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Abstract：
BACKGROUND: Limited research has explored the associations of gestational age (GA) and breastfeeding practices with growth and nutrition in term infants.
METHODS: This multicenter cross-sectional study recruited 7299 singleton term infants from well-child visits in Shandong, China, between March 2021 and November 2022. Data on GA, gender, ethnicity, birth weight, parental heights, gestational diabetes and hypertension, age at visit, breastfeeding practices (point-in-time data at visit for infants < 6 months and retrospective data at 6 months for infants ≥ 6 months), complementary foods introduction, infant length and weight, were collected. 7270 infants were included in the analysis after excluding outliers with Z-scores of length (LAZ), weight or weight for length (WLZ) <-4 or > 4. Linear regression models adjused for covariates explored the impact of GA and breastfeeding practices on LAZ and WLZ, while logistic regression models evaluated their effect on the likelihood of moderate and severe stunting (MSS, LAZ<-2), moderate and severe acute malnutrition (MSAM, WLZ<-2) and overweight/obesity (WLZ > 2). Sensitivity analysis was conducted on normal birth weight infants (2.5-4.0 kg).
RESULTS: Infants born early-term and exclusively breastfed accounted for 31.1% and 66.4% of the sample, respectively. Early-term birth related to higher WLZ (< 6 months: β = 0.23, 95% confidence interval (CI): 0.16, 0.29; ≥6 months: β = 0.12, 95% CI: 0.04, 0.20) and an increased risk of overweight/obesity throughout infancy (< 6 months: OR: 1.41, 95% CI 1.08, 1.84; ≥6 months: OR: 1.35, 95% CI 1.03, 1.79). Before 6 months, early-term birth correlated with lower LAZ (β=-0.16, 95% CI: -0.21, -0.11) and an increased risk of MSS (OR: 1.01, 95%CI 1.00, 1.02); Compared to exclusive breastfeeding, exclusive formula-feeding and mixed feeding linked to lower WLZ (β=-0.15, 95%CI -0.30, 0.00 and β=-0.12, 95%CI -0.19, -0.05, respectively) and increased risks of MSAM (OR: 5.57, 95%CI 1.95, 15.88 and OR: 3.19, 95%CI 1.64, 6.19, respectively). Sensitivity analyses confirmed these findings.
CONCLUSIONS: The findings emphasize the health risks of early-term birth and the protective effect of exclusive breastfeeding in singleton term infants, underscoring the avoidance of nonmedically indicated delivery before 39 weeks and promoting exclusive breastfeeding before 6 months.
METHODS: This multicenter cross-sectional study recruited 7299 singleton term infants from well-child visits in Shandong, China, between March 2021 and November 2022. Data on GA, gender, ethnicity, birth weight, parental heights, gestational diabetes and hypertension, age at visit, breastfeeding practices (point-in-time data at visit for infants < 6 months and retrospective data at 6 months for infants ≥ 6 months), complementary foods introduction, infant length and weight, were collected. 7270 infants were included in the analysis after excluding outliers with Z-scores of length (LAZ), weight or weight for length (WLZ) <-4 or > 4. Linear regression models adjused for covariates explored the impact of GA and breastfeeding practices on LAZ and WLZ, while logistic regression models evaluated their effect on the likelihood of moderate and severe stunting (MSS, LAZ<-2), moderate and severe acute malnutrition (MSAM, WLZ<-2) and overweight/obesity (WLZ > 2). Sensitivity analysis was conducted on normal birth weight infants (2.5-4.0 kg).
RESULTS: Infants born early-term and exclusively breastfed accounted for 31.1% and 66.4% of the sample, respectively. Early-term birth related to higher WLZ (< 6 months: β = 0.23, 95% confidence interval (CI): 0.16, 0.29; ≥6 months: β = 0.12, 95% CI: 0.04, 0.20) and an increased risk of overweight/obesity throughout infancy (< 6 months: OR: 1.41, 95% CI 1.08, 1.84; ≥6 months: OR: 1.35, 95% CI 1.03, 1.79). Before 6 months, early-term birth correlated with lower LAZ (β=-0.16, 95% CI: -0.21, -0.11) and an increased risk of MSS (OR: 1.01, 95%CI 1.00, 1.02); Compared to exclusive breastfeeding, exclusive formula-feeding and mixed feeding linked to lower WLZ (β=-0.15, 95%CI -0.30, 0.00 and β=-0.12, 95%CI -0.19, -0.05, respectively) and increased risks of MSAM (OR: 5.57, 95%CI 1.95, 15.88 and OR: 3.19, 95%CI 1.64, 6.19, respectively). Sensitivity analyses confirmed these findings.
CONCLUSIONS: The findings emphasize the health risks of early-term birth and the protective effect of exclusive breastfeeding in singleton term infants, underscoring the avoidance of nonmedically indicated delivery before 39 weeks and promoting exclusive breastfeeding before 6 months.
摘要：
背景：有限的研究探讨了胎龄（GA）和母乳喂养习惯与足月婴儿生长和营养的关系。
方法：这项多中心横断面研究招募了山东7299名来自好孩子就诊的单胎足月婴儿，中国,2021年3月至2022年11月。GA上的数据，性别,种族,出生体重,父母的高度，妊娠期糖尿病和高血压,参观的年龄，母乳喂养实践（<6个月婴儿就诊时的时间点数据和≥6个月婴儿6个月时的回顾性数据），辅食介绍,婴儿身长和体重，被收集。在排除具有长度Z评分（LAZ）的异常值后，将7270名婴儿纳入分析，重量或长度重量(WLZ)<-4或>4。用于协变量的线性回归模型探讨了GA和母乳喂养实践对LAZ和WLZ的影响，而逻辑回归模型评估了它们对中度和重度发育迟缓可能性的影响(MSS，LAZ<-2),中度和重度急性营养不良(MSAM，WLZ<-2)和超重/肥胖(WLZ>2)。对正常出生体重婴儿(2.5～4.0kg)进行敏感性分析。
结果：早期出生和纯母乳喂养的婴儿占样本的31.1％和66.4％，分别。早产与较高的WLZ（<6个月：β=0.23，95％置信区间（CI）：0.16，0.29；≥6个月：β=0.12，95％CI：0.04，0.20）和整个婴儿期超重/肥胖风险增加（<6个月：OR：1.41，95％CI1.08，1.84；≥6个月：OR：1.35，95％CI1.03，1.79）。6个月前,早期出生与较低的LAZ（β=-0.16，95％CI：-0.21，-0.11）和MSS风险增加（OR：1.01，95CI1.00，1.02）相关；与纯母乳喂养相比，独家配方喂养和混合喂养与较低的WLZ（分别为β=-0.15，95CI-0.30，0.00和β=-0.12，95CI-0.19，-0.05）和MSAM风险增加（OR：5.57，95CI1.95，15.88和OR：3.19，95CI1.64，6.19）。敏感性分析证实了这些发现。
结论：研究结果强调了早产的健康风险和纯母乳喂养对单胎足月婴儿的保护作用，强调在39周前避免非医学指示分娩,并在6个月前提倡纯母乳喂养.
方法：这项多中心横断面研究招募了山东7299名来自好孩子就诊的单胎足月婴儿，中国,2021年3月至2022年11月。GA上的数据，性别,种族,出生体重,父母的高度，妊娠期糖尿病和高血压,参观的年龄，母乳喂养实践（<6个月婴儿就诊时的时间点数据和≥6个月婴儿6个月时的回顾性数据），辅食介绍,婴儿身长和体重，被收集。在排除具有长度Z评分（LAZ）的异常值后，将7270名婴儿纳入分析，重量或长度重量(WLZ)<-4或>4。用于协变量的线性回归模型探讨了GA和母乳喂养实践对LAZ和WLZ的影响，而逻辑回归模型评估了它们对中度和重度发育迟缓可能性的影响(MSS，LAZ<-2),中度和重度急性营养不良(MSAM，WLZ<-2)和超重/肥胖(WLZ>2)。对正常出生体重婴儿(2.5～4.0kg)进行敏感性分析。
结果：早期出生和纯母乳喂养的婴儿占样本的31.1％和66.4％，分别。早产与较高的WLZ（<6个月：β=0.23，95％置信区间（CI）：0.16，0.29；≥6个月：β=0.12，95％CI：0.04，0.20）和整个婴儿期超重/肥胖风险增加（<6个月：OR：1.41，95％CI1.08，1.84；≥6个月：OR：1.35，95％CI1.03，1.79）。6个月前,早期出生与较低的LAZ（β=-0.16，95％CI：-0.21，-0.11）和MSS风险增加（OR：1.01，95CI1.00，1.02）相关；与纯母乳喂养相比，独家配方喂养和混合喂养与较低的WLZ（分别为β=-0.15，95CI-0.30，0.00和β=-0.12，95CI-0.19，-0.05）和MSAM风险增加（OR：5.57，95CI1.95，15.88和OR：3.19，95CI1.64，6.19）。敏感性分析证实了这些发现。
结论：研究结果强调了早产的健康风险和纯母乳喂养对单胎足月婴儿的保护作用，强调在39周前避免非医学指示分娩,并在6个月前提倡纯母乳喂养.
