Fetal growth restriction and preterm as determinants of child growth in the first two years and potential interventions.
Fetal growth restriction and preterm as determinants of child growth in the first two years and potential interventions.
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DOI：
10.1159/000354943
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发表时间：
2014-01-01
影响因子：
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通讯作者：
Christian, Parul
中科院分区：
文献类型：
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作者：
Christian, Parul
2010年，全球估计有1.71亿5岁以下儿童发育迟缓，其中98%来自中低收入国家。包括胎儿生长受限在内的低出生体重在这些地区也很常见，并可能导致儿童营养不良。作为儿童健康参考组（CHERG）的一部分，使用14个纵向出生队列和24个月时进行的人体测量，计算合并比值比（OR），以检查小于胎龄儿（SGA）和早产与随后的儿童发育迟缓和消瘦之间的关系。相对于足月足够胎龄（阿加），与阿加早产、SGA足月和SGA早产相关的发育迟缓的OR（95%置信区间）分别为1.94（1.59-2.36）、2.82（2.40-3.32）和4.98（3.79-6.55）。在消瘦和体重不足方面也观察到类似程度的风险。这一分析表明，儿童期营养不良可能部分源于胎儿期，这表明需要在怀孕期间的生命早期阶段甚至在有偏见的情况下进行干预，但也要强调一般的产妇营养和青少年营养。影响胎儿生长的干预措施包括产前补充平衡的卡路里和蛋白质，铁叶酸和多种微量营养素。在某些情况下，对营养敏感的干预措施，如推迟第一次怀孕、抗疟疾药物和戒烟可能很重要。
In 2010, 171 million children under 5 years old were estimated to be stunted globally, with 98% being from low- and middle-income countries. Low birthweight including fetal growth restriction is also common in these regions and may contribute to childhood undernutrition. As part of the Child Health Reference Group (CHERG) and using 14 longitudinal birth cohorts and anthropometric measurements taken at 24 months of age, pooled odds ratios (ORs) were calculated to examine the relationship between small for gestational age (SGA) and preterm birth and subsequent stunting and wasting in children. Relative to term adequate size for gestational age (AGA), the OR (95% confidence interval) for stunting associated with AGA-preterm, SGA-term and SGA-preterm was 1.94 (1.59-2.36), 2.82 (2.40-3.32) and 4.98 (3.79-6.55), respectively. A similar magnitude of risk was also observed for wasting and underweight. This analysis indicates that childhood undernutrition may have its origins, in part, in the fetal period, suggesting a need to intervene during an earlier life stage during pregnancy and even preconceptionally, but also putting emphasis on maternal nutrition in general and adolescent nutrition. Interventions shown to impact fetal growth include antenatal supplementation with balanced calorie and protein, iron-folic acid, and multiple micronutrients. Nutrition-sensitive interventions such as delaying the first pregnancy, antimalarials and smoking cessation in some settings may be important.