title: Anthropometric Characterization of Impaired Fetal Growth: Risk Factors for and Prognosis of Newborns With Stunting or Wasting.
abstract: OBJECTIVE
  Stunting (short length for age) and wasting (low body mass index [BMI] for age) are widely used to assess child nutrition. In contrast, newborns tend to be assessed solely based on their weight.
  
  
  OBJECTIVE
  To use recent international standards for newborn size by gestational age to assess how stunted and wasted newborns differ in terms of risk factors and prognoses.
  
  
  METHODS
  A cross-sectional study with follow-up until hospital discharge was conducted at urban sites in Brazil, China, India, Italy, Kenya, Oman, England, and the United States that are participating in the INTERGROWTH-21st Project. The study was conducted from April 27, 2009, to March 2, 2014, and the final dataset for analyses was locked on March 19, 2014.
  
  
  METHODS
  Sociodemographic and behavioral maternal risk factors, previous pregnancy history, and maternal and fetal conditions during pregnancy were investigated as risk factors for stunting and wasting. Anthropometry at birth was used to predict for neonatal prognosis.
  
  
  METHODS
  Newborn stunting and wasting were defined as birth length and BMI for gestational age below the third centiles of the INTERGROWTH-21st standards. Prognosis was assessed through mortality before hospital discharge, admission to neonatal intensive care units, and newborn complications.
  
  
  RESULTS
  From the 60 206 singleton live births during the study period, we selected all newborns between 33 weeks' and 42 weeks 6 days' gestation at birth (51 200 [85%]) with reliable ultrasound dating. Stunting affected 3.8% and wasting 3.4% of all newborns; both conditions were present in 0.7% of the sample. Of the 26 conditions studied, five were more strongly associated with stunting than with wasting (reported as odds ratios [OR]; 95% CI): short maternal height (6.7; 5.1-9.0), younger maternal age (0.7; 0.5-0.9), smoking (2.8; 2.3-3.3), illicit drug use (2.3; 1.5-3.6), and clinically suspected intrauterine growth restriction (5.2; 4.5-6.0). Wasting was more strongly related than stunting with 4 newborn outcomes (neonatal intensive care stay, 6.7 [5.5-8.1]; respiratory distress syndrome, 4.0 [3.3-4.9]; transient tachypnea, 2.1 [1.5-2.9]; and no oral feeding for >24 hours, 5.0 [3.9-6.5]). Maternal gestational diabetes mellitus was protective against wasting (0.6; 0.5-0.8) but not against stunting (0.9; 0.7-1.1).
  
  
  CONCLUSIONS
  Although newborn stunting and wasting share some common determinants, they are distinct phenotypes with their own risk factors and neonatal prognoses. To be consistent with the literature on infant and child nutrition, newborns should be classified using the 2 phenotypes of stunting and wasting. The distinction will help to prioritize preventive interventions and focus the management of fetal undernutrition.
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England.
authors.forename: José
authors.initials: J
authors.lastname: Villar
authors.affiliation: Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil3Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England.
authors.forename: Leila Cheikh
authors.initials: LC
authors.lastname: Ismail
authors.affiliation: Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio.
authors.forename: Cameron
authors.initials: C
authors.lastname: Chumlea
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England.
authors.forename: Aris T
authors.initials: AT
authors.lastname: Papageorghiou
authors.affiliation: Dipartimento di Scienze della Sanita Pubblica e Pediatriche, Struttura Complessa di Neonatologia Universitaria, Università degli Studi di Torino, Torino, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Bertino
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England6Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, Engla.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Ohuma
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England.
authors.forename: Ann
authors.initials: A
authors.lastname: Lambert
authors.affiliation: Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.
authors.forename: Maria
authors.initials: M
authors.lastname: Carvalho
authors.affiliation: Department of Family and Community Health, Ministry of Health, Muscat, Sultanate of Oman.
authors.forename: Yasmin A
authors.initials: YA
authors.lastname: Jaffer
authors.affiliation: Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, England.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Altman
authors.affiliation: Department of Engineering Science, University of Oxford, Oxford, England.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Noble
authors.affiliation: Global Alliance to Prevent Prematurity and Stillbirth, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Gravett
authors.affiliation: Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India.
authors.forename: Manorama
authors.initials: M
authors.lastname: Purwar
authors.affiliation: Center for Perinatal Studies, Swedish Medical Center, Seattle, Washington.
authors.forename: Ihunnaya O
authors.initials: IO
authors.lastname: Frederick
authors.affiliation: School of Public Health, Peking University, Beijing, China.
authors.forename: Ruyan
authors.initials: R
authors.lastname: Pang
authors.affiliation: Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan 15Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, England.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Kennedy
mesh_terms: D000886:Anthropometry / Q000379:methods*; D001827:Body Height; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D004739:England; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011379:Prognosis; D012307:Risk Factors