Early childhood parent-reported speech problems in small and large for gestational age term-born and preterm-born infants: a cohort study

Cognitive and academic outcomes of large-for-gestational-age babies born at early term: A systematic review and meta-analysis

INTRODUCTION

Early induction of labor (37+0-38+6 gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term vs full term (combined or independent exposures).

MATERIAL AND METHODS

The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible.

RESULTS

Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, -0.13; 95% confidence interval, -0.21 to -0.05), but not at 38 weeks (standard mean difference, -0.04; 95% confidence interval, -0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01-0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.

CONCLUSIONS

No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.

Re-evaluating large for gestational age: differential effects on perinatal outcomes in term and premature births

Objective

Pregnancies with large-for-gestational-age (LGA) fetuses are associated with increased risks of various adverse perinatal outcomes. While existing research primarily focuses on term neonates, less is known about preterm neonates. This study aims to explore the risks of adverse maternal and neonatal perinatal outcomes associated with LGA in term neonates and neonates with different degrees of prematurity, compared to appropriate-for-gestational-age (AGA) neonates.

Methods

Using the Birth Reporting Databases (2007-2018) linked to Taiwan's National Health Insurance Research Database, we conducted a retrospective nationwide cohort study of singleton neonates delivered between 24 and 42 weeks of gestation. Based on gestational age at delivery, the enrolled neonates were classified into term (37-42 weeks of gestation), late preterm (34-36 weeks of gestation), moderate preterm (32-33 weeks of gestation), very preterm (28-31 weeks of gestation), and extremely preterm (24-27 weeks of gestation). LGA was defined by the 2013 World Health Organization (WHO) growth standard and the Taiwan growth standard. Perinatal outcomes were compared between LGA and AGA neonates across different gestational age groups.

Results

Among the 1,602,638 neonates, 44,359 were classified as LGA by the 2013 WHO growth standard. Compared to AGA neonates, LGA neonates in term and late preterm groups exhibited higher risks of primary cesarean section, prolonged labor, neonatal hypoglycemia, birth trauma, hypoxic ischemic encephalopathy, jaundice needing phototherapy, respiratory distress, neonatal intensive care unit (NICU) admission, newborn sepsis, and fetal death. However, most of these risks were not increased in moderate, very, and extremely preterm groups. Conversely, being LGA was associated with lower risks of primary cesarean section (very preterm group), jaundice needing phototherapy (moderate and very preterm groups), respiratory distress (moderate and very preterm groups), NICU admission (moderate and very preterm groups), newborn sepsis (very preterm group), retinopathy of prematurity (late, moderate, and very preterm groups), and bronchopulmonary dysplasia (very preterm group). These findings remained consistent when the Taiwan growth standard was applied.

Conclusion

Being LGA is associated with increased risks of perinatal complications in term and late preterm neonates, but not in earlier preterm groups. These findings underscore the importance of tailoring management strategies for LGA neonates to consider different degrees of prematurity.

[Neuropsychological development of large for gestational age infants at the age of 12 months]

OBJECTIVES

To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months.

METHODS

The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age.

RESULTS

After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05).

CONCLUSIONS

The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.