Small for gestational age is associated with reduced lung function in middle age: A prospective study from first to fifth decade of life

Melvin Tandra; E Haydn Walters; Jennifer Perret; Adrian J Lowe; Caroline J Lodge; David P Johns; Paul S Thomas; Gayan Bowatte; Peter G Davis; Michael J Abramson; Shyamali C Dharmage; Dinh S Bui

doi:10.1111/resp.14379

Small for gestational age is associated with reduced lung function in middle age: A prospective study from first to fifth decade of life

Respirology. 2023 Feb;28(2):159-165. doi: 10.1111/resp.14379. Epub 2022 Oct 5.

Authors

Melvin Tandra¹, E Haydn Walters^{1

2}, Jennifer Perret¹, Adrian J Lowe¹, Caroline J Lodge¹, David P Johns^{1

2}, Paul S Thomas³, Gayan Bowatte^{1

4}, Peter G Davis^{5

6}, Michael J Abramson⁷, Shyamali C Dharmage^#¹, Dinh S Bui^#¹

Affiliations

¹ Allergy and Lung Health Unit, School of Population and Global health, The University of Melbourne, Melbourne, Victoria, Australia.
² School of Medicine and Menzies Institute, University of Tasmania, Hobart, Tasmania, Australia.
³ Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.
⁵ Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
⁶ Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
⁷ School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

^# Contributed equally.

Abstract

Background and objective: The association between birth weight, particularly relative to gestational age, and adult lung function is uncertain. We investigated the associations between birth weight relative to gestational age and measures of lung function in middle age, and mediation of these associations by adult height.

Methods: Participants in the Tasmanian Longitudinal Health Study who had both known birth weight and lung function assessment at age 45 years were included (n = 849). Linear regression models were fitted to investigate the association between small for gestational age and birth weight with post-bronchodilator lung function measures (forced expiratory volume in 1 second [FEV₁ ], forced vital capacity [FVC], FEV₁ /FVC, diffusing capacity for carbon monoxide [D_L co], residual volume [RV] and total lung capacity [TLC]), adjusting for potential confounders. The contribution of adult height as a mediator of these associations was investigated.

Results: Compared with infants born with normal weight for gestational age, those born small for gestational age had reduced FEV₁ (coefficient: -191 ml [95%CI: -296, -87]), FVC (-205 ml [-330, -81]), TLC (-292 ml [-492, -92]), RV (-126 ml [-253, 0]) and D_L co (-0.42 mmol/min/kPa [-0.79, -0.041]) at age 45 years. However, they had comparable FEV₁ /FVC. For every 1 kg increase in birth weight, lung function indices increased by an average of 117 ml (95%CI: 40, 196) for FEV₁ , 124 ml (30, 218) for FVC, 215 ml (66, 365) for TLC and 0.36 mmol/min/kPa (0.11, 0.62) for D_L co, independent of gestational age, but again not for FEV₁ /FVC. These associations were significantly mediated by adult height (56%-90%).

Conclusion: Small for gestational age was associated with reduced lung function that is likely due to smaller lungs with little evidence of any specific parenchymal impairment.

Keywords: Tasmanian Longitudinal Health Study; adult lung function deficit; low birth weight; restriction; small for gestational age; spirometry.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Birth Weight
Forced Expiratory Volume
Gestational Age
Humans
Infant
Infant, Newborn
Infant, Newborn, Diseases*
Lung*
Middle Aged
Prospective Studies
Spirometry
Vital Capacity