Association of Birth Weight Centiles and Gestational Age With Cognitive Performance at Age 5 Years.
Association of Birth Weight Centiles and Gestational Age With Cognitive Performance at Age 5 Years.
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DOI：
10.1001/jamanetworkopen.2023.31815
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发表时间：
2023-08-01
影响因子：
13.8
通讯作者：
Lemola, Sakari
中科院分区：
文献类型：
--
作者：
Eves, Robert;Wolke, Dieter;Spiegler, Juliane;Lemola, Sakari
这项队列研究调查了出生体重和胎龄与后来的认知表现之间的文化不变的非线性关联。出生体重和胎龄与认知能力呈非线性相关吗？在这项包括4个纵向队列、30643名受试者的队列研究中，智商与出生体重z评分的增加相关，直到z评分等于第69百分位数，随后出现平台期。相比之下，怀孕的每一周都与智商的增加显著相关，但在非常早产的范围内，即怀孕32周之前，观察到最强的关联。使用第10个出生体重百分位数来估计低认知表现并不能充分代表2个结构之间的非线性关联。出生体重指数（BWP）通常在第10百分位数处二分，并且对于早产儿和足月出生的儿童，其与后期认知表现具有统计学显著性相关。然而，测试BWP和认知表现之间的非线性关联的研究很少。研究BWP和胎龄与后期认知表现的文化不变的非线性关联。在这项队列研究中，具有有效新生儿和认知数据的参与者来自4个观察性队列，包括千禧年队列研究，1979年全国青年纵向调查儿童和年轻成人队列，在爱尔兰长大，以及澳大利亚儿童纵向研究，其中儿童出生于2000年至2002年，1980年至2010年，分别是2007年和2008年以及2003年和2004年。新生儿数据是父母在1岁前报告的。在大约5岁时，进行了多项认知测试。5岁时的随访是主要重点。数据分析于2023年7月17日进行。根据芬顿生长图，使用父母报告的新生儿数据计算BWP。智商的得分是从多个认知指标中产生的，这些指标在每个队列中分别进行了z标准化。在30643名参与者（50.8%为男性）中，7.5%为早产（妊娠37周之前），92.5%为足月出生（妊娠37至42周）。在使用多变量自适应回归样条的汇总数据中，当BWP从第一百分位数增加到第69百分位数时，IQ线性增加4.2点，然后完全稳定。对于胎龄，IQ每周线性增加1.3分，直到32周，32周后每周减少到0.3分。BWP与IQ的相关性不受胎龄的影响。对于足月出生的婴儿，只有当出生体重低于第三百分位数时，估计的智商得分才低于平均水平。当使用多变量回归时，发现一致的结果，其中胎龄和BWP被分类到组中。在这项队列研究中，较低的BWP和胎龄与较低的智商独立相关。对于足月出生的婴儿，当目标是估计有意义的认知差异时，第三百分位数的截止值比传统上使用的第十百分位数更合适。
This cohort study investigates culturally invariant, nonlinear associations of birth weight percentiles and gestational age with later cognitive performance. Are birth weight percentiles and gestational age nonlinearly associated with cognitive performance? In this cohort study of 4 longitudinal cohorts with 30 643 pooled participants, IQ was associated with increasing birth weight z scores until the z score equaled the 69th percentile, with a subsequent plateau. In contrast, every week of gestation was significantly associated with increased IQ, but the strongest association was observed in the very preterm range, before 32 weeks gestation. Using the 10th birth weight percentile to estimate low cognitive performance does not adequately represent the nonlinear association between the 2 constructs. Birth weight percentiles (BWPs) are often dichotomized at the 10th percentile and show statistically significant association with later cognitive performance, for both preterm and term-born children. However, research testing nonlinear associations between BWPs and cognitive performance is scarce. To investigate culturally invariant, nonlinear associations of BWPs and gestational age with later cognitive performance. In this cohort study, participants with valid neonatal and cognitive data were combined from 4 observational cohorts, including the Millennium Cohort Study, the National Longitudinal Survey of Youth 1979 Child and Young Adult cohort, Growing Up in Ireland, and the Longitudinal Study of Australian Children, with children born between 2000 and 2002, 1980 and 2010, 2007 and 2008, and 2003 and 2004, respectively. Neonatal data were parent reported before age 1 year. At approximately 5 years of age, multiple cognitive tests were performed. Follow-up at 5 years of age was the predominant focus. Data were analyzed July 17, 2023. The parent-reported neonatal data were used to calculate BWPs according to the Fenton growth chart. Scores for IQ were created from multiple measures of cognition, which were z standardized separately within each cohort. Of 30 643 participants (50.8% male), 7.5% were born preterm (before 37 weeks gestation) and 92.5% were term born (between 37 and 42 weeks gestation). In the pooled data using multivariate adaptive regression splines, IQ linearly increased by 4.2 points as BWPs increased from the first to the 69th percentile before completely plateauing. For gestational age, IQ linearly increased by 1.3 points per week up until 32 weeks, with the association reducing to 0.3 points per week after 32 weeks. The association of BWP with IQ was not moderated by gestational age. For term-born infants, the estimated IQ score was only clinically meaningfully lower than average when birth weight was below the third percentile. Consistent results were found when instead using multivariable regression where gestational age and BWPs were categorized into groups. In this cohort study, lower BWPs and gestational age were independently associated with lower IQ. For term-born infants, a cutoff of the third percentile would be more appropriate than the traditionally used 10th percentile when the aim is estimating meaningful cognitive differences.
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影响因子：
3.5
作者：
Hernández-Alava M;Popli G
通讯作者：
Popli G
影响因子：
3
作者：
Hegelund, Emilie Rune;Flensborg-Madsen, Trine;Mortensen, Erik Lykke
通讯作者：
Mortensen, Erik Lykke
影响因子：
2.4
作者：
Fenton TR;Kim JH
通讯作者：
Kim JH
DOI：
10.1111/1471-0528.16341
发表时间：
2020-07-03
影响因子：
5.8
作者：
Eves, R.;Mendonca, M.;Wolke, D.
通讯作者：
Wolke, D.
影响因子：
2.5
作者：
Ananth, Cande V.;Vintzileos, Anthony M.
通讯作者：
Vintzileos, Anthony M.