Ong Yi Ying, Ng Nicholas Beng Hui, Michael Navin, Cai Shirong, Thway Tint Mya, Ooi Delicia Shu Qin, Tan Ai Peng, Tan Kok Hian, Shek Lynette, Yap Fabian, Chong Yap Seng, Eriksson Johan Gunnar, Chan Shiao-Yng, Broekman Birit F P, Godfrey Keith M, Silveira Patricia Pelufo, Tiemeier Henning, Law Evelyn C, Aris Izzuddin M, Lee Yung Seng
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Int J Epidemiol. 2024 Dec 16;54(1). doi: 10.1093/ije/dyaf012.
Using longitudinal ultrasounds as an improved fetal growth marker, we aimed to investigate if increased postnatal growth following fetal abdominal circumference (AC) growth deceleration is associated with improved child cognition.
Among 797 term-born singletons in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, we derived 2nd-3rd trimester fetal AC growth z-score, fetal AC growth deceleration, standardized height, weight, and body mass index (BMI) growth at early infancy (0-4 months), late infancy (4-15 months), toddlerhood (15-37 months), and early childhood (3-7 years), and investigated their associations with intelligence quotient (IQ) at ages 4.5 years (verbal, non-verbal) and 7 years (non-verbal-block design, matrix reasoning), adjusting for socio-demographic and biological confounders.
Among term-born newborns, 23.3% experienced fetal AC growth deceleration, which was associated with lower non-verbal IQ (4.5 years) [β (95% CI), -4.00 (-7.49, -0.51)]. Higher 0-7 years z-BMI gain was associated with lower non-verbal IQ (block design) (7 years) [-1.33 (-2.51, -0.14)]. Higher late infancy z-BMI gain was associated with higher verbal IQ (4.5 years) [3.36 (0.82,5.90)] but lower non-verbal IQ (matrix reasoning) (7 years) [-2.32 (-4.48, -0.17)]. Among those with fetal AC growth deceleration, higher 0-7 years z-weight gain was associated with lower non-verbal IQ (block design) (7 years) (P-interaction = .049); at z-weight gain of +2 standard deviation score (SDS), those with fetal AC growth deceleration had lower IQ [margins (95% CI), -2.6 (-7.1,1.9)]. On average, children with fetal AC growth deceleration caught up in z-height, z-weight, and z-BMI by 7 years.
Fetal AC growth deceleration was associated with lower cognition scores at preschool age. Increased weight or BMI growth from 0-7 years following fetal AC growth deceleration might not be favorable to cognition among generally well-nourished term-born children.
使用纵向超声作为一种改进的胎儿生长指标，我们旨在研究胎儿腹围（AC）生长减速后出生后生长加速是否与儿童认知能力的改善相关。
在新加坡成长为健康结局（GUSTO）队列中的797名单胎足月儿中，我们得出孕中期第2-3阶段胎儿AC生长z评分、胎儿AC生长减速、婴儿早期（0-4个月）、婴儿晚期（4-15个月）、幼儿期（15-37个月）和儿童早期（3-7岁）的标准化身高、体重和体重指数（BMI）增长情况，并研究它们与4.5岁（语言、非语言）和7岁（非语言 - 积木设计、矩阵推理）时的智商（IQ）的关联，同时对社会人口统计学和生物学混杂因素进行了调整。
在足月儿中，23.3%经历了胎儿AC生长减速，这与较低的非语言智商（4.5岁）相关[β（95%CI），-4.00（-7.49，-0.51）]。0-7岁z-BMI增长较高与较低的非语言智商（积木设计）（7岁）相关[-1.33（-2.51，-0.14）]。婴儿晚期z-BMI增长较高与较高的语言智商（4.5岁）相关[3.36（0.82，5.90）]，但与较低的非语言智商（矩阵推理）（7岁）相关[-2.32（-4.48，-0.17）]。在胎儿AC生长减速的儿童中，0-7岁z体重增长较高与较低的非语言智商（积木设计）（7岁）相关（P交互作用 = 0.049）；在z体重增长为+2标准差分数（SDS）时，胎儿AC生长减速的儿童智商较低[边际（95%CI），-2.6（-7.1，1.9）]。平均而言，胎儿AC生长减速的儿童在7岁时z身高、z体重和z-BMI方面追赶了上来。
胎儿AC生长减速与学龄前儿童较低的认知分数相关。胎儿AC生长减速后0-7岁体重或BMI增长加速，对于营养状况总体良好的足月儿的认知可能并无益处。
