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Title: The association between impaired fetal growth and neurodevelopment in childhood
Author: Murray, Elizabeth
ISNI:       0000 0004 6346 7812
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2015
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Impaired fetal growth is associated with an increased risk of negative neurodevelopmental outcomes. The majority of research to date, however, has relied on birth weight as an index of fetal growth impairment. Furthermore, few studies have included samples from low- and middle-income countries (LMICs). The objective of this thesis was to examine the association between impaired fetal growth, using a range of birth indices, and neurodevelopment in childhood. A systematic review showed that cognitive development and attention are two domains particularly affected by impaired fetal growth and thus was the focus of this thesis. Cognitive development and attention were assessed in three large, prospective birth cohorts drawn from high-, middle- and low-income countries: Pelotas (Brazil) 2004 (N=3579), ALSPAC (UK) (N=7354) and INTERGROWTH-21st (UK, Italy, Brazil, India and Kenya) (N=1073). INTERGROWTH-21st only enrolled low-risk mothers, whereas Pelotas and ALSPAC were not selective. In all three cohorts, indices of birth weight, stunting, wasting and asymmetry were collected at birth. Attention was assessed using subscales of the Child Behaviour Checklist or the Strengths and Difficulties Questionnaire; and cognition was assessed using the Wechsler Preschool and Primary Scales of Intelligence-Revised or INTERGROWTH-21st Neurodevelopmental Assessment (INTER-NDA). Each cohort measured these outcomes at one time point (range = 2-6 years of age). As part of this thesis the INTER-NDA was validated against the Bayley Scales of Infant Development. Associations between birth anthropometric indices and both cognitive and attention outcomes were assessed using hierarchical ordinal logistic regression. Attention impairment was associated with stunted birth length (BL) but only in females (OR=1.21-1.69, p < .05), across cohorts drawn from high-, middle- and low-income countries. In contrast, cognitive impairment was associated with stunted head circumference (HC) and low ponderal index (PI) in both sexes, although predominantly in LMIC settings (HC: OR=1.73-1.91, p < .05; PI: OR=1.46-4.91, p < .05). Identification of a female-specific association between stunted BL and poor attention across cohorts from different settings, suggests the association is robust to differential confounding effects. In contrast, the stronger association in LMICs between cognitive impairment and stunted HC and low PI suggests confounding structures (e.g. maternal and neonatal health care) may modify the effect of fetal growth on cognitive development. Birth indices (specifically BL, HC and PI) may be particularly helpful in identifying children at risk of neurodevelopmental impairment for early intervention.
Supervisor: Stein, Alan ; Fernandes, Michelle Sponsor: Rhodes Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available