Association of birthweight centiles and early childhood development of singleton infants born from 37 weeks of gestation in Scotland: a population-based cohort study

Adanikin, A., Lawlor, D. A., Pell, J. P. , Nelson, S. M. , Smith, G. C.S. and Iliodromiti, S. (2022) Association of birthweight centiles and early childhood development of singleton infants born from 37 weeks of gestation in Scotland: a population-based cohort study. PLoS Medicine, 19(10), e1004108. (doi: 10.1371/journal.pmed.1004108) (PMID:36219591) (PMCID:PMC9553050)

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Abstract

Background: Birthweight centiles beyond the traditional thresholds for small or large babies are associated with adverse perinatal outcomes but there is a paucity of data about the relationship between birthweight centiles and childhood development among children born from 37 weeks of gestation. This study aims to establish the association between birthweight centiles across the whole distribution and early childhood development among children born from 37 weeks of gestation. Methods and findings: This is a population-based cohort study of 686,284 singleton infants born from 37 weeks of gestation. The cohort was generated by linking pregnancy and delivery data from the Scottish Morbidity Records (2003 to 2015) and the child developmental assessment at age 2 to 3.5 years. The main outcomes were child’s fine motor, gross motor, communication, and social developmental concerns measured with the Ages and Stages Questionnaires—3 (ASQ-3) and Ages and Stages Questionnaire: Social & Emotional—2 (ASQ:SE-2), and for a subset of children with additional specialist tools such as the Modified Checklist for Autism in Toddlers (M-CHAT) if the ASQ3/SE indicate these are necessary. The ASQ score for each domain was categorised as “concern” and “no concern.” We used multivariate cubic regression splines to model the associations between birthweight centiles and early childhood developmental concerns. We used multivariate Poisson regression models, with cluster robust errors, to estimate the relative risks (RRs) of developmental concerns below and above the established thresholds. We adjusted for maternal age, early pregnancy body mass index (BMI), parity, year of delivery, gestational age at delivery, smoking history, substance misuse in pregnancy, alcohol intake, ethnicity, residential area deprivation index, maternal clinical conditions in pregnancy (such as diabetes and pre-eclampsia), induction of labour, and child’s sex. Babies born from 37 weeks of gestation with birthweight below the 25th centile, compared to those between the 25th and 74th centile, were at higher risk of developmental concerns. Those born between the 10th and 24th centile had an RR of 1.07 (95% CI: 1.03 to 1.12, p < 0.001), between the 3rd and 9th centile had an RR: 1.18 (95% CI: 1.12 to 1.25, p < 0.001), and <3rd centile had an RR of 1.37 (95% CI: 1.24 to 1.50, p < 0.001). There was no substantial increase in the risk of early childhood developmental concerns for larger birthweight categories of 75th to 89th (RR: 1.01; 95% CI: 0.97 to 1.05; p = 0.56), 90th to 96th (RR: 0.99; 95% CI: 0.94 to 1.05; p = 0.86), and ≥97th centiles (RR: 1.04; 95% CI: 0.97 to 1.12; p = 0.27), referent to birthweight between 25th and 74th centile. The percentage of developmental concerns attributable to birthweight between the 10th and 24th centile was more than that of birthweight <3rd centile (p = 0.023) because this group includes more of the population. Approximately 2.50% (95% CI: 1.26 to 3.61) of social skills concerns and 3.00% (95% CI: 1.33 to 4.67) of fine motor developmental concerns were attributable to birthweight between the 10th and 24th centile compared to 0.90% (95% CI: 0.48 to 1.26) and 2.30% (95% CI: 1.73 to 2.67) respectively for birthweight <3rd centile. We acknowledge the limitation of ASQ as a screening tool, the subjective nature of developmental assessments (particularly for speech) among young children, and inability to control for early childhood illness and upbringing factors may have an impact on our findings. Conclusions: We observed that from 37 weeks of gestation birthweight below the 25th centile was associated with child developmental concerns, with an association apparent at higher centiles above the conventional threshold defining small for gestational age (SGA, 3rd or 10th centile). Mild to moderate SGA is an unrecognised potentially important contributor to the prevalence of developmental concerns. Closer surveillance, appropriate parental counselling, and increased support during childhood may reduce the risks associated with lower birthweight centiles.

Item Type:Articles
Additional Information:This work was supported by Wellbeing of Women (WoW) Research Grant (RG2028 grant to SI), https://www.wellbeingofwomen.org.uk/. DALs contribution is supported by the European Research Council (669545), https://erc.europa.eu/, US National Institute for Health (R01 DK10324), https://www.nih.gov/, UK Medical Research Council (MC_UU_00011/6), https://www.ukri.org/councils/mrc/, and the Bristol NIHR Biomedical Research Centre; she is an NIHR senior investigator (NF-0616-10102), https://www.bristolbrc.nihr.ac.uk/. GCSS is supported by the NIHR Cambridge Biomedical Research Centre (Women’s Health and Paediatrics theme), https://cambridgebrc.nihr.ac.uk/.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Nelson, Professor Scott and Pell, Professor Jill and Iliodromiti, Dr Stamatina
Creator Roles:
Pell, J. P.Conceptualization, Supervision, Writing – review and editing
Nelson, S. M.Conceptualization, Supervision, Writing – review and editing
Iliodromiti, S.Conceptualization, Funding acquisition, Methodology, Supervision, Validation, Writing – review and editing
Authors: Adanikin, A., Lawlor, D. A., Pell, J. P., Nelson, S. M., Smith, G. C.S., and Iliodromiti, S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:PLoS Medicine
Publisher:Public Library of Science
ISSN:1549-1277
ISSN (Online):1549-1676
Published Online:11 October 2022
Copyright Holders:Copyright © 2022 Adanikin et al.
First Published:First published in PLoS Medicine 19(10): e1004108
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
302992Association of birthweight with perinatal, childhood and maternal outcomes: A population based linkage studyStamatina IliodromitiWellbeing of Women (WELLWOM)RG2028Med - Reproductive and Maternal Medicine
171922NIH DOHaD mechanisms GlasgowScott NelsonNational Institutes of Health (NIH)1R01DK103246-01Med - Reproductive and Maternal Medicine