BIRTH CERTIFICATE LINKAGE TO GROWTH & HEALTH MEASURES US

本项目使用第三次全国健康和营养检查调查（NHANES III, 1988- 1994）的数据，与2-83个月样本儿童的出生证明相关联（由Overpeck博士通过与国家卫生和中心/疾病预防控制中心的机构间协议协调），以探索宫内生长对健康的影响。最新的分析集中在母乳喂养，运动和社会发展（MSD）和幼儿龋齿（ECC）。有关婴儿喂养和MSD的分析已经完成，并已开始为ECC进行分析。我们研究了4个月纯母乳喂养的婴儿是否与其他喂养方式的婴儿在尺寸上存在差异，以及这种差异是否持续到5岁。虽然4个月纯母乳喂养的婴儿在8-11个月时体重较轻（p<0.05），但与早期婴儿喂养有关的一年后的生长几乎没有显著差异。由于也有研究表明，母乳喂养对儿童的超重有保护作用，并且母乳喂养的持续时间存在剂量依赖性，因此根据新的国家人口统计中心生长图表的截止点，根据体重指数（kg/m2）将3-5岁的儿童分类为超重（OW95， bb0 95百分位数）。调整混杂因素后，出现OW95的风险没有显著降低（AOR=0.90, 95% CI=0.67-1.21），全母乳喂养时间也没有明显的剂量依赖效应。母乳喂养仍然被强烈推荐，但可能不是预防幼儿超重的主要指标。在其他分析中，我们确定了出生体重和胎龄对MSD的独立影响，使用的年龄范围为2-47个月。3%的婴儿和儿童出生时为早产儿，2.2%为足月LBW。调整混杂因素后，早产儿LBW儿童的MSD评分仍然较低（-1.5 ~ 0.3分，p<0.0001），足月LBW儿童的MSD评分也较低（-0.8 ~ 0.4分，p<0.03）。LBW状态和早产与童年早期MSD的微小但可测量的延迟独立相关。即使对于中度低体重或中度早产的儿童，围产期因素也应与其他已知的发育迟缓风险因素结合考虑，以确定是否需要进行临床随访和评估。

This project uses data from the third National Health and Nutrition Examination Survey (NHANES III, 1988-94), linked to birth certificates for sample children ages 2-83 mo (coordinated by Dr. Overpeck through an interagency agreement with NCHS/CDC) to explore the health consequences of intrauterine growth. The latest analyses have focused breast-feeding, motor and social development (MSD), and early childhood caries (ECC). Analyses have been completed related to infant feeding and MSD, and have been initiated for ECC. We addressed whether infants exclusively breast-fed for 4 mo differed in size from infants fed other ways, and whether such differences persist through age 5 y. While infants exclusively breast-fed for 4 mo weighed less at 8-11 mo (p<0.05), there were few significant differences in growth after the first year related to early infant feeding. Since it has also been suggested that breast-feeding is protective against overweight in children and that there is a dose-dependent effect of its duration, children ages 3-5 y were categorized by body mass index (kg/m2) as being overweight (OW95, > 95th percentile) based on cutoffs from the new NCHS growth charts. Adjusting for confounders, there was no significant reduced risk of being OW95 (AOR=0.90, 95% CI=0.67-1.21) and no clear dose-dependent effect of the duration of full breast-feeding. Breast-feeding continues to be strongly recommended, but may not be a leading indicator for the prevention of overweight in early childhood. In other analyses, we determined the independent effects of birth weight and gestational age on MSD, using an age-appropriate scale from 2-47 mo. Three percent of the infants and children were born preterm LBW and 2.2% term LBW. Adjusting for confounders, preterm LBW children still had lower MSD scores (-1.5?0.3 points, p<0.0001), as did term LBW children (-0.8?0.4 points, p<0.03). LBW status and preterm delivery were associated independently with small, but measurable delays in MSD through early childhood. Even for children only moderately LBW or moderately preterm, perinatal factors should be considered in association with other known risk factors for development delays in determining the need for clinical follow-up and evaluation.