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The Auxological and Metabolic Consequences for Children Born Small for Gestational Age
Wayne Cutfield1, Ahila Ayyavoo2
1Department of Pediatric Endocrinology, Liggins Institute, University of Auckland, Auckland, New Zealand.
Insights
Children born small for gestational age (SGA) may experience short stature. Recombinant human growth hormone (rhGH) treatment effectively improves adult height, with most achieving normal ranges.
Area of Science:
- Pediatrics
- Endocrinology
- Auxology
Background:
- Small for gestational age (SGA) is defined by birth size relative to gestational age (≥2 SD below mean).
- Most SGA children achieve catch-up growth, but many remain shorter than expected based on mid-parental height.
- Being born SGA is a significant factor contributing to adult short stature.
Purpose of the Study:
- To evaluate the efficacy of recombinant human growth hormone (rhGH) in improving adult height in SGA children.
- To assess the impact of different rhGH dosages on final adult height.
- To review long-term metabolic consequences associated with being born SGA.
Main Methods:
- Review of studies on rhGH treatment in SGA children.
- Comparison of adult height outcomes between conventional and higher rhGH doses.
- Analysis of cross-sectional data on metabolic health in SGA individuals.
Main Results:
- rhGH treatment improves adult height in SGA children by approximately 0.9 SDs.
- A higher rhGH dose (67 μgm/kg/d) did not yield greater adult height than a conventional dose (33 μgm/kg/d).
- Approximately 85% of SGA children treated with rhGH achieve normal adult height.
- SGA is associated with long-term metabolic issues including insulin resistance, abdominal adiposity, dyslipidemia, and type 2 diabetes.
Conclusions:
- rhGH is a safe and effective treatment for improving adult height in SGA children.
- Conventional rhGH dosing appears sufficient for achieving normal adult height.
- Children born SGA face increased risks for adverse metabolic sequelae, potentially linked to in utero nutritional restriction.
Abstract:
'Small for gestational age' (SGA) is an auxological and not an etiological definition that characterizes children born small based upon low-birth-weight and/or birth-length criteria [≥ 2 standard deviations (SD) below the mean for gestational age]. Most SGA children exhibit catch-up growth into the normal range within 6 mo of age. Overall SGA children are 4 cm shorter than expected based upon midparental height and being born SGA is a common cause of adult short stature. Recombinant human growth hormone (rhGH) has been shown to improve adult height by 0.9 SDs and is a safe treatment. Surprisingly, a higher rhGH dose (67 μgm/kg/d) did not lead to a greater adult height than a conventional dose (33 μgm/kg/d). At least 85% of SGA children treated through childhood with rhGH achieve a height within the normal adult range. Other long-term consequences for children born SGA include insulin resistance, abdominal adiposity, dyslipidemia, type 2 diabetes mellitus, and metabolic syndrome. Cross-sectional studies have found reduced insulin sensitivity in the neonatal, childhood, and young adult periods. Increased abdominal fat has been shown in preschool SGA children and is more evident in young adults. Increased adiposity markedly accentuates reduction in insulin sensitivity. Many SGA children have suffered from in utero nutritional restriction that leads to long-term growth restriction and adverse metabolic sequelae.
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