Fetal ultrasound measurements and associations with postnatal outcomes in infancy and childhood: a systematic review of an emerging literature

Abstract

BackgroundSeveral hypotheses predict that faltering fetal growth is an antecedent for common non-communicable diseases. This is the first systematic review of an emerging literature linking antenatal fetal measurements to postnatal outcomes.MethodsElectronic databases (OVID, EMBASE and Google Scholar) and cohort study websites were searched in July 2014. Studies were selected which examined associations between antenatal fetal ultrasound measurements and postnatal outcomes. Neonatal outcomes, e.g. premature delivery, were not included.ResultsThere were 23 papers identified from cohorts in Western countries, including 11 from a single cohort. Four papers reported outcomes in children aged over 6 years. Small, but not large, for gestational age (SGA) was associated with adverse outcomes except for one study where individuals with the lightest or heaviest estimated fetal weight risk were at increased risk for autistic spectrum disorder. The magnitude of associations was modest, e.g. each z score reduction in fetal size was associated with 10–20% increased risk for delayed development or a 1 mm Hg increase in blood pressure. Both growth acceleration and deceleration were both associated with adverse outcomes.ConclusionsThere is consistency for antenatal SGA and growth deceleration being associated with adverse outcomes determined in early childhood. Accelerating fetal growth was associated with both advantageous and disadvantageous outcomes, and this is consistent with the concept of predictive adaptive responses where exposure to a postnatal environment which was not anticipated predisposes the fetus to adverse health.

Fetal growth trajectory and risk for eczema in a Saudi population

“…Our findings confirm previously described association between change in abdominal circumference between the second and third trimesters and altered eczema risk and atopy risk , but the novel finding is that the direction of the relationship is reversed in the Saudi population compared with populations in the Netherlands and UK. A recent systematic review has identified apparently inconsistent findings between antenatal growth and postnatal outcomes between different populations ; for example, blood pressure has been positively and negatively associated with femur length, and the results presented here compliment the findings of the systematic review and support the principle of predictive adaptive responses or developmental plasticity where a fetus might reach more than one postnatal phenotype depending on the antenatal cues experienced at critical points of development.…”

“…Importantly, the observations to date linking antenatal fetal growth to outcomes, such as eczema risk, are limited to populations in Australia, the Netherlands, the USA, and UK where the antenatal environment and potential confounders are similar. Studies in non‐Western populations, where antenatal environmental cues may differ, may give new understanding of the developmental origins of disease .…”

Thin-for-gestational age infants are at increased risk of neurodevelopmental delay at 2 years

“…Up to one-third of SGA infants are not FGR but are simply constitutionally small,16 and while identification of FGR infants is improved by the use of birthweight centiles, their use alone will still include many normal infants 17. These difficulties have led to inconsistent findings, with some studies showing a modest or negligible effect of SGA on cognitive outcome when standard centiles alone are used 18. Improved postnatal assessment of risk would help clinicians and parents to target follow-up and early intervention.…”

Antenatal origins of reduced lung function‐but not asthma?

“…too big or small) when there is a mismatch between antenatal cues and the postnatal environment. A small number of groups have established cohorts to test the DOHaD by measuring antenatal and postnatal growth and relating this to NCDs, which in children are limited to asthma and relatively few other conditions …”

“…A small number of groups have established cohorts to test the DOHaD by measuring antenatal and postnatal growth and relating this to NCDs, which in children are limited to asthma and relatively few other conditions. 6 The exact relationship between very early (antenatal) growth and respiratory outcomes in childhood is not clear from the small number of publications currently available, but a study in this issue of Respirology brings some clarity. 7 The work by Sonnenschein-van der Voort et al 7 reports associations between antenatal and postnatal growth, asthma symptoms and pulmonary function at 6 years of age.…”