The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania.
Objectives were to examine the growth patterns of preterm and growth-restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV-negative pregnant women-infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length-for-age (LAZ), weight-for-length (WLZ), and weight-for-age (WAZ) z-scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut-off of <-2 SD of the respective z-scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term-SGA infants and despite some catch-up growth, preterm-SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z-scores among the groups remained similar throughout the follow-up. Compared with term-AGA babies, relative risk (RR) of stunting among preterm-AGA babies was 2.13 (95% confidence interval (CI) 1.93-2.36), RR among term-SGA was 2.21 (95% CI 2.02-2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41-10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource-limited settings.
Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.
Ayesha
http://orcid.org/0000-0002-6445-9481
A
Sania
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.|Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
Donna
D
Spiegelman
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.|The Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Janet
J
Rich-Edwards
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Ellen
E
Hertzmark
Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
Ramadhani S
RS
Mwiru
Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Rodrick
R
Kisenge
Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.|Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
Wafaie W
WW
Fawzi
D000328:Adult; D001724:Birth Weight; D015984:Causality; D015897:Comorbidity; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D006130:Growth Disorders / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D013636:Tanzania / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology; D019282:Wasting Syndrome / Q000453:epidemiology; D055815:Young Adult
fetal growth; intrauterine growth retardation; low birthweight; preterm birth; undernutrition; underweight