Neurodevelopmental outcomes of children born small-for-gestation and large-for-gestation compared with appropriate-for-gestation

Abstract

Data are limited regarding the association between growth status at birth and childhood neurodevelopment (ND) outcomes. We compared ND of small (SGA) and large-for-gestational age (LGA) to appropriate-for-gestational age (AGA) newborns. Secondary analysis of the Environmental Contributors to Child Health Outcomes of the Fetal Growth Study involving children (5-9 years) of healthy women who received serial fetal growth ultrasounds. ND assessments at one time point included executive and motor functioning (age-appropriate NIH toolbox measures and parent reported scales from Ages and Stages Questionnaire, behavior and autism score). The primary outcome was executive functioning. The exposure comparisons were birth weight percentile for age and sex: SGA ( < 10th) and LGA ( >90th) vs AGA (10th-90th, reference). Additionally, SGA < 5th, and SGA + abnormal UA Doppler (S/D, PI or RI >90th percentile) subgroups were compared to AGA. Linear regression models with significant covariates yielded adjusted mean differences (95% CI). Of 795 children; 67 were SGA (8.4%), 86 LGA (10.8%) and 642 AGA (80.8%). Selected maternal and child characteristics differed by group (Table 1). Adjusting for these differences, LGA mean scores were 2.1-2.5 points higher (vs. AGA) for 2 of the 3 executive function measures with no differences for all other outcomes (Table 2). For SGA, only 1 out of 3 motor functions measures (grip strength) was lower (by 2.7 points) vs. AGA. Scores for other outcomes were similar. The subgroup comparisons were consistent with overall findings. Continuous analyses showed each 10 percentile increase in birth weight was associated with increased grip strength measure (0.48 (0.23-0.72)). Among children born to a healthy cohort of women, LGA was associated with higher executive function scores and SGA was associated with lower grip strength. Larger confirmatory studies are needed to further investigate these findings.