Fetal growth restriction and preterm as determinants of child growth in the first two years and potential interventions

In 2010, 171 million children under 5 years old were estimated to be stunted globally, with 98% being from low- and middle-income countries. Low birthweight including fetal growth restriction is also common in these regions and may contribute to childhood undernutrition. As part of the Child Health Reference Group (CHERG) and using 14 longitudinal birth cohorts and anthropometric measurements taken at 24 months of age, pooled odds ratios (ORs) were calculated to examine the relationship between small for gestational age (SGA) and preterm birth and subsequent stunting and wasting in children. Relative to term adequate size for gestational age (AGA), the OR (95% confidence interval) for stunting associated with AGA-preterm, SGA-term and SGA-preterm was 1.94 (1.59-2.36), 2.82 (2.40-3.32) and 4.98 (3.79-6.55), respectively. A similar magnitude of risk was also observed for wasting and underweight. This analysis indicates that childhood undernutrition may have its origins, in part, in the fetal period, suggesting a need to intervene during an earlier life stage during pregnancy and even preconceptionally, but also putting emphasis on maternal nutrition in general and adolescent nutrition. Interventions shown to impact fetal growth include antenatal supplementation with balanced calorie and protein, iron-folic acid, and multiple micronutrients. Nutrition-sensitive interventions such as delaying the first pregnancy, antimalarials and smoking cessation in some settings may be important.