The Longitudinal Impact of Fetal Malnutrition on the Anthropometric Growth of Young Children in Leyte, the Philippines

Poor intrauterine growth has long-term implications for child growth and nutritional status. Fetal malnutrition (FM) is a type of poor intrauterine growth defined by the presence of soft tissue wasting at birth and is identified using the Clinical Assessment of Nutritional Status Score (CANSCORE) tool, independent of gestational age. There is limited evidence evaluating FM as a predictor of longitudinal growth and nutritional status in young children. In this longitudinal birth cohort in Leyte, the Philippines, mother-infant dyads were enroled, and infants were followed for 24 months after delivery. Infants were evaluated using CANSCORE within 48 h of birth by a trained midwife, and FM was defined as CANSCORE < 25. Weight and length were measured at birth, 1-, 6-, 12-, 18- and 24-month visits. Weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z scores were determined using WHO Anthro. Associations between FM and anthropometric z scores were assessed using multivariable linear regression, adjusting for maternal body mass index (BMI), family socioeconomic status (SES) and child's sex. Among N = 246 infants included for analysis, 8 (3%) were classified with FM at birth. Despite limited power, FM was significantly associated with reduced WAZ, LAZ and WLZ at nearly all timepoints in the fully adjusted models. CANSCORE is a user-friendly tool for assessing FM in areas with limited equipment and predicted that newborns with FM were at continued risk for undernutrition and growth stunting until age 24 months. Identification of FM at birth provides opportunities for targeted early nutrition interventions for high-risk infants.