Placental insufficiency and markers of fetal growth are associated with longitudinal infant growth and body composition trajectories up to two years of age

Abstract

Placental insufficiency affects fetal nutrition and growth. We describe two-year anthropometric and body composition trajectories in term-born South African infants with/without placental insufficiency, and early-life predictors thereof. Eighty-one infants were screened for placental insufficiency at 28-34 weeks’ gestation using Doppler-derived umbilical artery resistance index (UmA-RI). At eight postnatal time points, z-scores were calculated for weight-for-age (WAZ), length-for-age (LAZ), weight-for-length (WLZ), BMI-for-age (BMIZ), and mid-upper arm circumference-for-age (MUACZ). Fat-free mass (FFM) and fat mass (FM) were assessed using deuterium dilution, and z-scores calculated for FM-for-age (FMZ), FFM-for-age (FFMZ), FM index-for-age (FMIZ), and FFM index-for-age (FFMIZ). Latent class trajectory modelling identified characteristic growth trajectories, and multivariable logistic models investigated predictors of growth trajectories. Three trajectory classes were identified for WAZ, LAZ, WLZ, BMIZ, and FFMZ, and two for MUACZ, FMZ, FMIZ, and FFMIZ. In multivariable analysis, lower birth weight z-score (BWZ) was associated with lower trajectories for WAZ (OR:9.32(95%CI:2.32-37.50)), WLZ (OR:2.95(95%CI:1.33-6.55)), BMIZ (OR:3.70(95%CI:1.56-9.09)), FMZ (OR:2.78(95%CI:1.37-5.55)), and FFMZ (OR:2.63(95%CI:1.45-4.76)). Higher (more abnormal) UmA-RI was associated with lower trajectories for LAZ (OR:1.95(95%CI:1.15-3.30) and FFMZ (OR:1.78(95%CI:1.13-2.80)). Thus, while BWZ predicts WAZ, WLZ, BMIZ, FMZ and FFMZ trajectories, UmA-RI predicts LAZ and FFMZ. Routine UmA-RI screening could identify fetuses at increased risk of later stunting.