She has been a personal trainer and yoga instructor for almost a decade and is passionate about movement and helping people lead active, healthy lives. The Human Life Cycle Stages The stages of life have been defined by cultures and religions in many ways. In ancient Greece, the human life cycle was mapped in seven-year periods.
Details of the five cohorts which have linked antenatal fetal measurements to postnatal outcomes View this table: Growth acceleration between the first and second trimesters was associated with lower FEF25—75 at 5 and 10 years but lower asthma risk at 10 years compared with persistent high growth.
Increasing AC growth between 19 and 34 weeks was also associated with lower risk for atopic wheeze. Allergy outcomes There were four papers identified.
In the SEATON cohort, fetal size for a given gestation was not associated with risk for hay fever or eczema at 10 years 16 results not presented at 5 years nor with skin prick reactivity 5 15 or 10 years When compared with persistent high growth, accelerated fetal growth size during the first and second trimesters was associated with higher eczema risk and decelerating fetal growth with lower hay fever risk at 10 years.
Obesity Obesity outcomes were reported in five studies, four from Generation R. In a second paper from Generation R, SGA for third but not second trimester EFW was associated with an increase of borderline significance in ultrasound-determined abdominal fat deposits at age 2 years 21 ; the change in EFW between the second and third trimesters was not associated with abdominal fat measurements.
There were positive associations between second but not third trimester EFW and peak weight velocity and FL and peak height velocity. Second and third trimester EFW and relative growth between these times were all positively related to BMI at adiposity peak.
In the final paper from the Generation R Cohort, first trimester size was related to total body fat at a median age of 6 years and each increase in z score in CRL was associated with a 0.
There were no associations between EFW and birth weight and skinfold thickness at 3 years of age, i.
There was also a trend which approached significance for an inverse relationship between CRL and plasma low density lipoprotein, but no association was apparent for triglycerides. Neurodevelopment There were three studies to consider neurodevelopment. Reduced relative size in HC between early and mid pregnancy was associated with higher risk for delayed fine motor development and SGA HC growth in later pregnancy with higher risk for delayed self-help abilities, gross and fine motor and language development at 12 months.
The prevalence of microcephaly i. A study from the Raine Cohort found no difference in HC at 18 weeks gestation and birth between 14 cases with ASD and 56 matched controls.
In a post hoc analysis, cases were subcategorised as multiplex autism i. When individuals were subcategorised as ASD with or without intellectual disability, the associations with EFW were similar.
Febrile seizures The Generation R Cohort team related SGA second and third trimester fetal transverse cerebellar diameter to risk for febrile seizures by 2 years of age.
Individuals in the lowest tertile of third trimester EFW, AC and FL but not HC measurements were also at higher risk for febrile seizures compared with the highest tertile. Cardiovascular outcomes Four reports considered cardiovascular outcomes.
Renal outcomes In the one paper identified, third but not second trimester HC and AC were positively associated with kidney volume at the age of 2 years. In the first of three studies from the SWS, FL measurements at 19 and 34 weeks and growth between these gestations were positively associated with bone mineral content BMC and skeletal size expressed as bone area in 4-year-olds 33 ; bone outcomes were determined by whole-body DEXA scan.
There were less convincing positive associations between AC and bone mineralisation. Femoral neck section modulus, an index of bending strength and relevant to fractures in the elderly, was determined in 6-year-olds in SWS, and increasing FL growth between 19 and 34 weeks and to a lesser degree between 11 and 19 weeks was positively associated with this outcome.
Change in EFW between 20 and 30 weeks, but not between 30 weeks and term, was also positively associated with BMD for total body. Discussion This is the first systematic review of the literature relating antenatal fetal size and growth to postnatal outcomes.
We considered a broad spectrum of postnatal outcomes since some organs pass through important developmental stages at the same gestation and an antenatal exposure at a given time might affect more than one organ.
Equally, different organs develop at different gestations and serial fetal ultrasound measurements can give insight into the developmental origins of different health outcomes.
The first main finding was that when associations were present, it was small for a given gestational age and not large that was linked to adverse outcomes with the exception of one study which found higher risk for ASD among the smallest and largest second trimester fetuses. The final important finding was that in utero growth acceleration was associated with adverse and beneficial outcomes e.
The magnitude of associations between fetal measurements and outcomes, when present, was generally modest for an individual, but these associations may be relevant to public health where small changes in risk may lead to large absolute number of individuals with incurable outcomes such as coronary artery disease, type II diabetes and asthma.
Our conclusions are based on studies from Europe, North America and Australia; this adds a limitation that the results may not be generalisable to other populations where different genetic, environmental and socioeconomic influences may be present.
We point out that causation cannot be implied from the associations we describe from the observational studies identified. The cohort members are still young; some of the associations described may resolve over time and it will be many years before follow-up will be able to link fetal measurements to outcomes such as cardiovascular disease 5 and type II diabetes.Schwimer Weinstein, LLP, is a boutique civil litigation law firm in Los Angeles that is distinguished by the experience, quality and dedication of our attorneys in the aggressive pursuit of our clients’ goals.
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