Gestational age, intrauterine growth and body composition at 11 years of age

Bortolotto, Caroline Cardozo; Santos, Iná da Silva dos; Vaz, Juliana dos Santos; Matijasevich, Alicia

doi:10.11606/s1518-8787.2022056004022

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004022 copy

Gestational age, intrauterine growth and body composition at 11 years of age

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJETIVE

To assess the association of gestational age (GA) and intrauterine growth with body composition at 11 years of age.

METHOD

Analysis of data from the 2004 Pelotas birth cohort, whose outcomes were fat mass (FM, kg), fat mass index (FMI, kg/m²), fat-free mass (FFM, kg), fat-free mass index (FFMI, kg/m²) – measured by air displacement plethysmography – and body mass index for age (BMI/age, Z-score). The exposures of interest were the gestational index (GA) of infants born at less than 33 weeks, from 34 to 36 and from 37 to 41, and intrauterine growth categorized as small (SGA), adequate (AGA) and large (LGA) for gestational age. Analysis of variance was used to compare means and linear regression was used to assess the strength of association. The analyses were adjusted according to variables collected at birth, such as monthly family income, maternal characteristics – education, age, pre-gestational body mass index (BMI), weight gain during pregnancy, smoking during pregnancy, type of delivery, and parity – and adolescent characteristics – skin color and birth weight. For analysis, FM and FMI underwent logarithmic transformation due to data asymmetry.

RESULTS

A total of 3,401 adolescents were analyzed, including boys and girls born at less than 33 weeks, with lower FM and FFM means than those born at term. However, in the adjusted analyses, there was no association between GA and any of the outcomes in either sex. LGA boys had a 10.5% higher FMI (p = 0.026) and +0.3 BMI/age Z-score (p = 0.019) as compared to AGA boys, and LGA girls had +0.3 kg/m ² of FFMI (p = 0.039) than AGA girls.

CONCLUSION

GA was not associated with body composition at 11 years of age. However, LGA boys had higher BMI and BMI/age Z-score, and LGA girls had higher FFMI than AGA girls.

Child Development; Body Composition; Gestational Age; Plethysmography; Cohort Studies

Features	Included in the analysis n = 3.401
Maternal education (completed years)^a	(n = 3,371)	%
0–4	497	14.7
5–8	1,387	41.2
9–11	1,162	34.5
≥ 12	325	9.6
Maternal age (years)	(n = 3,399)
< 20	648	19.1
20–34	2,279	67.0
≥ 35	472	13.9
Pre-gestational BMI	(n = 2,407)
Low weight (≤ 18.49 kg/m²)	91	3.8
Adequate (18.5–24.9 kg/m²)	1,432	59.4
Overweight (25.0–29.9 kg/m²)	608	25.3
Obesity (≥ 30 kg/m²)	276	11.5
Smoking in pregnancy	(n = 1,757)
No	2,487	73.1
Yes	914	26.9
Type of delivery	(n = 1,878)
Normal	1,878	55.2
Caesarean	1,523	44.8
Parity (number of children born alive or dead)	(n = 3,400)
1	1,345	39.6
2	919	27.0
3	539	15.9
≥ 4	597	17.6
Weight gain during pregnancy (kg)	(n = 3,310)
(mean, SD)	10.5 (5.6)	-
Family income (quintiles)	(n = 3,401)
Q1 (lower income)	657	19.3
Q2	682	20.1
Q3	680	20.0
Q4	730	21.5
Q5 (higher income)	652	19.2
Skin color	(n = 3,384)
White	2,287	67.6
Brown	677	20.0
Black	420	12.4
Birth weight (g)	(n = 3,401)
< 2,500 (low weight)	260	7.6
2,500–2,999	832	24.5
3,000–3,499	1,369	40.3
3,500–3,999	768	22.6
≥ 4,000	172	5.1
GA (weeks)	(n = 3,186)
≤ 33	71	2.2
34–36	359	11.3
37–41	2,756	86.5
Intrauterine growth	(n = 3,294)
SGA	280	8.5
AGA	2,446	74.3
LGA	568	17.2

Variable	Boys				Girls

	Total	FM (kg)	FMI (kg/m²)	BMI/A (Z-score)	Total	FM (kg)	FMI (kg/m²)	BMI/A (Z-score)

	n	Median (95%CI)	Median (95%CI)	Median (95%CI)	n	Median (95%CI)	Median (95%CI)	Median (95%CI)
GA		9.6 (3.0 to 26.5)	4.5 (1.6 to 11.5)	0.8 (0.7 to 0.9)		10.0 (3.8 to 27.1)	4.6 (1.9 ^a 11.9)	0.7 (0.6 to 0.7)
(Weeks)		p < 0.001 ^a	p < 0.001 ^a	p < 0.001 ^b		p = 0.024 ^a	p = 0.082 ^a	p = 0.167 ^b
≤ 33	38	6.1 (1.9 to 40.3)	3.3 (1.0 to 14.9)	0.3 (- 0.3 to 0.8)	33	7.6 (3.8 to 20.1)	4.0 (1.9 to 9.4)	0.6 (0.2 to 1.0)
34–36	187	7.6 (2.8 to 24.4)	3.7 (1.5 to 10.4)	0.4 (0.2 to 0.7)	172	9.2 (3.0 to 24.8)	4.3 (1.4 to 10.4)	0.5 (0.3 to 0.7)
37–41	1.425	10.1 (3.1 to 26.5)	4.7 (1.6 to 11.5)	0.9 (0.8 to 1.0)	1.331	10.2 (3.9 to 28.1)	4.7 (1.9 to 12.1)	0.7 (0.6 to 0.8)
Intrauterine growth		p = 0.028 ^a	p = 0.021 ^a	p < 0.001 ^b		p = 0.004 ^a	p = 0.006 ^a	p = 0.001 ^b
SGA	142	8.1 (2.9 to 21.9)	3.9 (1.6 to 9.5)	0.5 (0.3 to 0.7)	138	8.9 (2.9 to 20.9)	4.1 (1.5 to 9.1)	0.3 (0.1 to 0.5)
AGA	1.286	9.1 (2.9 to 23.7)	4.4 (1.5 to 10.6)	0.7 (0.6 to 0.8)	1.160	9.7 (3.8 to 24.2)	4.5 (1.9 to 10.7)	0.6 (0.5 to 0.7)
LGA	1.704	10.7 (3.1 to 25.3)	5.0 (1.6 to 11.1)	1.0 (0.8 to 1.2)	292	10.7 (3.8 to 25.4)	4.8 (1.9 to 11.1)	0.7 (0.6 to 0.9)

Variable	Boys			Girls

	Total	FFM (kg)	FFMI (kg/m²)	Total	FFM (kg)	FFMI (kg/m²)

	n	Median (95%CI)	Median (95%CI)	n	Median (95%CI)	Median (95%CI)
GA		30.0 (29.8 to 30.2)	14.3 (14.2 to 14.3)		31.1 (30.8 to 31.4)	14.4 (14.3 to 14.4)
(Weeks)		p < 0.001 ^a	p = 0.001 ^a		p = 0.025 ^a	p = 0.413 ^a
≤ 33	38	28.1 (26.0 to 29.5)	13.9 (13.5 to 14.4)	33	30.1 (28.1 to 32.1)	14.6 (13.9 to 15.3)
34–36	187	29.0 (28.3 to 29.7)	13.9 (13.7 to 14.2)	172	30.2 (29.4 to 31.1)	14.2 (14.0 to 14.5)
37–41	1,425	30.3 (30.0 to 30.5)	14.3 (14.2 to 14.4)	1,331	31.3 (30.9 to 31.6)	14.4 (14.3 to 14.5)
Intrauterine growth		p = 0.027 ^a	p = 0.020 ^a		p = 0.018 ^a	p = 0.100 ^a
SGA	142	29.4 (28.6 to 30.1)	14.0 (13.8 to 14.2)	138	30.1 (29.1 to 31.1)	14.0 (13.7 to 14.3)
AGA	1,286	29.7 (29.5 to 30.0)	14.2 (14.1 to 14.3)	1,160	30.7 (30.4 to 31.0)	14.3 (14.2 to 14.4)
LGA	1,704	30.6 (30.0 to 31.1)	14.5 (14.3 to 14.6)	292	31.7 (31.0 to 32.4)	14.5 (14.3 to 14.7)

GA (Weeks)	FM (kg)^a		FMI (kg/m²)^a		BMI/A (Z-Score)		FFM (kg)		FFMI (kg/m²)

	β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)

	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted
Boys	p < 0.001	p = 0.119 ^b	p < 0.001	p = 0.415 ^c	p < 0.001	p = 0.206 ^d	p < 0.001	p = 0.134 ^e	p < 0.001	p = 0.228 ^f
≤ 33	-0.4 (-0.6 to -0.1)	0.0 (-0.3 to 0.1)	-0.3 (-0.5 to -0.1)	0.0 (-0.3 to 0.2)	-0.6 (-1.1 - -0.2)	0.0 (-0.6 to 0.5)	-2.2 (-3.8 -0.7)	-0.7 (-1.3 to -0.1)	-0.4 (-0.8 to 0.1)	-0.3 (-0.6 to 0.0)
34–36	-0.2 (-0.3 to -0.1)	0.0 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	0.0 (-0.2 to 0.0)	-0.5 (-0.7 a -0.2)	-0.2 (-0.5 to 0.0)	-1.3 (-2.0 -0.6)	0.0 (-1.3 to 1.3)	-0.4 (-0.6 -0.2)	0.0 (-0.6 to 0.6)
37–41	ref.	ref.	ref.	ref.	ref..	ref.	ref.	ref.	ref.	ref.
Girls	p = 0.022	p = 0.983 ^g	p = 0.070	p = 0.714 ^h	p = 0.167	p = 0.357 ⁱ	p = 0.025	p = 0.574 ^j	p = 0.831	p = 0.206 ^k
≤ 33	-0.2 (-0.4 to 0.1)	0.0 (-0.3 to 0.3)	-0.1 (-0.3 to 0.1)	0.0 (-0.3 to 0.3)	-0.1 (-0.6 to 0.4)	0.2 (-0.5 to 0.8)	-1.0 (-2.0 -0.1)	0.3 (-0.5 to 1.0)	0.3 (-0.4 to 0.9)	0.2 (-0.2 to 0.6)
34–36	-0.1 (-0.2 to 0.0)	0.0 (0.1 to 0.1)	-0.1 (-0.2 to 0.0)	0.0 (-0.1 to 0.2)	-0.2 (-0.5 to 0.0)	0.1 (-0.2 to 0.4)	-1.2 (-3.3 - 0.9)	0.1 (-1.6 to 1.7)	-0.2 (-0.4; 0.1)	0.3 (-0.5 to 1.2)
37–41	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.

Intrauterine growth	FM (kg)^a		FMI (kg/m²)^a		BMI/A (Z-score)		FFM (kg)		FFMI (kg/m²)

	β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)		β (95%CI)

	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted	Gross	Adjusted
Boys	p = 0.003	p = 0.083 ^b	p = 0.003	p = 0.026 ^c	p < 0.001	p = 0.019 ^d	p = 0.027	p = 0.356 ^e	p = 0.020	p = 0.193 ^f
SGA	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.2 (-0.4 to 0.0)	-0.2 (-0.4 to 0.1)	-0.4 (-1.2 to 0.4)	-0.3 (-0.9 to 0.3)	-0.2 (-0.4 to 0.1)	-0.2 (-0.5 to 0.1)
AGA	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
LGA	0.1 (0.0 to 0.2)	0.1 (0.0 to 0.2)	0.1 (0.0 to 0.2)	0.1 (0.1 to 0.2)	0.3 (0.1 to 0.5)	0.3 (0.1 to 0.5)	0.8 (0.2 to 1.4)	0.3 (-0.2 to 0.8)	0.3 (0.1 to 0.5)	0.2 (0.0 to 0.4)
Girls	p = 0.005	p = 0.178 ^g	p = 0.006	p = 0.067 ^h	p = 0.001	p = 0.050 ⁱ	p = 0.018	p = 0.088 ^j	p = 0.100	p = 0.039 ^k
SGA	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.1 (-0.2 to 0.0)	-0.3 (-0.5 to 0.0)	0.0 (0.0 to 0.2)	-0.6 (-1.6 to 0.5)	-0.3 (-1.0 to 0.5)	-0.3 (-0.6 to 0.0)	-0.1 (-0.5 to 0.2)
AGA	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.	ref.
LGA	0.0 (0.0 to 0.2)	0.0 (0.0 to 0.2)	0.0 (0.0 to 0.1)	0.1 (0.0 to 0.2)	0.2 (0.0 to 0.3)	0.0 (0.0 to 0.0)	1.1 (0.3 to 1.8)	0.6 (0.0 to 1.1)	0.2 (0.0 to 0.5)	0.3 (0.1 to 0.6)

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[1] Correspondence: Caroline Cardozo Bortolotto Rua Marechal Deodoro, 1.160 3° Piso 96020-220 Pelotas, RS, Brasil Caixa Postal 464 E-mail: kkbortolotto@hotmail.com