Table 1.2b.
LGA, high birth weight, and long-term outcomes—cognitive performance.
| Author, year, country | Study design | Cases | Outcomes (risk estimates) | Reference group (weight) | Comments/adjustments | Risk of bias | Directness | Precision |
|---|---|---|---|---|---|---|---|---|
| Original articles n = 21 | ||||||||
| Alati et al. (2009), Australia (98) | • Cohort • 4,971 |
• Social problems Quintile 5 (highest birth weight): OR 1.57 (95% CI 1.12–2.20) • Anxious/depressive symptoms Quintile 5: OR 1.1 (95% CI 0.80–1.51) |
Quintile 3 | Adjustments: parity and child age, socio-economic position, maternal alcohol and tobacco use, maternal anxiety and depression in pregnancy | Moderate | Good | Good | |
| Bergvall et al. (2006), Sweden (108) | • Cohort • 357,768 |
35,821 | Risk of low intellectual performance: birth weight (SDS) more than 2: OR 0.98 (95% CI 0.90–1.06) | Birth weight (SDS) −2 to +2 | Adjustments: gestational age, mothers age and parity, socioeconomic factors (household socioeconomic status, education, family structure) | Moderate | Good | Good |
| Buschgens (2009), The Netherlands (97) | • Cohort • 2,230 |
• Birth weight >4,500 g • Inattention (TCP**p < 0.01); • Hyperactivity/impulsivity (TCP p < 0.01) • Aggression (CBCL*** <0.05; TCP < 0.01) • Delinquency (TCP < 0.01) |
2,500–4,500 g | Multiple linear regression analyses, for each separate (standardized) variable | Low | Good | Good | |
| Dawes et al. (2015), UK (114) | • UK Biobank resource • 18,819 |
For hearing, vision, reaction time and IQ, the middle category had significantly better performance than both the low and high categories (both p < 0.001) | The top and bottom 3% by birth weight were compared with the middle 3% (centered on the 50th percentile) | An ANOVA model was applied, hearing, vision, and cognition as the dependent variable and group (bottom, middle, or top 3% of the distribution) as the independent variable in the model, with the covariates age, sex, Townsend deprivation index quintile, educational level, smoking, diabetes, cardiovascular disease, hypertension, high cholesterol, and maternal smoking | Serious | Poor | Fair | |
| Duffy et al. (2020), USA (113) | • Cohort • 108,348 |
• Children born LGA • Did not meet proficiency on mathematics ARR 0.96 (95% CI 0.92–0.99) • Did not meet proficiency on English language or arts ARR 0.97 (95% CI 0.95–0.99) • Referred for special education ARR 0.98 (95% CI 0.94–1.03) |
AGA | Adjustments: maternal ethnicity, age, education, nativity, marital status, Medicaid status, parity, maternal obesity, pre-gestational or gestational diabetes, tobacco, alcohol, or drug during pregnancy, excessive weight gain during pregnancy, infant gender, and year of birth | Moderate | Good | Good | |
| Eide et al. (2007), Norway (109) | Cohort 317,761 | 4,912 | Large infants (z-score birth weight >3.00) had a slightly elevated risk of low intelligence score (OR 1.22, 95% CI 1.00–1.48) | z-score −0.49 to 0.50 | Adjustments: maternal age, maternal education, parity, adult height, BMI The gestational age–specific z-score (SD above or below the mean of birth weight was calculated using Norwegian population standards) | Moderate | Good | Good |
| Flensborg-Madsen and Mortensen (2017), Denmark (112) | Cohort 4,696 | • Standardized intelligence score • Birth weight >4,000 g • At the age 19 years • mean difference 1.35 (95% CI −0.83 to 3.52), 28 years −0.03 (−4.05 to 4.00), 50 years 2.90 (−0.35 to 6.14) |
3,001–3,500 g | Adjustments: infant sex, infant socioeconomic status, mother's age at birth, birth order, mother's smoking in last trimester, gestational age | Moderate | Good | Good | |
| Haglund and Källen (2011), Sweden (94) | • Case–control • 68,964 |
250 | • Both autism and Asperger: LGA vs. adequate weight for gestational age OR 0.3 (95% CI 0–1.9) • Any obstetrical risk factor (prematurity, low Apgar scores, growth restriction, or macrosomia) • Autism with mental retardation, AOR 1.3 (95% CI 0.3–2.2) • Autism without cognitive impairment AOR 3.1 (95% CI 1.7–5.7) |
2,500–4,000 g | Adjusted for year of birth, maternal age 40 years or older, primiparity, maternal birth outside Sweden, and gender | Moderate | Fair | Good |
| Kristensen et al. (2014), Norway (111) | • Cohort • 217,746 |
• The crude mean IQ score • Birth weights of ≥5,000 g was 1.2 points (95% CI 0.3–2.2) lower |
4,000–4,499 g | In the multivariable analysis included gestational age, year of birth, birth order, sibship size, mother's and father's ages at child's birth, mother's marital status, highest parental educational level, father's income level. Mean sibship birth weight, maximum sibship birth weight, and fraternal relatedness were added to the random-effects model | Moderate | Good | Good | |
| Leonard et al. (2008), Australia (95) | Cohort 219,877 | 2,625 | • Mild-moderate ID (>4,500 g) OR 1.10 (95% CI 0.75–1.61) • Severe ID: OR 1.29 (95% CI 0.40–4.10); ID with autism spectrum disorder: OR 1.66 (95% CI 0.60–4.56) • Caucasian infants with excess intrauterine growth (percentage of optimal birth weight 124) were more likely to be diagnosed with ID associated with autism spectrum disorder OR 2.36 (95% CI 0.93–6.03) |
3,000–3,499 g | Adjustments: marital status, maternal country at birth, health insurance status, paternal occupation, geographic remoteness, socioeconomic well-being | Moderate | Good | Good |
| Lundgren et al. (2003), Sweden (110) | Cohort 620,834 | • Risk for subnormal intellectual performance: • High birth weight (>2 SDS) according to the BMI groups at young adulthood: normal BMI (18.5–24.9) OR 0.92 (95% CI 0.87–0.98), BMI 25–29.9 OR 1.33 (95% CI 1.20–1.48), BMI >30 OR 1.86 (1.58–2.19) |
Subjects born at term with normal birth weight | Adjusted for gestational age, low Apgar score, head circumference SDS at birth, height SDS at conscription and parental education | Moderate | Good | Good | |
| Moore et al. (2012), USA (96) | Cohort 5,979,605 | 20,206 | • Risk of autism: • Term LGA (95th percentile) infants 39–41 weeks AOR, 1.16 (95% CI 1.08–1.26) Preterm LGA infants 23–31 weeks AOR, 0.45 (95% CI 0.21–0.95) |
Subjects born with birth weight AGA | Adjusted for maternal age, race, hypertension, pre-eclampsia, diabetes, birth order, twin gestation, and months since last live birth | Moderate | Good | Good |
| Power et al. (2006), UK (107) | • Cohort • 13,980 |
• For 1 kg increase in birth weight, 7-year mathematics z-score increased 0.23 (0.19 adjusted for parental interest in child's progress) and adult qualifications increased 0.22 (on a 5-point scale) • Mean z-scores for math (>4,000): • boys 0.10, girls 0.14 |
Adjustments for gender, gestational age (32–44 weeks), exact age of test and for parental interest in child's progress | Moderate | Good | Good | ||
| Record et al. (1969), UK (103) | Cohort 41,543 | • Mean verbal reasoning scores of first-born children (40–41 weeks of gestation) • Birth weight 2,000–2,400: 96.9–98.9 • Birth weight 3,000–3,400: 102.1–104.2 • Birth weight 4,000–4,400: 104.3–105.3 |
Results reported according to sex, duration of gestation, birth order | Moderate | Poor | Good | ||
| Richards et al. (2001), UK (105) | Cohort 3,900 | • Birth weight was associated with cognitive ability at age 8 (with an estimated SD score of 0.44 (95% CI 0.28–0.59)) between the lowest and highest birth weight categories • At age 43 high birth weight (4,010–5,000) vs. normal birth weight • Standardized cognitive score: • Verbal memory −0.17 (−0.31 to −0.04) • Search accuracy 0.02 (−0.11 to 0.16) • Search speed −0.07 (−0.21 to 0.07) |
3,010–3,500 g | Adjusted for sex, father's social class, mother's education, birth order, and mother's age. From age 11 to age 43, each cognitive score was further adjusted for the score of previous age | Moderate | Good | Good | |
| Räikkonen et al. (2013), Finland (106) | Cohort 931 | The whole cohort | Men who were born larger were more likely to perform better in the Finnish Defense Forces Basic Intellectual Ability Test over time [1.22–1.43 increase in odds to remain in the top relative to the lower two thirds in ability over time per each SD increase in body size (95% CI 1.04–1.79)] | • No specific mention of birth weight categories • Adjustments: gestational age, mother's age, height and parity; social class in childhood; history of breast feeding; education; diagnosis of diseases |
Low | Good | Good | |
| Sörensen et al. (1997), Denmark (104) | • Cohort • 4,300 |
• The Boerge Piren test (validated intelligence test) increased from 39.9 at a birth weight of ≥2,500 g to 44.6 at a birth weight of 4,200 g. • Above a birth weight of 4,200 g the test score decreased slightly |
Adjusted for gestational age, length at birth, maternal age and parity, marital status, and employment | Moderate | Good | Good | ||
| Tamai (2020), Japan (101) | Cohort 36,321 | • At 2.5 years: • Unable to walk ARR 7.1 (95% CI 1.0–5.9) • Unable to say meaningful words ARR 10 (95% CI 3.8–26) • Unable to compose two-phrase sentence ARR 3.5 (95% CI 1.9–6.3) • Unable to say his/her name ARR 1.9 (95% CI 1.2–3) • Unable to use a spoon ARR 4.8 (95% CI 1.9–12.3) • All differences disappeared at 5.5 years of age • However not for LGA >3 SD |
• −1.28 to 1.28 SD • Normal birth weight |
Adjustments: parity, singleton, gender, maternal age, maternal smoking, maternal and paternal education level | Moderate | Good | Fair | |
| van Mil et al. (2015), The Netherlands (100) | • Cohort • 6,015 |
• Risk of attention problems in children born with high birth weight percentile β (95% CI): • The attention problems subscale of the CBCL/1.5–5*** • >90th percentile 0.05 (−0.02 to 0.12) p value 0.17 • >80th percentile 0.01 (−0.07 to 0.04), p = 0.61 |
Subjects born with birth weight AGA | Adjusted for Apgar score 1 minute after birth, mode of delivery, maternal age, national origin, educational level, parity, BMI, psychological symptoms, smoking, alcohol use, folic acid supplementation use, gestational diabetes, pre-eclampsia | Moderate | Good | Good | |
| Yang et al. (2019), China (99) | Cohort 9,295 | 724 | • Behavioral problems • Macrosomia (n = 268) OR 1.61 (95% CI 1.16–2.22) |
Normal and low birth weight | Adjustments: age, sex | Serious | Poor | Good |
| Zhang et al. (2020), China (102) | Cohort | 4,026 | • Gross motor DQ ARC 0.49 (95% CI 0.36–0.63) • Fine motor DQ ARC −2.73 (95% CI −2.87 to −2.59) • Adaptability DQ ARC −1.19 (95% CI −1.33 to −1.05) • Language DQ ARC 0.43 (95% CI 0.29–0.57) • Social behavior DQ ARC 1.10 (95% CI 0.95–1.24) • Overall no clear differences |
Normal birth weight | Adjustments: maternal smoking, gender of infant, mode of delivery, neonatal asphyxia, birth length, gestational week, educational level of parent | Moderate | Fair | Fair |
**
Teacher's Checklist of Psychopathology.
***
Child Behavior Checklist.
AGA, appropriate for gestational age; AOR, adjusted odds ratio; ARC, adjusted regression coefficient; ARR, adjusted relative risk; BMI, body mass index; CBCL, The Child Behavior Checklist; DQ, development quotient; ID, intellectual disability; IQ, intelligence quotient; LGA, large for gestational age; NA, not available; OR, odds ratio; SDS, standard deviation score; TCP, The Teacher's Checklist of Psychopathology.