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Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey

Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey
Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey
Summary

We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children with breech presentation. At 4 years, no differences in whole-body or spine measures were found, but hip BMC and area were lower after breech presentation.

Introduction

Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown.

Methods

In the prospective Southampton Women’s Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6 days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1 years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4 years.

Results

Neonates with breech presentation had 4.2 g lower whole-body BMC (95% CI −7.4 to − 0.9 g, P = 0.012) and 5.9 cm2 lower BA (− 10.8 to − 1.0 cm2, P = 0.019), but BMD was similar between groups (mean difference − 0.007, − 0.016 to 0.002 g/cm2, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4 years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (− 0.51, − 0.98 to − 0.04 g, P = 0.034) and BA (− 0.67, − 1.28 to − 0.07 cm2, P = 0.03) but not with BMD (− 0.009, − 0.029 to 0.012 g, P = 0.408), or spine outcomes.

Conclusions

These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.
0937-941X
1-7
Ireland, Alex
01924e16-2c9e-40ee-9965-4605b02090d1
Crozier, Sarah
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Heazell, Alexander E.P.
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Ward, Kathryn
39bd4db1-c948-4e32-930e-7bec8deb54c7
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Ireland, Alex
01924e16-2c9e-40ee-9965-4605b02090d1
Crozier, Sarah
9c3595ce-45b0-44fa-8c4c-4c555e628a03
Heazell, Alexander E.P.
65a70166-8575-44d6-9e2a-066aa166923b
Ward, Kathryn
39bd4db1-c948-4e32-930e-7bec8deb54c7
Godfrey, Keith
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Inskip, Hazel
5fb4470a-9379-49b2-a533-9da8e61058b7
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145

Ireland, Alex, Crozier, Sarah, Heazell, Alexander E.P., Ward, Kathryn, Godfrey, Keith, Inskip, Hazel, Cooper, Cyrus and Harvey, Nicholas (2018) Breech presentation is associated with lower bone mass and area: findings from the Southampton Women's Survey. Osteoporosis International, 1-7. (doi:10.1007/s00198-018-4626-2).

Record type: Article

Abstract

Summary

We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children with breech presentation. At 4 years, no differences in whole-body or spine measures were found, but hip BMC and area were lower after breech presentation.

Introduction

Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown.

Methods

In the prospective Southampton Women’s Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6 days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1 years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4 years.

Results

Neonates with breech presentation had 4.2 g lower whole-body BMC (95% CI −7.4 to − 0.9 g, P = 0.012) and 5.9 cm2 lower BA (− 10.8 to − 1.0 cm2, P = 0.019), but BMD was similar between groups (mean difference − 0.007, − 0.016 to 0.002 g/cm2, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4 years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (− 0.51, − 0.98 to − 0.04 g, P = 0.034) and BA (− 0.67, − 1.28 to − 0.07 cm2, P = 0.03) but not with BMD (− 0.009, − 0.029 to 0.012 g, P = 0.408), or spine outcomes.

Conclusions

These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.

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SWS breech manuscript v3.2 14_06_2018 R1 clean - Accepted Manuscript
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More information

Accepted/In Press date: 27 June 2018
e-pub ahead of print date: 12 July 2018
Published date: 2018

Identifiers

Local EPrints ID: 422055
URI: https://eprints.soton.ac.uk/id/eprint/422055
ISSN: 0937-941X
PURE UUID: fbb09e18-6ba4-4aa8-9162-dec416f75864
ORCID for Sarah Crozier: ORCID iD orcid.org/0000-0002-9524-1127
ORCID for Kathryn Ward: ORCID iD orcid.org/0000-0001-7034-6750
ORCID for Keith Godfrey: ORCID iD orcid.org/0000-0002-4643-0618
ORCID for Hazel Inskip: ORCID iD orcid.org/0000-0001-8897-1749
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 13 Jul 2018 16:30
Last modified: 10 Dec 2019 05:19

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