Birth status, child growth, and adult outcomes in low- and middle-income countries.
Stein AD., Barros FC., Bhargava SK., Hao W., Horta BL., Lee N., Kuzawa CW., Martorell R., Ramji S., Stein A., Richter L., Consortium of Health-Orientated Research in Transitioning Societies (COHORTS) investigators None.
OBJECTIVE: To assess the impact of being born preterm or small for gestational age (SGA) on several adult outcomes. STUDY DESIGN: We analyzed data for 4518 adult participants in 5 birth cohorts from Brazil, Guatemala, India, the Philippines, and South Africa. RESULTS: In the study population, 12.8% of males and 11.9% of females were born preterm, and 26.8% of males and 22.4% of females were born term but SGA. Adults born preterm were 1.11 cm shorter (95% CI, 0.57-1.65 cm), and those born term but SGA were 2.35 cm shorter (95% CI, 1.93-2.77 cm) compared with those born at term and appropriate size for gestational age. Blood pressure and blood glucose level did not differ by birth category. Compared with those born term and at appropriate size for gestational age, schooling attainment was 0.44 years lower (95% CI, 0.17-0.71 years) in those born preterm and 0.41 years lower (95% CI, 0.20-0.62 years) in those born term but SGA. CONCLUSION: Being born preterm or term but SGA is associated with persistent deficits in adult height and schooling, but is not related to blood pressure or blood glucose level in low- and middle-income settings. Increased postnatal growth is associated with gains in height and schooling regardless of birth status, but not with increases in blood pressure or blood glucose level.