Respiratory Function in Adolescence in Relation to Low Birth Weight, Preterm Delivery, and Intrauterine Growth Restriction

doi:10.1378/chest.128.4.2400

Chest

Volume 128, Issue 4, October 2005, Pages 2400-2407

https://doi.org/10.1378/chest.128.4.2400 Get rights and content

Objectives

To study the associations between respiratory function in 18-year-old male subjects and birth weight, preterm delivery, and intrauterine growth restriction (IUGR).

Methods

Population-based birth cohort. Subsamples of 118 male subjects with low birth weight (LBW) [< 2,500 g] and 236 male subjects with normal birth weight were examined at the age of 18 years.

Results

In the crude analysis, subjects with LBW showed reductions in FEV₁ and FVC of 0.166 L and 0.141 L, respectively, compared to those born weighing ≥ 2,500 g. These differences were not significant after adjustment for confounding. When subjects with LBW were stratified into those with preterm delivery and those with IUGR, the latter presented a significant reduction in both FEV₁ and FVC, when compared to the reference group. These differences also disappeared after adjustment for confounders. Preterm delivery per se was also not associated with poor lung function.

Conclusions

In this population, LBW was not associated with respiratory function in 18-year-old male subjects.

Section snippets

Materials and Methods

In the period between January 1, 1982, and December 31, 1982, all 6,011 births occurring in the city of Pelotas, in southern Brazil, were studied. These births represent 99.2% of deliveries in this city during this period. The mothers were weighed, measured, and interviewed concerning socioeconomic, demographic, gestational, and health-related issues. The 5,914 live births were weighed using regularly calibrated pediatric scales (Filizolla; São Paulo, Brazil) with 10-g precision. Since then,

Results

Of the 3,037 male subjects included in the cohort, 244 were born with LBW. Of these, 77.5% were located in 2000: 132 subjects were interviewed and 57 subjects were known to have died. Fifty-five subjects were not located, even after searching previous addresses. An additional 12 subjects attended the examination but due to logistic problems were not invited to the lung function tests. One hundred eighteen satisfactory pulmonary function tests were performed. There was one unsatisfactory

Discussion

The prospective design used in the present study has a number of advantages. Information on exposure—birth weight and gestational age—and confounders was carried out shortly after delivery, thus avoiding recall bias. The inclusion of all births occurred in the city in the perinatal study and the use of random samples in the subsequent follow-up surveys contributed to preventing selection bias. The 2000 research team was blinded to the information obtained earlier in the cohort. In addition, all

ACKNOWLEDGEMENT

We acknowledge the logistic support of the Brazilian Army, in particular Colonel J.C. Poppe, Major L.M. Coutinho, Captain J.L. Barros, and Mr. O Petiz, and the contribution of Jaqueline Joanol Dias.

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Cited by (16)

Impact of prematurity on exercise capacity and agility of children and youth aged 8 to 18
2017, Early Human Development
Citation Excerpt :
Similarly, Norwegian 25-year-old VPT males (N = 34) had significantly lower oxygen consumption than FT males (N = 33) [8], which suggests that respiratory system of PT individuals may be altered lifelong due to its immature status at birth. Namely, a small for gestational age (SGA) foetus adapts its growth progress in response to oxygen and nutrient restriction, which may in turn possibly lead to permanent structural and physiological changes in the lungs [29]. The latter, however, may not be associated with poor lung function per se [29], although it may well be indicated by the lower oxygen consumption of adult PT individuals [30].
Preterm (PT) birth and low birth mass (LBW) can impair growth and development of children and may therefore affect their physical performance up to adulthood.
Our aim was to evaluate long-term consequences of prematurity, especially (an)aerobic exercise capacity and agility up to adulthood, by comparing premature and full-term (FT) individuals.
From 474 subjects born in 1987, who were enrolled into a longitudinal study, 396 (178 PT and 218 FT (with 127 of them LBW)) were followed-up into their early adulthood. Their mass, respiratory status at birth, and results of SLOfit monitoring system (i.e. results of exercise capacity and agility) were monitored on a yearly basis from their age of 8 to 18 years. Data were compared statistically with Student t-test or ANOVA.
PT (or LBW) individuals performed aerobic (time of 600-meter run of females) and the majority of anaerobic tests (sit-ups, standing broad jump, and time of 60-meter run, but not bent arm hang) worse (p < 0.05) than FT individuals. Before puberty, however, the agility and fine motor tests (arm plate tapping, polygon backwards, and standing reach touch) were performed better (p < 0.05) by PT (or LBW) females, as compared to their FT peers, with no similar results in males.
Our results clearly demonstrate that prematurity (especially extreme prematurity) diminishes exercise capacity and agility on the long-term scale, therefore, PT children should be encouraged towards more regular participation in physical activities from early childhood onwards.
Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children
2016, Journal of Allergy and Clinical Immunology
Citation Excerpt :
The effect of birth weight was independent of preterm birth in both studies. However, studies among children showed conflicting results.12,13 We observed an association of lower birth weight with lower FEV1 independent of gestational age at birth.
Children born preterm or with a small size for gestational age are at increased risk for childhood asthma.
We sought to assess the hypothesis that these associations are explained by reduced airway patency.
We used individual participant data of 24,938 children from 24 birth cohorts to examine and meta-analyze the associations of gestational age, size for gestational age, and infant weight gain with childhood lung function and asthma (age range, 3.9-19.1 years). Second, we explored whether these lung function outcomes mediated the associations of early growth characteristics with childhood asthma.
Children born with a younger gestational age had a lower FEV₁, FEV₁/forced vital capacity (FVC) ratio, and forced expiratory volume after exhaling 75% of vital capacity (FEF₇₅), whereas those born with a smaller size for gestational age at birth had a lower FEV₁ but higher FEV₁/FVC ratio (P < .05). Greater infant weight gain was associated with higher FEV₁ but lower FEV₁/FVC ratio and FEF₇₅ in childhood (P < .05). All associations were present across the full range and independent of other early-life growth characteristics. Preterm birth, low birth weight, and greater infant weight gain were associated with an increased risk of childhood asthma (pooled odds ratio, 1.34 [95% CI, 1.15-1.57], 1.32 [95% CI, 1.07-1.62], and 1.27 [95% CI, 1.21-1.34], respectively). Mediation analyses suggested that FEV₁, FEV₁/FVC ratio, and FEF₇₅ might explain 7% (95% CI, 2% to 10%) to 45% (95% CI, 15% to 81%) of the associations between early growth characteristics and asthma.
Younger gestational age, smaller size for gestational age, and greater infant weight gain were across the full ranges associated with childhood lung function. These associations explain the risk of childhood asthma to a substantial extent.
Small for gestational age birth weight: Impact on lung structure and function
2013, Paediatric Respiratory Reviews
Citation Excerpt :
The authors conclude that although the above association is poor, it indicates that intrauterine factors might have a role in lung growth and development. Additionally, results from other studies did not find a significant association between fetal undernutrition and lung dysfunction in adolescence and adulthood.56–59 The varying results of the above studies could be due to small sample sizes, biases associated with the retrospective collection of birth weight data, high proportion of persons lost to follow-up or lack of information on potential confounders and mediating factors that may operate through life course.
Accumulating data suggest that prenatal compromises leading to intrauterine growth restriction (IUGR) increase the risk for respiratory deficiencies after birth. In this respect, a growing body of epidemiological evidence in infants, children and adults indicates that small for gestational (SGA) birth weight can adversely affect lung function, thus questioning the widely accepted concept that IUGR accelerates lung maturation and improves outcome.
Although the mechanisms responsible for the relationship between SGA and later lung dysfunction remain poorly documented, animal data indicate that intrauterine lung development can be adversely affected by factors associated with IUGR, namely reduced substrate supply, fetal hypoxemia and hypercortisolemia. Thus, it is suggested that fetal adaptations to intrauterine undernutrition result in permanent changes in lung structure, which in turn lead to chronic airflow obstruction.
The purpose of this review is to describe and discuss the effects of IUGR on lung structure and function.
Maternal and child undernutrition: consequences for adult health and human capital
2008, The Lancet
In this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure). We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and—for women—lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain—especially after infancy—is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.
Forced vital capacity, airway obstruction and survival in a general population sample from the USA
2011, Thorax
Citation Excerpt :
Barker's early study of adult ventilatory function and birth weight reported an association between lower birth weights and lower FEV1 in adulthood but did not report an association with a reduction in FVC.22 Since then, however, in spite of a few studies reporting no association between birth weight and subsequent ventilatory function,23–25 most studies have shown that the deficit in adult lung function associated with low birth weight is a deficit in FVC as well as FEV126 27 and not in the FEV1/FVC ratio.28–33 As cardiovascular disease is also closely associated with birth weig ht,34 this may also explain the association between lung function and cardiovascular mortality.
Many studies show a link between forced expiratory volume in 1 s (FEV₁) and survival in the general population and this has been interpreted as a link between airway obstruction and survival. However, the observation that vital capacity is also associated with survival weakens this interpretation.
Data on spirometry and survival were taken from the Atherosclerosis Risk in Communities (ARIC) limited access dataset. Survival among 7489 participants with usable spirometry and complete data was regressed against measures of ventilatory function after controlling for many other factors likely to be associated with survival.
Survival was strongly associated with forced vital capacity (FVC) after adjustment for FEV₁, but not the other way round. The fully adjusted hazard ratio (HR) associated with high FVC was 0.90 in men (95% CI 0.80 to 1.00; p=0.049) and 0.82 in women (95% CI 0.70 to 0.95; p=0.01). This compares with 0.98 for FEV₁ in men (95% CI 0.90 to 1.07; p.0.72) and 1.01 in women (95% CI 0.89 to 1.15; p=0.84). There was no association between survival and airway obstruction as measured by the FEV₁/FVC ratio.
FVC but not airway obstruction predicts survival in asymptomatic adults without chronic respiratory diagnoses or persistent respiratory symptoms. The association is not explained by age, anthropometry, smoking, income occupation or blood pressure. As FVC later in life, cardiovascular risk, type II diabetes mellitus and low-grade systemic inflammation are all associated with poor fet al growth, these other conditions may be partly responsible for the poor survival in those with low FVC.
Can birth weight predict offspring’s lung function in adult age? Evidence from two Swedish birth cohorts
2022, Respiratory Research

View all citing articles on Scopus

This study was financed by the Programa Nacional de Nu' cleos de Excelencia (PRONEX), the Ministry of Health of Brazil, and the Wellcome Trust. Earlier phases of the cohort study were financed by the International Development Research Center, the World Health Organization, and Overseas Development Administration of the United Kingdom.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Clinical InvestigationsRespiratory Function in Adolescence in Relation to Low Birth Weight, Preterm Delivery, and Intrauterine Growth Restriction

Objectives

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

ACKNOWLEDGEMENT

J Pediatr

Review of the evidence on fetal and early childhood antecedents of adult chronic disease

Epidemiol Rev

Fetal origins of adult disease: the hypothesis revisited

BMJ

The beginnings of chronic airflow obstruction

BMJ Bull

Relation of birth weight and childhood respiratory infection to adult lung function and death from chronic obstructive airways disease

BMJ

Lung function in children of low birth weight

Arch Dis Child

Birth weight <1501 g and respiratory health at age 14

Arch Dis Child

Prematurity is associated with abnormal airway function in childhood

Pediatr Pulmonol

Respiratory health and lung function in 8-year-old children of very low birth weight: a cohort study

Pediatrics

Birth weight, education, environment, and lung function at school age: a community study in an alpine area

Eur Respir J

Effects of prematurity and intrauterine growth on respiratory health and lung function in childhood

BMJ

Relation of fetal growth to adult lung function in south India

Thorax

Birth weight and adult function in China

Thorax

Pulmonary function and respiratory morbidity in school-age children born prematurely and ventilated for neonatal respiratory insufficiency

Pediatr Pulmonol

Clinical Investigations
Respiratory Function in Adolescence in Relation to Low Birth Weight, Preterm Delivery, and Intrauterine Growth Restriction