Ong, Yi Ying, Sadananthan, Suresh Anand, Aris, Izzuddin M., Tint, Mya Thway, Yuan, Wen Lun, Huang, Jonathan Y., Chan, Yiong Huak, Ng, Sharon, Loy, See Ling, Velan, Sendhil, Fortier, Marielle V., Godfrey, Keith, Shek, Lynette, Tan, Kok Hian, Gluckman, Peter D., Yap, Fabian, Choo, Jonathan Tze Liang, Ling, Lieng Hsi, Tan, Karen, Chen, Li, Karnani, Neerja, Chong, Yap-Seng, Eriksson, Johan G., Wlodek, Mary E., Chan, Shiao-Yng, Lee, Yung Seng and Michael, Navin (2020) Mismatch between poor fetal growth and rapid postnatal weight gain in the first 2 years of life Is associated with higher blood pressure and insulin resistance without increased adiposity in childhood: The GUSTO Cohort Study. International Journal of Epidemiology, 49 (5). (doi:10.1093/ije/dyaa143).
Abstract
Background: using longitudinal ultrasounds as an improved fetal growth marker, we aimed to investigate if fetal growth deceleration followed by rapid postnatal weight gain is associated with childhood cardiometabolic risk biomarkers in a contemporary well-nourished population.
Methods: we defined fetal growth deceleration (FGD) as ultrasound-measured 2nd-3rd-trimester abdominal circumference decrease by ≥0.67 standard deviation score [SDS] and rapid postnatal weight gain (RPWG) as 0-2-year-old weight increase by ≥0.67 SDS. In the GUSTO mother-offspring cohort, we grouped 797 children into 4 groups of FGD-only (14.2%), RPWG-only (23.3%), both (mismatch, 10.7%) or neither (reference, 51.8%). Adjusting for confounders and comparing to the reference group, we tested associations of these growth groups with childhood cardiometabolic biomarkers: MRI-measured abdominal fat (n=262), liver fat (n=216), intramyocellular lipids (n=227), Quantitative Magnetic Resonance-measured overall body fat % (BF%) (n=310), homeostasis model assessment of insulin resistance (HOMA-IR) (n=323), arterial wall thickness (n=422) and stiffness (n=443), and blood pressure trajectories (ages 3-6y).
Results: mean±SD birthweights were: FGD-only (3.11±0.38kg), RPWG-only (3.03±0.37kg), mismatch (2.87±0.31kg), reference (3.30±0.36kg). FGD-only children had elevated blood pressure trajectories without correspondingly increased BF%. RPWG-only children had altered body fat partitioning, higher BF% (B=4.26% 95%CI [2.34,6.19]), HOMA-IR (0.28units [0.11,0.45]), and elevated blood pressure trajectories. Mismatch children did not have increased adiposity, but had elevated ectopic fat, elevated HOMA-IR (0.29units [0.04,0.55]), and the highest blood pressure trajectories. Associations remained even after excluding small-for-gestational-age infants from analyses.
Conclusions: fetal growth deceleration coupled with rapid postnatal weight gain was associated with elevated childhood cardiometabolic risk biomarkers without correspondingly increased BF%.
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