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, 1988-84）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NCHS/CDC的机构间协议协调），以探索宫内生长对健康的影响。最近的分析集中在围产期因素对运动和社会发展（MSD）和幼儿龋齿（ECC）的影响。与MSD相关的分析已经完成，ECC的分析也即将完成。我们确定了出生体重和胎龄对MSD的独立影响，使用了2-47个月的年龄相适应的量表。3%的婴儿和儿童出生时早产，2.2%为足月LBW。调整混杂因素后，早产儿低体重儿童的MSD得分仍然较低（-1.5分，p<0.0001），足月低体重儿童的MSD得分也较低（-0.8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危险因素结合起来考虑，以确定是否需要进行临床随访和评估。在其他分析中，我们检查了与ECC相关的因素，特别是3-5岁儿童（N=3273）的轻度/中度ECC（1-7颗牙齿受影响）和严重ECC（8颗以上牙齿受影响），这些儿童被选中进行研究，因为在这些年龄段所有乳牙都应该完全萌出，但很少有乳牙自然脱落。虽然出生体重对ECC患病率的影响很小，但我们发现重度ECC的患病率在重度早产儿（11.1%）和中度早产儿（7.3%）中显著高于足月新生儿（3.6%）。墨西哥裔美国儿童和低收入家庭儿童的患病率也较高。24小时召回的总营养摄入（包括糖）分析显示与ECC风险无关。在调整了检查年龄（月）、种族/民族、产前吸烟、贫困水平、出生体重和乳牙数量的模型中，我们发现非常早产（AOR=11.56, 95% CI 1.11-120.1）和早产儿（AOR=2.24, 95% CI 0.60-8.48）的儿童发生严重ECC的风险增加。这与对乳牙列发育时间的理解是一致的，例如，早产和矿化不良可能使正在发育的牙冠更容易患龋。今后的分析将纳入关于接触含氟水源的地理数据，作为一个混杂因素

This project uses data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-84), 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 most recent analyses have focused on the effects of perinatal factors on motor and social development (MSD) and early childhood caries (ECC). Analyses have been completed related to MSD and are nearly completed for ECC. 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 points, p<0.0001), as did term LBW children (-0.8 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 developmental delays in determining the need for clinical follow-up and evaluation. In other analyses, we examined the factors associated with ECC, specifically mild/moderate ECC (1-7 teeth affected) and severe ECC (8+ teeth affected), in children ages 3-5 years (N=3273), who were selected for study because at these ages all deciduous teeth should be fully erupted, but few have been naturally shed. While there was little effect of birth weight on the prevalence of ECC, we found that the prevalence of severe ECC was significantly higher among those born very preterm (11.1%) and moderately preterm (7.3%), compared with those born at term (3.6%). Mexican-American children and those with low family income also had higher prevalence rates. Analyses of the total nutrient intake, including sugar, from 24-hour recalls showed no association with the risk of ECC. In models adjusting for age at exam (in months), race/ethnicity, prenatal smoking, poverty level, birth weight, and the number of deciduous teeth, we found that children born very preterm (AOR=11.56, 95% CI 1.11-120.1) and preterm (AOR=2.24, 95% CI 0.60-8.48) were at increased risk for severe ECC. This is consistent with understanding about the timing of development of the deciduous dentition, such that early birth and poor mineralization might make the developing tooth crowns more vulnerable to caries. Future analyses will incorporate geographical data on exposure to fluoridated sources of water as a confounding factor