Adverse Growth Outcomes Research Articles

Perinatal depression and adverse child growth outcomes in low-income and middle-income countries (LMICs): A systematic review and meta-analysis.

Perinatal depression (PND), which encompasses the antepartum and postpartum depression (APD and PPD), is a neglected crisis in low-income and middle-income countries (LMICs). We aimed to systematically search and meta-analyze existing evidence to determine whether a mother's PND affects adverse growth outcomes in children in LMICs (PROSPERO protocol: CRD42021246803). We conducted searches, including nine databases (PubMed, EMBASE, Web of Science, CINAHL Plus, Global Health Database, Google Scholar, WHO Regional Databases, PsycINFO, and LILACS) from January 2000 to September 2023. We restricted studies that assessed PND using validated screening tools or clinical interviews during pregnancy or within 12 months postpartum. We included studies that reported four types of adverse child growth outcomes (stunting, wasting, underweight, and overweight/obesity) in children younger than 5 years. We assessed the quality using the Newcastle Ottawa Scale and pooled risk ratios (RRs) and odds ratios (ORs) between PND and each adverse growth outcome using random-effects models. In total, 27 studies met the inclusion criteria for systematic review, with 24 eligible for meta-analysis, spanning data from 15 countries and 26,261 mother-baby pairs. Based on the studies that reported ORs, children below the age of 3 years with mothers experiencing PND had higher odds for stunting (OR 1.63, 95% CI 1.32, 2.02, I2 = 56.0%) and underweight (OR 2.65, 95% CI 1.90, 3.68, I2 = 34.5%) compared to children of mothers without PND. The pooled RRs for stunting and underweight did not show significant differences between mothers with and without PND. Studies on wasting (n = 5) and overweight/obesity (n = 2) were limited, demonstrating inconsistent results across studies. The association between PND and adverse growth outcomes varied according to the measure of association, region, country, PND type, outcome timepoint, and study design. There were limited studies in diverse LMICs, particularly on wasting, or overweight/obesity as an outcome.

Association between postterm birth and adverse growth outcomes in children aged 3-6 years: A national retrospective cohort study.

Gestational age significantly influences children's growth and development. Yet, the effect of postterm birth (gestation beyond 42 weeks) on children's growth outcomes remains underexplored. This study aimed to assess the impact of postterm birth on adverse growth outcomes in children using a nationally representative sample from China. A retrospective cohort study was conducted in China from 1 April 2018, to 31 December 2019. The final analysis included 141,002 children aged 3-6 years from 551 cities. Postterm birth was defined as children with postterm birth at a gestational age of 42 weeks or more. Obesity, overweight and thinness were assessed using body mass index-for-age (BMI-for-age) z-scores, based on the World Health Organization (WHO) Child Growth Standards. Generalised additive models were employed to investigate the non-linear relationship between maternal gestational age and BMI-for-age z scores. Poisson regression models and subgroup analyses with forest plots were performed to examine the associations between postterm birth and the risks of obesity, overweight and thinness in children. We included 141,002 mother-child pairs, of whom 7314 (5.2%) children were classified as postterm births. There exists a non-linear relationship between gestational age and BMI-for-age z scores. Children born postterm exhibited a 46% increased risk of obesity, a 27% increased risk of combined overweight/obesity and a 13% increased risk of thinness. Similar associations were observed in most cases when further sensitivity and subgroup analysis were conducted. Postterm birth was associated with elevated risks of obesity, overweight and thinness in children aged 3-6 years, independent of sex. These findings underscore the importance of further research across diverse populations to understand the implications of postterm births on child health outcomes.

Ultrasound Tracking of Fetal Growth Characteristics during the Third Trimester of Pregnancy and the Prediction of Adverse Birth Outcomes

Background Fetal growth is the outcome of complex interactions between genes and the environment. A human being undergoes a synchronized balance of growth and development of body proportions throughout the prenatal and postnatal phases. Fetal growth is affected by many factors including maternal sociodemographic, maternal lifestyle-related characteristics, and pathological conditions, such as infections and some genetic conditions. Objective To assess the role of 3rd trimester ultrasound and fetal growth measurements in the prediction of adverse birth outcomes. Patients and Methods This study was a prospective cohort study of 141 pregnant females, conducted at Ain Shams University Hospitals. Results HC, AC, Expected fetal weight, HC percentile and weight percentile were significantly higher in normal cases than still birth, preterm, neonatal death and SGA, and lower than fetal macrosomia. AC percentile was significantly higher in normal cases than preterm, neonatal death and SGA, and lower than fetal macrosomia. Conclusion Fetal biometric and Doppler measurements during the third trimester of pregnancy play an important role in early detection of adverse growth outcomes in order to initiate further monitoring, planning and managing of delivery.

Mixtures of phthalates and phthalate replacements in relation to size-for-gestational age in the LIFECODES Fetal Growth Study

BACKGROUND AND AIM: Phthalate exposure has been previously associated with reductions in fetal growth, including small-for-gestational age (SGA) births. Little is known about how phthalate replacements may be associated with adverse growth outcomes, including changes at both the small and large ends of the growth spectrum. Thus, we estimated joint associations between phthalates and their replacements with size-for-gestational age, including both SGA and large-for-gestational age (LGA) births. METHODS: Using the LIFECODES Fetal Growth Study, a case-cohort of 249 SGA, 411 appropriate-for-gestational age (AGA), and 241 LGA births, we measured concentrations of metabolites for 13 phthalates and 4 phthalate replacements at three timepoints during pregnancy. We used quantile g-computation as a multipollutant approach to estimate the joint association between phthalates or phthalate replacements and the odds ratios (OR) (95% confidence intervals [CI]) of an SGA or LGA birth. RESULTS: Of the metabolites analyzed, 12 phthalate and 2 phthalate replacements were detected frequently (> 70% of participants). The highest correlations were observed within chemical classes. Phthalate replacement metabolites were negatively correlated with phthalate metabolites. A simultaneous one-quartile increase in the concentrations of all phthalate replacement metabolites was associated with higher odds of an SGA birth (OR: 1.33, 95% CI: 1.13, 1.57) and inverse, though null, associations were observed for phthalate metabolites (OR: 0.82, 95% CI: 0.64, 1.07). Associations with LGA births were generally inverse or null. Single-pollutant models were consistent with our mixtures results. For example, an interquartile range-increase in concentrations of the phthalate replacement metabolite mono-2-ethyl 5-carboxypentyl terephthalate (OR: 1.64, 95% CI: 1.25, 2.15) was associated with higher odds of an SGA birth. CONCLUSIONS: Phthalate replacements were associated with higher odds of an SGA birth. Given the increasing prevalence of exposure to phthalate replacements, further research should continue to examine their health impacts. KEYWORDS: phthalates, phthalate replacements, fetal growth, mixtures

Association between postterm pregnancy and adverse growth outcomes in preschool-age children

ABSTRACTBackgroundPostterm pregnancy has been associated with higher risk of perinatal mortality and morbidity, but its long-term health effects on offspring are poorly understood.ObjectivesThe aim of the study was to investigate the prospective associations between maternal postterm pregnancy and adverse growth outcomes in children.MethodsThe Jiaxing Birth Cohort is part of a large population-based health surveillance system in China and recruited pregnant females resident in the Jiaxing area between 1999 and 2013; newborns were followed up for a median duration of 5.8 y until they went to school. Mother–child pairs with maternal gestational information and offspring's anthropometric data at 4–7 y old were included. Postterm pregnancy was defined as maternal gestational age ≥42 and <47 wk, and its associations with offspring obesity, overweight/obesity, and thinness during childhood were determined by using Poisson regression models.ResultsOf the 101,505 included mother–child pairs, 2369 (2.3%) children were born at postterm. Children born at postterm had significantly lower BMI-for-age z score, weight-for-age z score, and height-for-age z score than those born at term; the mean difference (95% CI) was −0.11 (−0.15, −0.06), −0.17 (−0.21, −0.13), and −0.16 (−0.20, −0.12), respectively. When comparing postterm with term pregnancy, the multivariable-adjusted RRs and 95% CIs among preschool-age children were 0.87 (0.68, 1.11) for obesity, 0.82 (0.72, 0.94) for overweight/obesity, and 1.18 (1.09, 1.28) for thinness, respectively. These risk estimates were robust in sensitivity analyses, but were attenuated in several subgroups stratified by age, sex, mode of delivery, and fetal distress.ConclusionsPostterm pregnancy was associated with a higher risk of thinness, and a lower risk of overweight/obesity, as well as lower growth parameters in preschool-age children. These findings imply that postterm pregnancy may impede the long-term growth of offspring.

Dynamics of the infant gut microbiota in the first 18 months of life: the impact of maternal HIV infection and breastfeeding

BackgroundAccess to antiretroviral therapy (ART) during pregnancy and breastfeeding for mothers with HIV has resulted in fewer children acquiring HIV peri- and postnatally, resulting in an increase in the number of children who are exposed to the virus but are not infected (HEU). HEU infants have an increased likelihood of childhood infections and adverse growth outcomes, as well as increased mortality compared to their HIV-unexposed (HUU) peers. We explored potential differences in the gut microbiota in a cohort of 272 Nigerian infants born to HIV-positive and negative mothers in this study during the first 18 months of life.ResultsThe taxonomic composition of the maternal vaginal and gut microbiota showed no significant differences based on HIV status, and the composition of the infant gut microbiota at birth was similar between HUU and HEU. Longitudinal taxonomic composition of the infant gut microbiota and weight-for-age z-scores (WAZ) differed depending on access to breast milk. HEU infants displayed overall lower WAZ than HUU infants at all time points. We observed a significantly lower relative abundance of Bifidobacterium in HEU infants at 6 months postpartum. Breast milk composition also differed by time point and HIV infection status. The antiretroviral therapy drugs, lamivudine and nevirapine, as well as kynurenine, were significantly more abundant in the breast milk of mothers with HIV. Levels of tiglyl carnitine (C5) were significantly lower in the breast milk of mothers without HIV. ART drugs in the breast milk of mothers with HIV were associated with a lower relative abundance of Bifidobacterium longum.ConclusionsMaternal HIV infection was associated with adverse growth outcomes of HEU infants in this study, and these differences persist from birth through at least 18 months, which is a critical window for the development of the immune and central nervous systems. We observed that the relative abundance of Bifidobacterium spp. was significantly lower in the gut microbiota of all HEU infants over the first 6 months postpartum, even if HEU infants were receiving breast milk. Breastfeeding was of benefit in our HEU infant cohort in the first weeks postpartum; however, ART drug metabolites in breast milk were associated with a lower abundance of Bifidobacterium.7evEDGTh3wF9QF2c-7o-e3Video abstract

Association Between Postterm Pregnancy and Adverse Growth Outcomes in Preschool-Aged Children

Association Between Postterm Pregnancy and Adverse Growth Outcomes in Preschool-Aged Children

The association between secondhand smoke exposure and growth outcomes of children: A systematic literature review.

INTRODUCTIONThe strong relation between maternal smoking and maternal secondhand smoke (SHS) exposure and the growth of newborn infants has been proven. However, the effect of SHS on growth outcomes of older children is not well defined. Through a systematic literature review, we sought to determine whether a relationship exists between SHS exposure and growth outcomes of children up to 8 years of age.METHODSA systematic review was performed, including articles published between 2004–2019, related to SHS exposure (prenatal and postnatal) and children’s growth (weight, length/height, and head circumference). The relevant articles were identified from Science Direct, ProQuest, Sage Publication, Scopus, Wiley Online Library, CINAHL Plus with Full Text (via EBSCOhost) and Google search.RESULTSSeventeen articles were identified, of which three categories of growth measurements were extracted, comprising weight (weight, WAZ, WHZ, and BMI), height (height/length and HAZ) and head circumference. SHS exposure both pre or postnatally was inversely associated with weight (deficit in weight, risk of underweight, risk of wasting) and height (lower length and risk of stunting) and elevated BMI of children. Furthermore, prenatal SHS exposure was associated with a lower head circumference.CONCLUSIONSThe current review identified that exposure to SHS may be associated with adverse growth outcomes in children. It is crucial that active smokers, specifically those who live with children or with a pregnant partner, are made aware of the potential effects of SHS exposure on non-smokers. Further assessment of the association between exposure to SHS and other growth outcomes in other age groups is needed.

Extended Prophylaxis With Nevirapine Does Not Affect Growth in HIV-Exposed Infants.

Effects of prolonged nevirapine prophylaxis exposure on growth among HIV-exposed uninfected (HEU) infants are unknown. This study examines the impact of extended nevirapine prophylaxis from 6 weeks to 6 months on the growth of HEU infants followed for 18 months and also identifies correlates of incident wasting, stunting, underweight, and low head circumference in the HPTN 046 trial. Intention-to-treat analysis examined the effect of extended nevirapine exposure on: weight-for-age Z-score, length-for-age Z-score, weight-for-length Z-score, and head circumference-for-age Z-score. Multivariable linear mixed-effects and Cox proportional hazard models were used to compare growth outcomes between the study arms and identify correlates of incident adverse growth outcomes, respectively. Compared to placebo, extended prophylactic nevirapine given daily from 6 weeks to 6 months did not affect growth in HEU breastfeeding (BF) infants over time (treatment × time: P > 0.05). However, overall growth declined over time (time effect: P < 0.01) when compared with WHO general population norms. Male sex was associated with higher risk of all adverse growth outcomes (P < 0.05), whereas short BF duration was associated with wasting (P = 0.03). Maternal antiretroviral therapy exposure was protective against underweight (P = 0.02). Zimbabwe tended to have worse growth outcomes especially stunting, compared to South Africa, Uganda and Tanzania (P < 0.05). It is reassuring that prolonged exposure to nevirapine for prevention-of-mother-to-child HIV transmission does not restrict growth. However, targeted interventions are needed to improve growth outcomes among at-risk HEU infants (i.e., male sex, short BF duration, lack of maternal antiretroviral therapy exposure, and resident in Zimbabwe).

Effect of supplementation of complex milk lipids in pregnancy on fetal growth: results from the Complex Lipids in Mothers and Babies (CLIMB) randomized controlled trial

Background Gangliosides (GAs) are important for neuronal function and development of the brain, accumulating rapidly in the fetal brain during the last trimester of pregnancy. No study in humans has investigated whether maternal supplementation of GAs during pregnancy has an effect on fetal growth, particularly of the head circumference. Objective To evaluate the effect of maternal dietary supplementation of complex milk lipids (CML; gangliosides and phospholipids) from the milk fat globule membrane (MFGM) during pregnancy on fetal growth. Design Double-blind three-arm parallel randomized controlled trial of 1500 pregnant women from the Chongqing Municipality of China, recruited between 11 and 14 weeks of pregnancy. Intervention was in the form of supplementation with: control maternal milk formulation containing a minimum of 2 mg GA per serving (4 mg GA per day) versus a CML-enriched (CML-E) maternal milk formulation containing a minimum of 4 mg GA per serving (8 mg GA per day) versus no maternal milk supplementation, but with standard obstetric care including prenatal folic acid supplementation. Main outcomes and measures were ultrasonographically-derived estimates of fetal growth in head circumference (HC) & biparietal diameter (BPD) (primary outcomes); and abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW) (secondary outcomes) (Clinical trial registry: ChiCTR-IOR-16007700). Results Supplementation with CML-E milk had no effects on size at midpregnancy or growth trajectories in any of the fetal biometric dimensions. Conclusions Supplementation of CML from the MFGM from the end of the first trimester did not have any effects on fetal growth. The absence of any adverse growth outcomes suggests that maternal MFGM supplementation during pregnancy is safe and using CML-E milk formula can be a method of providing an increased GA and phospholipid supply in early life, which has been associated with neurodevelopmental benefits. Clinical trial registry ChiCTR-IOR-16007700 (http://www.chictr.org.cn/enindex.aspx)

Ethnic/Racial Disparities in the Fetal Growth Outcomes of Ecuadorian Newborns

Size at birth is an important indicator of future infant morbidity and mortality. Ethnic/racial disparities in birth weight and other fetal growth outcomes are well documented for US and Canadian minority groups but not for those in Latin America. The study compared the growth outcomes of 1,227 full-term Ecuadorian newborns delivered by Afro-descendant and indigenous minority women with those of ethnic majority (mestizo) women. Minority newborns had higher risk for congenital microcephaly but no excess risk for low birth weight or stunted linear growth compared to mestizos. However, minority newborns were significantly heavier at birth, weighing an average of 3-5% more than mestizos. Afro-Ecuadorians newborns also were fatter. The risk profile of Ecuadorian ethnic groups for certain fetal growth outcomes differs from some of those reported for North American minorities. Further studies are needed to investigate the origins of these between-group differences and to develop ethnic specific interventions for adverse growth outcomes.