PEDIATRICS Vol. 86 No. 1 July 1990, pp. 18-26
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Determinants of Fetal Growth and Body Proportionality

Michael S. Kramer MD1, Marielle Olivier BSc1, Frances H. McLean BScN1, Geoffrey E. Dougherty MD1, Diana M. Willis MD1, and Robert H. Usher MD1

1 From the Departments of Pediatrics, Epidemiology and Biostatistics, and Obstetrics and Gynecology, McGill University Faculty of Medicine, Montreal, Quebec, Canada

Previous studies of fetal growth and body proportionality have been based on error-prone gestational age estimates and on inappropriate comparisons of infants with dissimilar birth weights. Based on a cohort of 8719 infants with validated (by early ultrasonography) gestational ages and indexes of body proportionality standardized for birth weight, potential maternal and fetal determinants of fetal growth and proportionality were assessed. Maternal history of previous low birth weight infants, pregnancy-related hypertension (particularly if severe), diabetes, prepregnancy weight, net gestational weight gain, cigarette smoking, height, parity, and fetal sex were all significantly associated with fetal growth in the expected directions. Consistent with previous reports, maternal age, marital status, and onset or total amount of prenatal care had no significant independent effects. Fetal growth ratio (relative weight for gestational age), pregnancy-related hypertension, fetal sex, and maternal height were the only significant determinants of proportionality. Infants who were growth-retarded, those with taller mothers, those whose mothers had severe pregnancy-related hypertension, and males tended to be longer and thinner and had larger heads for their weight, although these variables explained only a small fraction of the variance in the proportionality measures. Among infants with intrauterine growth retardation, gestational age was not independently associated with proportionality (in particular, late term and postterm infants did not tend to be more disproportional), a finding that does not support the hypothesis that earlier onset of growth retardation leads to more proportional growth retardation. The results raise serious questions about previous studies of proportionality, particularly those suggesting a nutritional etiology for proportional intrauterine growth retardation. They also emphasize the importance of controlling for degree of growth retardation, maternal stature, and pregnancy-related hypertension in evaluating the prognostic consequences of proportionality for mortality, morbidity, and functional performance.

Key Words: fetal growth • intrauterine growth retardation • body proportionality

Submitted on February 13, 1989
Accepted on June 14, 1989




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