Cognitive and Behavioral Outcomes of Intrauterine Growth Restriction School-Age Children

Abstract

CONTEXT: Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse neurologic developmental outcomes during the school-age years of life. OBJECTIVE:To estimate the effect of IUGR on cognition and behavior in school-aged children.DATA SOURCES: Medline, Embase, and PsycINFO were searched for English-language articles published after 1980.DATA SELECTION We included case-control studies reporting cognitive and/or behavioral data of children who had IUGR and were evaluated afterfifth birthday. DATA EXTRACTION:Cognitive data from 15 studies and behavioral data from 6 studies were selected with a total of 1559 cases and 1630 controls. The cognitive scores and behavioral outcomes were extracted. RESULTS:The controls had significantly higher cognitive scores than the children with IUGR (standardized mean difference [SMD] -0.38, 95% confidence interval [CI] -0.51 to -0.25, P < .00001). The IQ scores of the IUGR group were not significantly correlated with mean birth weight and gestational age (P > .05). Five trials were included in the behavioral outcomes trial, the behavior scores were significantly different between the groups with and without IUGR (SMD 0.31, 95% CI 0.13 to 0.48, P = .001). The incidence of attention-deficit/ hyperactivity disorder (ADHD) was not significantly different between 2 groups (P = .11). LIMITATIONS:The number of studies that assessed behavioral and ADHD outcome is small. CONCLUSIONS:The findings demonstrate that IUGR is associated with lower cognitive scores in school-age children. However, further large-scale trials are needed to assess the effects of IUGR on the outcome of behavioral disorder and ADHD.Neonatal Division, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China Dr P. Chen conceptualized and designed the study, and reviewed and revised the manuscript; Dr J. Chen carried out the initial analyses, and drafted the initial manuscript; Drs Bo and Luo collected data, and critically reviewed the manuscript; and all authors approved the fi nal manuscript as submitted and agree to be accountable for all aspects of the work. By 2 to 3 years after birth, infants with IUGR will undergo catch-up growth of both the body and head 3 ; however, approximately 10% of IUGR cases do not achieve catch-up growth and exhibit persistent growth delay. 4 Many studies have shown that IUGR is associated with increased neonatal morbidity and mortality as well as cardiovascular disease, insulin resistance, diabetes mellitus type 2, dyslipidemia, and end-stage renal disease in adulthood. In addition, numerous large-scale follow-up studies have shown that IUGR is associated with significant neurodevelopmental impairment across a range of outcomes in children. [5][6][7] The effects of IUGR persist beyond the neonatal period and may have a profound impact on childhood development. To date, neurodevelopment in school-age children with IUGR has received comparatively little attention. Here, we present a meta-analysis and systematic review...

Systematic review indicates postnatal growth in term infants born small‐for‐gestational‐age being associated with later neurocognitive and metabolic outcomes

“…However, one other review reported lower verbal and performance intelligence quotient scores in school‐age children born SGA 51 and neuroimaging studies have shown early microstructural changes related to altered neurobehavioral outcomes 52. We found consistently positive associations between postnatal growth and neurocognitive outcomes in four of the five observational studies included in the review 51. Interestingly, the only RCT included in this review reported a negative effect of growth induced by nutrient‐ and energy‐enriched formula feeding on developmental scores at nine months in just girls, but no differences between nutritional groups at 18 months.…”

Perinatal outcomes in children born after fresh or frozen embryo transfer: a Catalan cohort study based on 14,262 newborns

“…There is some published evidence on the long-term outcomes of children born preterm, and most studies show that adverse outcomes are strongly associated with prematurity, mainly in the neurologic and behavioral fields (31). Further analysis seems to establish an important relationship between LBW and impaired development, making it a more important contributing factor than gestational age at delivery among others, although the association is not very strong and several studies await longer-term results (32)(33)(34).…”

Fetal programming of neuropsychiatric disorders

“…Pluchino et al (2016), hypothesized that an altered progesterone/allopregnanolone fetal brain, during placental insufficiency, may result in behavioral consequences. IUGR may be at increased risk of having low cognitive scores in school-age (Chen et al, 2016).…”