Abstract
BackgroundImpaired fetal growth is associated with increased risks of kidney diseases in later life. Because human development rates are highest during the first trimester, this trimester may be a particularly critical period for kidney outcomes. We have therefore examined the association of fetal first trimester growth with kidney outcomes in childhood.MethodsThis study was embedded in a prospective population-based cohort study among 1176 pregnant women and their children. We used fetal first trimester crown–length as the growth measure among mothers with a regular menstrual cycle and a known first day of the last menstrual period. At the childhood age of 6 (median 5.7–6.8) years, we measured combined kidney volume, microalbuminuria and estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C concentrations.ResultsNo consistent associations of fetal first trimester crown–rump length with childhood combined kidney volume, eGFR and microalbuminuria were observed. Compared to children with a fetal first trimester crown–rump length in the highest quintile, those in the lowest quintile had a larger childhood combined kidney volume (difference 5.32 cm3, 95 % confidence interval 1.06 to 9.57), but no differences in kidney function.ConclusionOur results do not support the hypothesis that fetal first trimester growth restriction affects kidney size and function in childhood. Further studies are needed to focus on critical periods in early life for kidney function and disease in later life.
Highlights
Chronic kidney disease (CKD) may originate in the earliest phase of life [1]
Correlations between total kidney volume and body surface area (BSA)-related kidney volume with estimated glomerular filtration rate (eGFR) based on creatinine
The lack of significant associations in non-imputed datasets may be due to the smaller numbers: analyses on imputed data were based on 1176 datasets, whereas analyses on the non-imputed data were based on 934 datasets. In this population-based prospective cohort study, we evaluated the associations of fetal first trimester crown–rump length with kidney growth and function in childhood
Summary
It has been hypothesized that adverse environmental exposures in utero may lead to kidney developmental adaptations, including lower nephron numbers leading to glomerular hyperfiltration [2,3,4] These adaptations may subsequently progress to glomerulosclerosis, impaired kidney function and increased risks of CKD in adulthood [5, 6]. This hypothesis is supported by observational studies showing associations of preterm birth or small-size for gestational age at birth with smaller kidneys and increased risk of kidney disease later in life [7,8,9]. We have examined the association of fetal first trimester growth with kidney outcomes in childhood
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