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Postnatal Stature Does Not Largely Mediate the Relation between Adverse Birth Outcomes and Cognitive Development in

Zhonghai Zhu1,2, Nandita Perumal2, Wafaie W Fawzi2

  • 1Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.

The Journal of Nutrition
|September 22, 2021
PubMed

Insights

Low birth weight and small-for-gestational age are linked to lower cognitive scores, but postnatal growth in early childhood doesn't largely explain this. Interventions targeting root causes of poor growth are key for better child development outcomes.

Area of Science:

  • Pediatric Health
  • Developmental Psychology
  • Public Health Nutrition

Background:

  • Preterm birth and fetal growth restriction are linked to impaired linear growth and cognitive development.
  • Adverse birth outcomes pose long-term risks to child development.

Purpose of the Study:

  • To investigate the mediating role of postnatal stature in the association between adverse birth outcomes and cognitive development.
  • To quantify the extent to which early-life growth influences the relationship between birth status and later cognition.

Main Methods:

  • Prospective birth cohort study in rural China.
  • Assessed anthropometry at 6, 12, 24 months, and mid-childhood.
  • Cognitive development evaluated using Wechsler Intelligence Scale for Children-IV in mid-childhood and early adolescence.
  • Causal mediation analysis examined associations of low birth weight (LBW), small-for-gestational age (SGA), and preterm birth with cognitive outcomes mediated by postnatal growth (LAZ/HAZ).

Main Results:

  • Low birth weight (LBW) and small-for-gestational age (SGA) were associated with lower cognitive scores in mid-childhood and adolescence.
  • Postnatal length/height-for-age z-scores (LAZ/HAZ) at 6, 12, and 24 months mediated 16-32% of the association between LBW/SGA and adolescent cognitive development.
  • Preterm birth was not significantly associated with cognitive development in this cohort.

Conclusions:

  • The association between LBW/SGA and cognitive development is not substantially mediated by postnatal stature in the first two years of life.
  • Interventions should address underlying causes of poor child growth and development, not solely focus on early childhood growth, to mitigate risks.
  • Targeting antecedent factors is crucial for improving developmental trajectories in LBW and SGA infants.
Abstract

Keywords:
causal mediationcognitive developmentlow birth weightpostnatal length/height-for-age and -sex z scorepretermsmall-for-gestational age

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