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Born Small for Gestational Age and Poor School Performance: How Small Is Too Small?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (obstetrik)ORCID iD: 0000-0003-4427-1075
Karolinska Institutet, Stockholm, Sweden. (obstetrik)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (obstetrik)
Karolinska Institutet, Stockholm, Sweden. (pediatrik)
2017 (English)In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, p. 215-223Article in journal (Refereed) Published
Abstract [en]

Aim: To assess the relationship between severity of small for gestational age (SGA) and risk of poor school performance, and to investigate whether adult stature modifies this risk.

Methods: 1,088,980 term Swedish children born 1973-1988 were categorized into severe SGA (<-3 standard deviations (SD) of expected birth weight), moderate SGA (-2.01 to -3 SD), mild SGA (-1.01 to -2 SD) and appropriate for gestational age (-1 to 0.99 SD). Risk of poor school performance at time of graduating from compulsory school (grades <10th percentile) was calculated using unconditional logistic regression models and adjusted for socioeconomic factors. In a sub-analysis, we stratified boys by adult stature, and adjusted for maternal but not paternal height.

Results: All SGA groups were significantly associated with increased risk of poor school performance, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) ranging from 1.85 (1.65-2.07) for severe SGA to 1.25 (1.22-1.28) for mild SGA. In the sub-analysis, all birth weight groups were associated with increased risk of poor school performance among boys with short staturecompared with non-short stature.

Conclusion: Mild SGA is associated with significantly increased risk of poor school performance, and the risk increases with severity of SGA. Further, this risk diminishes after adequate catch-up growth.

Place, publisher, year, edition, pages
2017. Vol. 88, p. 215-223
Keywords [en]
Small for gestational age, intrauterine growth, cognitive development, catch-up growth, stature
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-330118DOI: 10.1159/000477905ISI: 000415251200005PubMedID: 28697501OAI: oai:DiVA.org:uu-330118DiVA, id: diva2:1144364
Projects
Perspectives on Intrauterine Growth and Perinatal Exposure
Funder
Swedish Research Council, 2014-3561Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2019-02-20Bibliographically approved
In thesis
1. Born Small for Gestational Age: Beyond Size at Birth
Open this publication in new window or tab >>Born Small for Gestational Age: Beyond Size at Birth
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Children born small for gestational age (SGA) run increased risk of perinatal morbidity and mortality, but also of long-term health impairment. Risks on long term may vary depending on postnatal growth patterns. The overall aim of the thesis was to gain further knowledge about long-term consequences of being born SGA, as well as the impact of perinatal exposures on postnatal growth patterns. The thesis is based on four register-based cohort studies.

In paper I, risk of chronic hypertension was assessed in 731,008 first-time mothers. Perinatal exposure to pre-eclampsia, being born SGA and preterm were all independently associated with increased risk of chronic hypertension. The risk was further enhanced after combined exposure. The strongest association was seen in combinations including pre-eclampsia.

In paper II, risk of poor school performance at time of graduation from compulsory school was assessed in 1,088,980 children born SGA at term. Being born SGA was associated with increased risk of poor school performance, following a dose-response pattern with increased risk even for birthweight for gestational age (GA) –1.01 to –2 SD. Boys with short adult stature were associated with higher risk of poor school performance than those with non-short stature.

In paper III, differences in postnatal growth patterns depending on SGA status and maternal smoking habits were assessed in 32,493 children. Children born SGA with smoking mothers had a more rapid catch-up growth than those with non-smoking mothers. Compared with children born appropriate for GA (AGA) with non-smoking mothers, only children born SGA with non-smoking mothers were associated with increased risk of short stature at 1.5 and 5 years.

In paper IV, differences in postnatal growth patterns until age five years, depending on SGA status and GA at birth, were assessed in 41,669 children born between 32-40 gestational weeks. Being born SGA and moderate to late preterm was associated with shorter stature and lower BMI, compared with being born AGA at term. SGA status had greater impact on growth and body proportions than GA at birth.

In conclusion, children born SGA are at higher risk of chronic hypertension and cognitive impairment than children born AGA. Postnatal growth patterns vary in children born SGA, depending on intrauterine exposure to smoking and GA at birth. This may modify risks of long-term health impairment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1543
Keywords
Small for Gestational Age, SGA, Epidemiology, Pregnancy, Postnatal growth, Intrauterine growth restriction, Chronic hypertension, School performance
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-374782 (URN)978-91-513-0581-3 (ISBN)
Public defence
2019-04-12, Humanistiska teatern, Engelska parken, Thunbergsv. 3H, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-03-21 Created: 2019-02-20 Last updated: 2019-05-07

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Lindström, LindaBergman, Eva

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