Summary: Babies born below the 25th percentile for birth weight are at higher risk for developmental concerns than children born between the 25-75th percentiles, with the smallest babies carrying the most risk.
Being born below the 25th percentile for birthweight may put a child at risk for developmental difficulties, according to a new study by Abiodun Adanikin of Coventry University, U.K., and colleagues, publishing October 11 in the open access journal PLOS Medicine.
Babies that are too big or too small are believed to be at risk of poor birth outcomes and problems related to childhood development, but little is known about this relationship across the entire range of birthweights for non-premature babies. To fill this gap, researchers studied the development of more than 600,000 infants born after 37 weeks of gestation in Scotland.
At around two or three years of age, the children underwent evaluation for social development and for fine motor, gross motor and communication skills. The researchers looked for associations between birthweight and early childhood developmental concerns, taking into account complicating factors, such as the child’s sex and gestational age at delivery, as well as the health, ethnicity and socio-economic status of the mother.
The study showed that babies born below the 25th percentile for birthweight had a higher risk of developmental concerns compared to babies born between the 25th and 75th percentiles, with the smallest babies carrying the greatest risk.
Babies born above the 75th percentile of weights did not have a substantially increased risk of developmental concerns compared to babies born in the middle range.
The researchers conclude that having a low birthweight is an unrecognized and potentially important contributor to the prevalence of issues related to childhood development.
Traditionally, babies below the 10th percentile were believed to be at risk for developmental concerns. But the new study found a greater number of babies within the 10th to 24th percentile range of birthweights with these issues, simply because there are a larger number of babies within that population.
The researchers suggest that better birthweight surveillance, counseling for the parents and increased support during childhood may help reduce the risks associated with babies born with lower birthweights.
Coauthor Abiodun Adanikin adds, “Though it is mostly unrecognized, babies who are mild-to-moderately small at birth are key contributors to the burden of childhood developmental concerns. They may need closer monitoring and increased support to reduce the risk of developmental concerns.”
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Association of birthweight centiles and early childhood development of singleton infants born from 37 weeks of gestation in Scotland: A population-based cohort study
Birthweight centiles beyond the traditional thresholds for small or large babies are associated with adverse perinatal outcomes but there is a paucity of data about the relationship between birthweight centiles and childhood development among children born from 37 weeks of gestation. This study aims to establish the association between birthweight centiles across the whole distribution and early childhood development among children born from 37 weeks of gestation.
Methods and findings
This is a population-based cohort study of 686,284 singleton infants born from 37 weeks of gestation. The cohort was generated by linking pregnancy and delivery data from the Scottish Morbidity Records (2003 to 2015) and the child developmental assessment at age 2 to 3.5 years. The main outcomes were child’s fine motor, gross motor, communication, and social developmental concerns measured with the Ages and Stages Questionnaires—3 (ASQ-3) and Ages and Stages Questionnaire: Social & Emotional—2 (ASQ:SE-2), and for a subset of children with additional specialist tools such as the Modified Checklist for Autism in Toddlers (M-CHAT) if the ASQ3/SE indicate these are necessary. The ASQ score for each domain was categorised as “concern” and “no concern.”
We used multivariate cubic regression splines to model the associations between birthweight centiles and early childhood developmental concerns. We used multivariate Poisson regression models, with cluster robust errors, to estimate the relative risks (RRs) of developmental concerns below and above the established thresholds. We adjusted for maternal age, early pregnancy body mass index (BMI), parity, year of delivery, gestational age at delivery, smoking history, substance misuse in pregnancy, alcohol intake, ethnicity, residential area deprivation index, maternal clinical conditions in pregnancy (such as diabetes and pre-eclampsia), induction of labour, and child’s sex.
Babies born from 37 weeks of gestation with birthweight below the 25th centile, compared to those between the 25th and 74th centile, were at higher risk of developmental concerns. Those born between the 10th and 24th centile had an RR of 1.07 (95% CI: 1.03 to 1.12, p < 0.001), between the 3rd and 9th centile had an RR: 1.18 (95% CI: 1.12 to 1.25, p < 0.001), and <3rd centile had an RR of 1.37 (95% CI: 1.24 to 1.50, p < 0.001). There was no substantial increase in the risk of early childhood developmental concerns for larger birthweight categories of 75th to 89th (RR: 1.01; 95% CI: 0.97 to 1.05; p = 0.56), 90th to 96th (RR: 0.99; 95% CI: 0.94 to 1.05; p = 0.86), and ≥97th centiles (RR: 1.04; 95% CI: 0.97 to 1.12; p = 0.27), referent to birthweight between 25th and 74th centile.
The percentage of developmental concerns attributable to birthweight between the 10th and 24th centile was more than that of birthweight <3rd centile (p = 0.023) because this group includes more of the population. Approximately 2.50% (95% CI: 1.26 to 3.61) of social skills concerns and 3.00% (95% CI: 1.33 to 4.67) of fine motor developmental concerns were attributable to birthweight between the 10th and 24th centile compared to 0.90% (95% CI: 0.48 to 1.26) and 2.30% (95% CI: 1.73 to 2.67) respectively for birthweight <3rd centile. We acknowledge the limitation of ASQ as a screening tool, the subjective nature of developmental assessments (particularly for speech) among young children, and inability to control for early childhood illness and upbringing factors may have an impact on our findings.
We observed that from 37 weeks of gestation birthweight below the 25th centile was associated with child developmental concerns, with an association apparent at higher centiles above the conventional threshold defining small for gestational age (SGA, 3rd or 10th centile). Mild to moderate SGA is an unrecognised potentially important contributor to the prevalence of developmental concerns. Closer surveillance, appropriate parental counselling, and increased support during childhood may reduce the risks associated with lower birthweight centiles.