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First-trimester fetal size, accelerated growth in utero, and child neurodevelopment in a cohort study
Xinmei Chen1, Hongxiu Liu1, Yuanyuan Li1
1Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
Insights
First-trimester fetal size impacts childhood neurodevelopment. Restricted growth in early pregnancy is linked to developmental delays, though accelerated intrauterine growth may improve mental development.
Area of Science:
- Neurodevelopmental research
- Prenatal development
- Pediatric health
Background:
- Early pregnancy is crucial for fetal neural system development.
- The link between first-trimester fetal size and later neurodevelopment requires further investigation.
- Understanding these associations can inform interventions for optimal child development.
Purpose of the Study:
- To examine the association between first-trimester fetal size and neurodevelopment at age 2.
- To determine if accelerated intrauterine growth can mitigate the effects of restricted early fetal growth.
- To provide insights into early predictors of childhood neurodevelopmental outcomes.
Main Methods:
- A cohort of 2058 fetuses in Wuhan, China, with first-trimester crown-rump length (CRL) measurements.
- Fetal growth patterns were categorized based on estimated fetal weight growth rate from mid to late pregnancy.
- Neurodevelopment was assessed at age 2 using the Bayley Scales of Infant Development of China Revision.
Main Results:
- Increased first-trimester CRL was associated with higher mental and psychomotor developmental index scores at age 2.
- Restricted first-trimester fetal size correlated with developmental delays.
- Accelerated intrauterine growth in fetuses with restricted early size improved mental development scores but not psychomotor scores.
Conclusions:
- Restricted first-trimester fetal size is linked to impaired mental and psychomotor development in children.
- Intrauterine accelerated growth may partially improve mental development in affected children.
- Further research in diverse populations is recommended to validate these findings.
Background:
Early pregnancy is a critical window for neural system programming; however, the association of first-trimester fetal size with children's neurodevelopment remains to be assessed. This study aimed to explore the association between first-trimester fetal size and children's neurodevelopment and to examine whether intrauterine accelerated growth could compensate for the detrimental effects of first-trimester restricted growth on childhood neurodevelopment.
Methods:
The participants were from a birth cohort enrolled from March 2014 to March 2019 in Wuhan, China. A total of 2058 fetuses with crown to rump length (CRL) (a proxy of first-trimester fetal size) measurements in the first trimester and neurodevelopmental assessment at age 2 years were included. We measured the first-trimester CRL and defined three fetal growth patterns based on the growth rate of estimated fetal weight from mid to late pregnancy. The neurodevelopment was assessed using the Bayley Scales of Infant Development of China Revision at 2 years.
Results:
Each unit (a Z score) increase of first-trimester CRL was associated with increased scores in mental developmental index (MDI) (adjusted beta estimate = 1.19, (95% CI: 0.42, 1.95), P = 0.03) and psychomotor developmental index (PDI) (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at age 2 years, respectively. No significant association was observed between fetal growth rate and PDI. For children with restricted first-trimester fetal size (the lowest tertile of first-trimester CRL), those with "intrauterine accelerated growth" pattern (higher growth rates) had significantly higher MDI (adjusted beta estimate = 6.14, (95% CI: 3.80, 8.49), P < 0.001) but indistinguishable PDI compared to those with "intrauterine faltering growth" pattern (lower growth rates). Main limitations of this study included potential misclassification of gestational age due to recall bias of the last menstrual period and residual confounding.
Conclusions:
The current study suggests that restricted first-trimester fetal size is associated with mental and psychomotor developmental delay in childhood. However, in children with restricted first-trimester fetal size, intrauterine accelerated growth was associated with improved mental development but had little effect on psychomotor development. Additional studies are needed to validate the results in diverse populations.
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