究宫内加速生长是否可以弥补第一孕期生长受限对儿童神经发育的不利影响。
参与者来自 2014 年 3 月至 2019 年 3 月在中国武汉参加的一个出生队列研究。共纳入 2058 例胎儿，在第一孕期进行了头臀长（CRL）（第一孕期胎儿大小的替代指标）测量，并在 2 岁时进行了神经发育评估。我们测量了第一孕期的 CRL，并根据从中孕期到晚孕期估计胎儿体重的生长速度定义了三种胎儿生长模式。在 2 岁时使用中国贝利婴幼儿发展量表修订版评估神经发育。
第一孕期 CRL 每增加一个单位（Z 分数），精神发育指数（MDI）（调整后的β估计值=1.19，（95%置信区间：0.42，1.95），P=0.03）和运动发育指数（PDI）（调整后的β估计值=1.36，（95%置信区间：0.46，2.26），P<0.01）得分均增加。胎儿生长速度与 PDI 之间无显著关联。对于第一孕期胎儿大小受限（CRL 最低三分位）的儿童，具有“宫内加速生长”模式（较高生长速度）的儿童 MDI 显著更高（调整后的β估计值=6.14，（95%置信区间：3.80，8.49），P<0.001），但与“宫内生长迟缓”模式（较低生长速度）的儿童相比，PDI 无差异。本研究的主要局限性包括末次月经回忆偏倚导致的胎龄潜在错误分类和残余混杂。
本研究表明，第一孕期胎儿大小受限与儿童精神和运动发育迟缓有关。然而，在第一孕期胎儿大小受限的儿童中，宫内加速生长与精神发育改善相关，但对运动发育影响不大。需要进一步的研究来验证在不同人群中的结果。
