Fetal growth does not modify the relationship of infant weight gain with childhood adiposity and blood pressure in the Southampton women's survey

Long-term implications of fetal growth restriction

Fetal growth restriction (FGR), or intrauterine growth restriction (IUGR), is a complication of pregnancy where the fetus does not achieve its genetic growth potential. FGR is characterized by a pathological retardation of intrauterine growth velocity in the curve of intrauterine growth. However, the FGR definition is still debated, and there is a lack of a uniform definition in the literature. True IUGR, compared to constitutional smallness, is a pathological condition in which the placenta fails to deliver an adequate supply of oxygen and nutrients to the developing fetus. Infants with IUGR, compared to appropriately grown gestational age infants, have a significantly higher risk of mortality and neonatal complications with long-term consequences. Several studies have demonstrated how suboptimal fetal growth leads to long-lasting physiological alterations for the developing fetus as well as for the newborn and adult in the future. The long-term effects of fetal growth retardation may be adaptations to poor oxygen and nutrient supply that are effective in the fetal period but deleterious in the long term through structural or functional alterations. Epidemiologic studies showed that FGR could be a contributing factor for adult chronic diseases including cardiovascular disease, metabolic syndrome, diabetes, respiratory diseases and impaired lung function, and chronic kidney disease. In this review we discussed pathophysiologic mechanisms of FGR-related complications and potential preventive measures for FGR.

Relationships between intrauterine fetal growth trajectories and markers of adiposity and inflammation in young adults

BACKGROUND

There is now good evidence that events during gestation significantly influence the developmental well-being of an individual in later life. This study aimed to investigate the relationships between intrauterine growth trajectories determined by serial ultrasound and subsequent markers of adiposity and inflammation in the 27-year-old adult offspring from the Raine Study, an Australian longitudinal pregnancy cohort.

METHODS

Ultrasound fetal biometric measurements including abdominal circumference (AC), femur length (FL), and head circumference (HC) from 1333 mother-fetal pairs (Gen1-Gen2) in the Raine Study were used to develop fetal growth trajectories using group-based trajectory modeling. Linear mixed modeling investigated the relationship between adult body mass index (BMI), waist circumference (WC), and high-sensitivity C-reactive protein (hs-CRP) of Gen2 at 20 (n = 485), 22 (n = 421) and 27 (n = 437) years and the fetal growth trajectory groups, adjusting for age, sex, adult lifestyle factors, and maternal factors during pregnancy.

RESULTS

Seven AC, five FL and five HC growth trajectory groups were identified. Compared to the average-stable (reference) group, a lower adult BMI was observed in two falling AC trajectories: (β = -1.45 kg/m², 95% CI: -2.43 to -0.46, P = 0.004) and (β = -1.01 kg/m², 95% CI: -1.96 to -0.05, P = 0.038). Conversely, higher adult BMI (2.58 kg/m², 95% CI: 0.98 to 4.18, P = 0.002) and hs-CRP (37%, 95% CI: 9-73%, P = 0.008) were observed in a rising FL trajectory compared to the reference group. A high-stable HC trajectory associated with 20% lower adult hs-CRP (95% CI: 5-33%, P = 0.011).

CONCLUSION

This study highlights the importance of understanding causes of the unique patterns of intrauterine growth. Different fetal growth trajectories from early pregnancy associate with subsequent adult adiposity and inflammation, which predispose to the risk of diabetes and cardiometabolic disease.

Antenatal Fetal Size and Obesity in Five-Year-Old Children in a Large Cohort Created by Data Linkage

Background: What is not well understood is the gestational age at which the fetal size deviates from normal for children who develop obesity. Here we test the hypothesis that large-for-gestational age before birth is associated with increased risk for obesity in early childhood. Methods: In this retrospective study, routinely acquired antenatal ultrasound assessments in the first, second, and third trimester were linked to anthropometric measurements at 5.5 years. Results: There were 15,760 individuals, including 678 with obesity, 1955 overweight, and 1254 thin. Compared with children of healthy weight, children who had obesity were shorter in the first trimester [mean difference 0.19 z scores (0.10, 0.28)] and heavier in the second [mean difference z scores 0.15 (0.03, 0.27)] and third trimester [mean difference z scores 0.18 (0.05, 0.32)]. Children in the thin category were lighter compared with children of healthy weight in the third trimester and those in the overweight category were heavier compared with children of healthy weight in the third trimester. All associations were independent of birth weight. Conclusions: The difference in growth trajectories between children who have obesity compared with overweight or thin suggests different underlying mechanisms.

Birth weight and body composition in 6-to-8 years old Maya children

OBJECTIVE

To test the hypothesis that fetal growth, indexed by birth weight (BW), induce metabolic adjustments in the fetus that will be reflected in differences in body composition in a sample of 6-to 8-years old urban Maya children from Yucatan, Mexico.

METHODS

We measured height (cm), weight (kg) and triceps skinfold (mm) in 260 children (boys: 132, girls: 128), and height (cm) and weight (kg) in their mothers. Body composition was estimated in children through bioelectrical impedance analysis. Outcome variables were fat free-mass index (FFMI = fat-free mass [kg]/height [m]² ) and fat mass index (FMI = fat mass [kg]/height [m]² ). The main independent variable was BW z-scores. Multiple linear regression models were used to analyze the association between BW z-scores and outcome variables measured during childhood. Separate analyses were done for boys and girls. Complementary models were run using outcomes as z-scores. Models were adjusted for location, children's and mothers' age, mother's body mass index and household overcrowding index.

RESULTS

BW in boys was positively associated with FFMI and FMI. FFMI increase 0.34 kg/m² per 1-SD increase in BW and FMI increase 0.40 kg/m² per 1-SD increase in BW. When outcomes were used as z-scores, FFMI increase 0.24 SD and FMI increase 0.18 SD per 1-SD increase in BW, respectively.

CONCLUSION

Our results are in contrast with previous findings that birth weight is more consistently associated with subsequent lean mass than with fat mass. Associations, detected only in boys, may be explained by sex differences in sensitivity to early life environments.