Birth Status, Child Growth, and Adult Outcomes in Low- and Middle-Income Countries

Aryeh D Stein,Fernando C Barros,Santosh K Bhargava,Wei Hao,Bernardo L Horta,Nanette Lee,Christopher W Kuzawa,Reynaldo Martorell,Siddarth Ramji,Alan Stein,Linda Richter

doi:10.1016/j.jpeds.2013.08.012

Abstract

ObjectiveTo assess the impact of being born preterm or small for gestational age (SGA) on several adult outcomes.Study designWe analyzed data for 4518 adult participants in 5 birth cohorts from Brazil, Guatemala, India, the Philippines, and South Africa.ResultsIn the study population, 12.8% of males and 11.9% of females were born preterm, and 26.8% of males and 22.4% of females were born term but SGA. Adults born preterm were 1.11 cm shorter (95% CI, 0.57-1.65 cm), and those born term but SGA were 2.35 cm shorter (95% CI, 1.93-2.77 cm) compared with those born at term and appropriate size for gestational age. Blood pressure and blood glucose level did not differ by birth category. Compared with those born term and at appropriate size for gestational age, schooling attainment was 0.44 years lower (95% CI, 0.17-0.71 years) in those born preterm and 0.41 years lower (95% CI, 0.20-0.62 years) in those born term but SGA.ConclusionBeing born preterm or term but SGA is associated with persistent deficits in adult height and schooling, but is not related to blood pressure or blood glucose level in low- and middle-income settings. Increased postnatal growth is associated with gains in height and schooling regardless of birth status, but not with increases in blood pressure or blood glucose level.

Highlights

Primarily but not exclusively from high-income countries, have found inverse associations between size at birth and later blood pressure and blood glucose levels[2,3]; many of those studies did not pay adequate attention to the potential independent contributions of gestational age (GA) and birth size according to GA
The prevalence of preterm births and small for gestational age (SGA) births remains high in many populations,[5] and preterm birth and SGA status have been associated with undernutrition at age 2 years,[6] the later growth patterns of children born preterm have not been examined extensively, especially in low- and middle-income countries
The prevalences of preterm births, SGA and large for GA (LGA) status, and all adult outcomes differed across the cohorts (Table IV; available at www. jpeds.com)

Summary

Methods

The Consortium of Health-Orientated Research in Transitioning Societies is a collaborative endeavor pooling data from birth cohorts in 5 low- and middle-income countries: Brazil, Guatemala, India, the Philippines, and South Africa.[13]. Measures at Delivery In India and Guatemala, birth weight was measured by research teams. In the Philippines, birth weight was measured by birth attendants using hanging scales for home births and was obtained from hospital records for hospital births. In Brazil and South Africa, birth weight was measured by birth attendants in hospitals and was extracted from the hospital birth records. In Guatemala, India, and the Philippines, birth length was measured by the research teams using portable length boards within 15 days of delivery. Birth length was not measured in Brazil or South Africa

Results

Discussion

Conclusion