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Abstract：
BACKGROUND: Early pregnancy is a critical window for neural system programming; however, the association of first-trimester fetal size with children\'s neurodevelopment remains to be assessed. This study aimed to explore the association between first-trimester fetal size and children\'s neurodevelopment and to examine whether intrauterine accelerated growth could compensate for the detrimental effects of first-trimester restricted growth on childhood neurodevelopment.
METHODS: The participants were from a birth cohort enrolled from March 2014 to March 2019 in Wuhan, China. A total of 2058 fetuses with crown to rump length (CRL) (a proxy of first-trimester fetal size) measurements in the first trimester and neurodevelopmental assessment at age 2 years were included. We measured the first-trimester CRL and defined three fetal growth patterns based on the growth rate of estimated fetal weight from mid to late pregnancy. The neurodevelopment was assessed using the Bayley Scales of Infant Development of China Revision at 2 years.
RESULTS: Each unit (a Z score) increase of first-trimester CRL was associated with increased scores in mental developmental index (MDI) (adjusted beta estimate = 1.19, (95% CI: 0.42, 1.95), P = 0.03) and psychomotor developmental index (PDI) (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at age 2 years, respectively. No significant association was observed between fetal growth rate and PDI. For children with restricted first-trimester fetal size (the lowest tertile of first-trimester CRL), those with \"intrauterine accelerated growth\" pattern (higher growth rates) had significantly higher MDI (adjusted beta estimate = 6.14, (95% CI: 3.80, 8.49), P < 0.001) but indistinguishable PDI compared to those with \"intrauterine faltering growth\" pattern (lower growth rates). Main limitations of this study included potential misclassification of gestational age due to recall bias of the last menstrual period and residual confounding.
CONCLUSIONS: The current study suggests that restricted first-trimester fetal size is associated with mental and psychomotor developmental delay in childhood. However, in children with restricted first-trimester fetal size, intrauterine accelerated growth was associated with improved mental development but had little effect on psychomotor development. Additional studies are needed to validate the results in diverse populations.
METHODS: The participants were from a birth cohort enrolled from March 2014 to March 2019 in Wuhan, China. A total of 2058 fetuses with crown to rump length (CRL) (a proxy of first-trimester fetal size) measurements in the first trimester and neurodevelopmental assessment at age 2 years were included. We measured the first-trimester CRL and defined three fetal growth patterns based on the growth rate of estimated fetal weight from mid to late pregnancy. The neurodevelopment was assessed using the Bayley Scales of Infant Development of China Revision at 2 years.
RESULTS: Each unit (a Z score) increase of first-trimester CRL was associated with increased scores in mental developmental index (MDI) (adjusted beta estimate = 1.19, (95% CI: 0.42, 1.95), P = 0.03) and psychomotor developmental index (PDI) (adjusted beta estimate = 1.36, (95% CI: 0.46, 2.26), P < 0.01) at age 2 years, respectively. No significant association was observed between fetal growth rate and PDI. For children with restricted first-trimester fetal size (the lowest tertile of first-trimester CRL), those with \"intrauterine accelerated growth\" pattern (higher growth rates) had significantly higher MDI (adjusted beta estimate = 6.14, (95% CI: 3.80, 8.49), P < 0.001) but indistinguishable PDI compared to those with \"intrauterine faltering growth\" pattern (lower growth rates). Main limitations of this study included potential misclassification of gestational age due to recall bias of the last menstrual period and residual confounding.
CONCLUSIONS: The current study suggests that restricted first-trimester fetal size is associated with mental and psychomotor developmental delay in childhood. However, in children with restricted first-trimester fetal size, intrauterine accelerated growth was associated with improved mental development but had little effect on psychomotor development. Additional studies are needed to validate the results in diverse populations.
摘要：
背景：早孕是神经系统编程的关键窗口；但是，孕早期胎儿大小与儿童神经发育的关系尚待评估.本研究旨在探讨妊娠早期胎儿大小与儿童神经发育之间的关系，并研究宫内加速生长是否可以补偿妊娠早期生长受限对儿童神经发育的不利影响。
方法：参与者来自2014年3月至2019年3月在武汉注册的出生队列，中国。共包括2058个胎儿，其在妊娠早期和2岁时的神经发育评估中的冠部至臀部长度（CRL）（妊娠早期胎儿大小的代表）测量值。我们测量了妊娠早期CRL，并根据从妊娠中期到晚期估计的胎儿体重的增长率定义了三种胎儿生长模式。使用中国修订的Bayley婴儿发育量表评估2年的神经发育。
结果：孕早期CRL的每个单位（Z得分）增加与智力发育指数（MDI）得分增加相关（调整后的β估计值=1.19，（95％CI：0.42，1.95），P=0.03）和精神运动发育指数（PDI）（调整后的β估计值=1.36，（95％CI：0.46，2.26），P<0.01）在2岁时，分别。在胎儿生长速率和PDI之间没有观察到显著关联。对于妊娠早期胎儿大小受限的儿童（妊娠早期CRL的最低三位数），那些具有“宫内加速生长”模式（较高的增长率）的MDI明显较高（调整后的β估计值=6.14，（95％CI：3.80，8.49），P<0.001），但与“宫内生长步履蹒跚”模式（较低的增长率）相比，PDI难以区分。这项研究的主要局限性包括由于上次月经期的回忆偏差和残留的混杂因素而导致的胎龄潜在错误分类。
结论：目前的研究表明，妊娠早期胎儿大小受限与儿童期智力和精神运动发育迟缓有关。然而,在妊娠早期胎儿大小受限的儿童中，宫内生长加速与智力发育改善相关,但对精神运动发育影响不大.需要更多的研究来验证不同人群的结果。
方法：参与者来自2014年3月至2019年3月在武汉注册的出生队列，中国。共包括2058个胎儿，其在妊娠早期和2岁时的神经发育评估中的冠部至臀部长度（CRL）（妊娠早期胎儿大小的代表）测量值。我们测量了妊娠早期CRL，并根据从妊娠中期到晚期估计的胎儿体重的增长率定义了三种胎儿生长模式。使用中国修订的Bayley婴儿发育量表评估2年的神经发育。
结果：孕早期CRL的每个单位（Z得分）增加与智力发育指数（MDI）得分增加相关（调整后的β估计值=1.19，（95％CI：0.42，1.95），P=0.03）和精神运动发育指数（PDI）（调整后的β估计值=1.36，（95％CI：0.46，2.26），P<0.01）在2岁时，分别。在胎儿生长速率和PDI之间没有观察到显著关联。对于妊娠早期胎儿大小受限的儿童（妊娠早期CRL的最低三位数），那些具有“宫内加速生长”模式（较高的增长率）的MDI明显较高（调整后的β估计值=6.14，（95％CI：3.80，8.49），P<0.001），但与“宫内生长步履蹒跚”模式（较低的增长率）相比，PDI难以区分。这项研究的主要局限性包括由于上次月经期的回忆偏差和残留的混杂因素而导致的胎龄潜在错误分类。
结论：目前的研究表明，妊娠早期胎儿大小受限与儿童期智力和精神运动发育迟缓有关。然而,在妊娠早期胎儿大小受限的儿童中，宫内生长加速与智力发育改善相关,但对精神运动发育影响不大.需要更多的研究来验证不同人群的结果。
