Maternal Smoking During Pregnancy and Offspring Head Growth in Comparison to Height and Weight Growth Up to 6 Years of Age: A Longitudinal Study.

BACKGROUND: Maternal smoking during pregnancy causes fetal growth retardation. Thereafter, it has been associated with excessive childhood weight gain and decreased linear growth in the offspring. However, it is not known whether head circumference (HC), the surrogate of brain size in childhood, is altered after intrauterine tobacco exposure. We assessed the association of maternal smoking during pregnancy with offspring HC growth up to age 6 years in comparison with length/height growth and weight gain. METHODS: We combined data from Medical Birth Register and longitudinal growth data from primary care of 43,632 children (born 2004-2017). Linear mixed effects models were used for modeling, adjusting for potential perinatal and socioeconomic confounders. RESULTS: At birth, maternal smoking during pregnancy was associated with a mean deficit of 0.19 standard deviation score (SDS) (95% CI: -0.25, -0.12) in HC, -0.38 SDS (95% CI: -0.43, -0.32) in length, and -0.08 SDS (95% CI:-0.14, -0.02) in weight-for-length. HC in smokers' children failed to catch up to that of non-smokers' children. Height of smokers' infants reached that of non-smokers' infants by 12 months but declined thereafter. Weight-for-height of smokers' infants exceeded the level of non-smokers' infants at 3 months and remained significantly elevated thereafter. HC in the offspring of mothers who quit smoking in the first trimester was not deficient, but their weight-for-height was elevated. CONCLUSION: HC of smokers' children is still deficient at age 6 years. Since most of the head growth occurs during the first 2 years of life, the defect may be permanent. In smokers' children, weight gain was excessive up to 6 years and height was deficient at 6 years consistent with previous literature. Efforts should be made to encourage pregnant women to quit smoking in the beginning of the pregnancy.

Screening of hydrocephalus in infants using either WHO or population-based head circumference reference charts.

AIM: The aim was to compare the performances of the World Health Organization (WHO) and population-based (PB) references in the screening for hydrocephalus in infants aged <2 years. METHODS: We collected 341 longitudinal head circumference (HC) measurements of hydrocephalic infants and 120 181 measurements of 15 145 healthy infants from primary care. The measurements were converted into z-scores, and a new screening parameter, change in HC standard deviation score (SDS) over time (ΔHC SDS), was calculated. Comparisons were made using receiver operating characteristics analysis and linear mixed models. RESULTS: The mean HC SDSWHO was 3.5 and the mean HC SDSPB was 2.9 in the hydrocephalic infants, and in healthy children, those numbers were 1.0 SDSWHO and 0 SDSPB , respectively. The best screening accuracy was obtained with the PB reference in combination with the ΔHC SDS parameter (AUC 0.89). The accuracy of the WHO standard could be improved to a similar level by customising the screening cut-offs of HC SDS according to the population and combining screening parameters. CONCLUSIONS: Auxology alone was not sufficient for the screening of hydrocephalus. The WHO standard should be validated in the population, and population-specific cut-offs for normality defined before its introduction.

Elevated head circumference-to-height ratio is an early and frequent feature in children with neurofibromatosis type 1.

BACKGROUND/AIMS: Children with neurofibromatosis type 1 (NF1) tend to be macrocephalic and short. Our aim was to define the incidence and diagnostic accuracy of elevated head circumference-to-height ratio (HCHR) in children with NF1 and to assess if elevated HCHR would facilitate early diagnosis of NF1. METHODS: Retrospective analysis of growth and health data of 80 NF1 patients aged 0-7 years was performed. The incidence and diagnostic accuracy of elevated HCHR for NF1 was analyzed using receiver operating characteristic curves. RESULTS: The median age when the first elevated (≥2.0 SDS) HCHR value was detected was 0.3 years (range 0.0-5.3). At the median age of diagnosis (3.6 years), 53.8% of NF1 children exhibited elevated HCHR. The diagnostic accuracy of HCHR alone was 0.78 (95% CI 0.72-0.84), but in comparison with the seven National Institutes of Health diagnostic criteria for NF1, elevated HCHR was the second most prevalent feature. CONCLUSION: Elevated HCHR is an early and frequent feature in NF1 children. Taking HCHR into account would facilitate the early detection of NF1.