The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania

Abstract

Objectives were to examine the growth patterns of preterm and growth‐restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV‐negative pregnant women–infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length‐for‐age (LAZ), weight‐for‐length (WLZ), and weight‐for‐age (WAZ) z‐scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut‐off of <−2 SD of the respective z‐scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term‐SGA infants and despite some catch‐up growth, preterm‐SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z‐scores among the groups remained similar throughout the follow‐up. Compared with term‐AGA babies, relative risk (RR) of stunting among preterm‐AGA babies was 2.13 (95% confidence interval (CI) 1.93–2.36), RR among term‐SGA was 2.21 (95% CI 2.02–2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41–10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource‐limited settings.

Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda

“…Poor post-natal growth (weight, length or head circumference) is primarily due to inadequate nutritional intake [6]. This early growth deficit affects brain development and has been shown to result in poorer neurodevelopmental outcomes later in life [7,8].…”

“…Early growth deficits amongst preterm infants results from protein and energy deficits after birth [6] and are associated with poor growth and neurodevelopmental outcomes later in childhood [7,8]. Even with growing evidence that optimizing nutrition with total parenteral nutrition, early enteral feeds with fast advancement and fortification of human milk improves growth outcomes, resource limited settings have not been able to implement all this because of cost.…”

Factors affecting stunting among under-five children in Bangladesh

“…Studies show that both physical and social factors are responsible for chronic undernutrition among children [7,8]. Stunting often begins in the pre-natal phase and continues to two years (a time period called the '1,000 days') after the birth of a child [9][10][11][12][13]. Furthermore, the volume, frequency and nature of supplementary feeding, birth weight, gender, birth order and disease conditions are all linked with stunting among children [14][15][16].…”

Factors Associated with Stunting among Pre-school Children in Southern Highlands of Tanzania

“…Stunting often begins in utero , as maternal nutrition is the first determinant of the child nutritional status [ 1 , 10 ], and continues generally during the first two years after birth [ 11 , 12 ]. Although the pathogenesis of stunting is not yet well-understood, studies have shown that inadequate nutrient intake, infections, unsafe water and poor child care are among its main determinants [ 13 , 14 ].…”