Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries

Int J Epidemiol. 2013 Oct;42(5):1340-55. doi: 10.1093/ije/dyt109. Epub 2013 Aug 6.

Abstract

Background: Low- and middle-income countries continue to experience a large burden of stunting; 148 million children were estimated to be stunted, around 30-40% of all children in 2011. In many of these countries, foetal growth restriction (FGR) is common, as is subsequent growth faltering in the first 2 years. Although there is agreement that stunting involves both prenatal and postnatal growth failure, the extent to which FGR contributes to stunting and other indicators of nutritional status is uncertain.

Methods: Using extant longitudinal birth cohorts (n=19) with data on birthweight, gestational age and child anthropometry (12-60 months), we estimated study-specific and pooled risk estimates of stunting, wasting and underweight by small-for-gestational age (SGA) and preterm birth.

Results: We grouped children according to four combinations of SGA and gestational age: adequate size-for-gestational age (AGA) and preterm; SGA and term; SGA and preterm; and AGA and term (the reference group). Relative to AGA and term, the OR (95% confidence interval) for stunting associated with AGA and preterm, SGA and term, and SGA and preterm was 1.93 (1.71, 2.18), 2.43 (2.22, 2.66) and 4.51 (3.42, 5.93), respectively. A similar magnitude of risk was also observed for wasting and underweight. Low birthweight was associated with 2.5-3.5-fold higher odds of wasting, stunting and underweight. The population attributable risk for overall SGA for outcomes of childhood stunting and wasting was 20% and 30%, respectively.

Conclusions: This analysis estimates that childhood undernutrition may have its origins in the foetal period, suggesting a need to intervene early, ideally during pregnancy, with interventions known to reduce FGR and preterm birth.

Keywords: Foetal growth restriction; childhood; preterm birth; stunting; wasting.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Child, Preschool
  • Cohort Studies
  • Developing Countries* / statistics & numerical data
  • Female
  • Fetal Growth Retardation* / epidemiology
  • Gestational Age
  • Humans
  • Infant
  • Infant, Low Birth Weight / growth & development
  • Infant, Premature / growth & development
  • Infant, Small for Gestational Age* / growth & development
  • Longitudinal Studies
  • Male
  • Malnutrition / epidemiology
  • Malnutrition / etiology*
  • Pregnancy
  • Premature Birth / epidemiology
  • Risk Factors