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Differences in the epidemiology of prematurity and intrauterine growth retardation
Insights
Maternal nutritional supplementation during pregnancy reduced preterm birth risk but not intrauterine growth retardation. Low maternal size and male sex increased risks for both conditions, highlighting the need for distinct outcome measures.
Area of Science:
- Maternal and Child Health
- Nutritional Epidemiology
- Perinatal Medicine
Background:
- Preterm (PT) and intrauterine growth retarded (IUGR) infants can present with similar birth weights but exhibit distinct clinical features.
- Understanding the distinct etiologies of PT and IUGR is crucial for targeted interventions and improved infant outcomes.
Purpose of the Study:
- To investigate the differential effects of maternal nutritional supplementation and maternal characteristics on the incidence of preterm birth and intrauterine growth retardation.
- To emphasize the importance of using both gestational age and birth weight as distinct outcome measures in epidemiological research.
Main Methods:
- Analysis of data from 623 newborns in a Guatemalan longitudinal study.
- Utilized a long-linear model for simultaneous adjustment of variables.
- Identified risk factors including maternal nutritional status, maternal anthropometrics, and fetal sex.
Main Results:
- Calorie and/or protein supplementation during pregnancy significantly lowered the risk of preterm birth (OR=0.52 and 0.43, respectively).
- Nutritional supplementation did not affect the incidence of intrauterine growth retardation.
- Low maternal head circumference and weight were associated with increased IUGR risk (OR=1.4 and 2.3, respectively).
- Male fetuses had a higher risk for both PT and IUGR.
Conclusions:
- Maternal nutritional supplementation and maternal characteristics have differential effects on preterm birth and intrauterine growth retardation.
- The findings underscore the necessity of considering both gestational age and birth weight separately, rather than solely relying on low birth weight (LBW).
- This approach is vital for accurate epidemiological assessments and the development of effective public health strategies.
Abstract:
Although both preterm (PT) and intrauterine growth retarded (IUGR) infants can have similar birth weights, they are known to show different neonatal and post-neonatal features. Newborns (n = 623) from the Guatemalan longitudinal study of nutritional supplementation during pregnancy were studied. There were 61 PT (less than or equal to 37 wk) and 173 IUGR (less than or equal to 10th percentile) infants. Simultaneous adjustment using the long-linear model showed that calorie and/or protein supplementation during pregnancy lowered the risk of PT (adjusted odd ratios (OR) = 0.52, 95%, CI = 0.40-0.77, and 0.43 CI = 0.36-0.59, respectively), but did not affect the incidence of IUGR. Low maternal head circumference and weight increased the risk of IUGR only (OR = 1.4, CI = 1.02-1.8 and 2.3 CI = 1.8-2.7, respectively). Male fetuses were at higher risk of both PT and IUGR. These data confirm the differential effect of maternal characteristics and nutritional supplementation during pregnancy on both PT and IUGR, and strongly suggest the need to include both gestational age and birth weight as outcome measures in epidemiological studies, thus avoiding the exclusive use of LBW (less than or equal to 2500 g).