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Published on: January 19, 2024
The Association of Infant Birth Sizes and Anemia under Five Years Old: A Population-Based Prospective Cohort Study in
Xiaojing Liu1,2, Xiaowen Liu1,2, Zeping Yang1,2
1Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing 100191, China.
Insights
Infant birth size, including birth weight and head circumference, is linked to childhood anemia risk. Folic acid use and maternal occupation may modify this association.
Area of Science:
- Pediatrics
- Public Health
- Nutritional Science
Background:
- Infant birth size is crucial for predicting early-life health outcomes.
- The relationship between infant anthropometrics and childhood anemia is not fully understood.
- Early detection of anemia risk factors is essential for timely intervention.
Purpose of the Study:
- To investigate the association between infant birth size (birth weight, crown-heel length, head circumference) and anemia in early childhood.
- To identify potential modifying factors, such as maternal folic acid use and occupation, in this relationship.
Main Methods:
- A population-based prospective cohort study involving 204,556 singleton live births (gestational age 28-42 weeks).
- Logistic regression models were employed to analyze the associations between birth size measures (and their Z-scores) and anemia up to five years of age.
- Statistical adjustments were made for potential confounders.
Main Results:
- Anemia prevalence was 13.10% (26,802 children) by age five.
- Lower birth weight and smaller head circumference were significantly associated with increased childhood anemia risk.
- Longer crown-heel length showed an opposite trend, associated with reduced anemia risk.
- Significant interactions were observed between birth size, folic acid supplementation, and maternal occupation.
Conclusions:
- Abnormal infant birth sizes are significantly associated with the risk of developing childhood anemia.
- Maternal folic acid intake during pregnancy and maternal occupation are important modifiers of this association.
- These findings highlight the importance of monitoring infant growth parameters for early anemia risk assessment.
Abstract:
Infant birth sizes are vital clinical parameters to predict poor growth and micronutrient deficiency in early life. However, their effects on childhood anemia remain unclear. We aimed to explore the associations between birth weight, crown-heel length, and head circumference with anemia in early childhood, as well as potential modification factors. This population-based prospective cohort study included 204,556 participants with singleton live births delivered at gestational ages of 28-42 weeks. A logistic regression model was used to estimate the associations of the measures of infant birth size and their Z-score with anemia under five years old. There were 26,802 (13.10%) children under five years old who were diagnosed has having anemia. Compared with children who did not have anemia, children who had anemia had a lower birth weight and smaller head circumference and a longer crown-heel length (all p-values < 0.05). After adjusting for confounders, not only birth weight (β coefficient, -0.008; 95% CI, -0.011--0.004; p < 0.001) and head circumference (β coefficient, -0.004; 95% CI, -0.007--0.001; p = 0.009), but also the related Z-scores were negatively associated with childhood anemia, while the trends for crown-heel length were the opposite. We further found significant interactions of folic acid use and maternal occupation with infant birth sizes. In conclusion, infants having abnormal sizes at birth are significantly associated with the risk for childhood anemia, which can be modified by folic acid use during pregnancy and maternal occupation.
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