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Am J Perinatol 2024; 41(S 01): e1313-e1323
DOI: 10.1055/s-0043-1761920
Original Article

The Association between Infant Birth Weight, Head Circumference, and Neurodevelopmental Outcomes

Maged M. Costantine 
1   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Alan T. N. Tita
2   University of Alabama at Birmingham, Birmingham, Alabama
,
Lisa Mele
3   George Washington University Biostatistics Center, Washington, District of Columbia
,
Brian M. Casey
4   University of Texas – Southwestern, Dallas, Texas
,
Alan M. Peaceman
5   Northwestern University, Chicago, Illinois
,
Michael W. Varner 
6   University of Utah Health Sciences Center, Salt Lake City, Utah
,
Uma M. Reddy
7   Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Ronald J. Wapner
8   Columbia University, New York, New York
,
John M. Thorp Jr.
9   University of North Carolina, Chapel Hill, North Carolina
,
George R. Saade
10   University of Texas Medical Branch, Galveston, Texas
,
Dwight J. Rouse
11   Brown University, Providence, Rhode Island
,
Baha Sibai
12   University of Texas – Houston, Houston, Texas
,
Brian M. Mercer
13   Case Western Reserve University, Cleveland, Ohio
,
Steve N. Caritis
14   University of Pittsburgh, Pittsburgh, Pennsylvania
,
for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units Network Bethesda MD › Author Affiliations FundingSupported by grants (HD34116, HD40512, HD27917, HD34208, HD40485, HD40560, HD53097, HD27869, HD40500, HD40545, HD27915, HD40544, HD53118, HD21410, and HD36801) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke. The views expressed in this article are those of the authors and do not necessarily represent the views of the National Institutes of Health.
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Abstract

Objective The aim of this study was to evaluate whether being small for gestational age (SGA) or large for gestational age (LGA) or having a small or large head circumference (HC) at birth is associated with adverse neurodevelopmental outcomes.

Study Design This is a secondary analysis of a multicenter negative randomized trial of thyroxine therapy for subclinical hypothyroid disorders in pregnancy. The primary outcome was child intelligence quotient (IQ) at 5 years of age. Secondary outcomes included several neurodevelopmental measures. Associations between the outcomes in children with SGA (<10th percentile) or LGA (>90th percentile) birth weights, using ethnicity- and sex-specific population nomogram as well as nomograms from the National Fetal Growth (NFG) study, were compared with the referent of those with appropriate for gestational age (AGA) birth weight. Similar analyses were performed for HC.

Results Using the population nomogram, 90 (8.2%) were SGA and 112 (10.2%) were LGA. SGA neonates were more likely to be born preterm to mothers who were younger, smoked, and were less likely to have less than a high school education, whereas LGA neonates were more likely to be born to mothers who were older and have higher body mass index, compared with AGA neonates. SGA at birth was associated with a decrease in the child IQ at 5 years of age by 3.34 (95% confidence interval [CI], 0.54–6.14) points, and an increase in odds of child with an IQ < 85 (adjusted odds ratio [aOR], 1.9; 95% CI, 1.1–3.2). There was no association between SGA and other secondary outcomes, or between LGA and the primary or secondary outcomes. Using the NFG standards, SGA at birth remained associated with a decrease in the child IQ at 5 years of age by 3.14 (95% CI, 0.22–6.05) points and higher odds of an IQ < 85 (aOR, 2.3; 95% CI, 1.3–4.1), but none of the other secondary outcomes. HC was not associated with the primary outcome, and there were no consistent associations of these standards with the secondary outcomes.

Conclusion In this cohort of pregnant individuals with hypothyroid disorders, SGA birth weight was associated with a decrease in child IQ and greater odds of child IQ < 85 at 5 years of age. Using a fetal growth standard did not appear to improve the detection of newborns at risk of adverse neurodevelopment.

Keywords

birth weight - head circumference - neurodevelopmental outcomes - child IQ

Supplementary Material



Publication History

Received: 09 May 2022

Accepted: 19 December 2022

Article published online:
15 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 McIntire DD, Bloom SL, Casey BM, Leveno KJ. Birth weight in relation to morbidity and mortality among newborn infants. N Engl J Med 1999; 340 (16) 1234-1238
    CrossrefPubMedSearch in Google Scholar
  • 2 Barker DJ, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005; 353 (17) 1802-1809
    CrossrefPubMedSearch in Google Scholar
  • 3 Ozanne SE, Fernandez-Twinn D, Hales CN. Fetal growth and adult diseases. Semin Perinatol 2004; 28 (01) 81-87
    CrossrefPubMedSearch in Google Scholar
  • 4 Kajantie E, Osmond C, Barker DJ, Forsén T, Phillips DI, Eriksson JG. Size at birth as a predictor of mortality in adulthood: a follow-up of 350 000 person-years. Int J Epidemiol 2005; 34 (03) 655-663
    CrossrefPubMedSearch in Google Scholar
  • 5 Grobman WA, Lai Y, Rouse DJ. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. The association of cerebral palsy and death with small-for-gestational-age birthweight in preterm neonates by individualized and population-based percentiles. Am J Obstet Gynecol 2013; 209 (04) 340.e1-340.e5
    CrossrefPubMedSearch in Google Scholar
  • 6 Costantine MM, Lai Y, Bloom SL. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Population versus customized fetal growth norms and adverse outcomes in an intrapartum cohort. Am J Perinatol 2013; 30 (04) 335-341
    PubMedSearch in Google Scholar
  • 7 Gardosi J, Francis A. Adverse pregnancy outcome and association with small for gestational age birthweight by customized and population-based percentiles. Am J Obstet Gynecol 2009; 201 (01) 28.e1-28.e8
    CrossrefPubMedSearch in Google Scholar
  • 8 Bukowski R, Burgett AD, Gei A, Saade GR, Hankins GD. Impairment of fetal growth potential and neonatal encephalopathy. Am J Obstet Gynecol 2003; 188 (04) 1011-1015
    CrossrefPubMedSearch in Google Scholar
  • 9 Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000  g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol 2009; 200 (06) 672.e1-672.e4
    CrossrefPubMedSearch in Google Scholar
  • 10 Costantine MM, Mele L, Landon MB. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, Maryland. Customized versus population approach for evaluation of fetal overgrowth. Am J Perinatol 2013; 30 (07) 565-572
    PubMedSearch in Google Scholar
  • 11 Arcangeli T, Thilaganathan B, Hooper R, Khan KS, Bhide A. Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol 2012; 40 (03) 267-275
    CrossrefPubMedSearch in Google Scholar
  • 12 Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966; 37 (03) 403-408
    CrossrefPubMedSearch in Google Scholar
  • 13 Alexander GR, Kogan MD, Himes JH. 1994-1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J 1999; 3 (04) 225-231
    CrossrefPubMedSearch in Google Scholar
  • 14 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (02) 163-168
    CrossrefPubMedSearch in Google Scholar
  • 15 Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (01) 129-133
    CrossrefPubMedSearch in Google Scholar
  • 16 Buck Louis GM, Grewal J, Albert PS. et al. Racial/ethnic standards for fetal growth: the NICHD Fetal Growth Studies. Am J Obstet Gynecol 2015; 213 (04) 449.e1-449.e41
    CrossrefPubMedSearch in Google Scholar
  • 17 Casey BM, Thom EA, Peaceman AM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med 2017; 376 (09) 815-825
    CrossrefPubMedSearch in Google Scholar
  • 18 Savchev S, Figueras F, Cruz-Martinez R, Illa M, Botet F, Gratacos E. Estimated weight centile as a predictor of perinatal outcome in small-for-gestational-age pregnancies with normal fetal and maternal Doppler indices. Ultrasound Obstet Gynecol 2012; 39 (03) 299-303
    CrossrefPubMedSearch in Google Scholar
  • 19 Paulson JF, Chauhan SP, Hill JB, Abuhamad AZ. Severe small size for gestational age and cognitive function: catch-up phenomenon possible. Am J Obstet Gynecol 2012; 207 (02) 119.e1-119.e5
    CrossrefPubMedSearch in Google Scholar
  • 20 Sicard M, Nusinovici S, Hanf M. et al. Fetal and postnatal head circumference growth: synergetic factors for neurodevelopmental outcome at 2 years of age for preterm infants. Neonatology 2017; 112 (02) 122-129
    CrossrefPubMedSearch in Google Scholar
  • 21 Wright CM, Emond A. Head growth and neurocognitive outcomes. Pediatrics 2015; 135 (06) e1393-e1398
    CrossrefPubMedSearch in Google Scholar
  • 22 Cetin I, Barberis B, Brusati V. et al. Lactate detection in the brain of growth-restricted fetuses with magnetic resonance spectroscopy. Am J Obstet Gynecol 2011; 205 (04) 350.e1-350.e7
    CrossrefPubMedSearch in Google Scholar
  • 23 van Wassenaer A. Neurodevelopmental consequences of being born SGA. Pediatr Endocrinol Rev 2005; 2 (03) 372-377
    PubMedSearch in Google Scholar
  • 24 Kilby MD, Verhaeg J, Gittoes N, Somerset DA, Clark PM, Franklyn JA. Circulating thyroid hormone concentrations and placental thyroid hormone receptor expression in normal human pregnancy and pregnancy complicated by intrauterine growth restriction (IUGR). J Clin Endocrinol Metab 1998; 83 (08) 2964-2971
    CrossrefPubMedSearch in Google Scholar
  • 25 Mallard EC, Rees S, Stringer M, Cock ML, Harding R. Effects of chronic placental insufficiency on brain development in fetal sheep. Pediatr Res 1998; 43 (02) 262-270
    CrossrefPubMedSearch in Google Scholar
  • 26 Mallard C, Loeliger M, Copolov D, Rees S. Reduced number of neurons in the hippocampus and the cerebellum in the postnatal guinea-pig following intrauterine growth-restriction. Neuroscience 2000; 100 (02) 327-333
    CrossrefPubMedSearch in Google Scholar
  • 27 Kim YJ, Shin SH, Lee ES. et al. Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children. Sci Rep 2021; 11 (01) 6836
    CrossrefPubMedSearch in Google Scholar
  • 28 Taine M, Charles MA, Beltrand J. et al. Early postnatal growth and neurodevelopment in children born moderately preterm or small for gestational age at term: a systematic review. Paediatr Perinat Epidemiol 2018; 32 (03) 268-280
    CrossrefPubMedSearch in Google Scholar
  • 29 Li X, Eiden RD, Epstein LH, Shenassa ED, Xie C, Wen X. Etiological subgroups of small-for-gestational-age: differential neurodevelopmental outcomes. PLoS One 2016; 11 (08) e0160677
    CrossrefPubMedSearch in Google Scholar