The Impact of Prenatal Alcohol Exposure on Longitudinal Growth, Nutritional Status, and Insulin-Like Growth Factor 1 in Early Childhood in Leyte, the Philippines

Abstract

Objective: To assess the impact and potential mechanistic pathways of prenatal alcohol exposure (PAE) on longitudinal growth and nutritional status in early childhood.

Study design: A cohort of 296 mother-infant dyads (32% with PAE vs 68% unexposed) were recruited in Leyte, the Philippines, and followed from early gestation through 24 months of age. PAE was assessed using serum phosphatidylethanol (PEth) captured twice prenatally and in cord blood and supplemented with self-reported alcohol consumption. Linear mixed models were used to examine longitudinal effects of PAE on growth from birth through 2 years including key potential mediating factors (placental histopathology, and infant serum leptin and Insulin-like Growth Factor 1 [IGF-1]).

Results: After adjusting for potential confounders, we found that PAE was significantly associated with a delayed blunting of linear growth trajectories (height-for-age z-score, body length) and weight (weight-for-age z-score, body weight) that manifested between 4 and 6 months and continued through 12-24 months. PAE was also associated with a decreased rate of mid-upper-arm circumference growth from birth to 12 months, and a lower mean IGF-1 levels at birth and 6 months.

Conclusion: This study demonstrates a delayed impact of PAE on growth that manifested around 6 months of age, underscoring the importance of routine clinical monitoring in early childhood. Furthermore, the findings supported prior animal model findings that suggest a mechanistic role for IGF-1 in PAE-induced growth delay.

Keywords: IGF-1 in early childhood; growth; prenatal alcohol.

Figure 1.

Adjusted linear mixed model marginal plots of predicted mean height estimates over time by exposure group (+/− shaded 95% confidence limits). (A) Predictive Mean Height-for-Age z-score (HAZ) over 12-months, and (B) 24-months. (C) Predictive Mean Body Length (cm) over 12-months, and (D) 24-months.

Figure 2.

Adjusted linear mixed model marginal plots of predicted mean weight estimates over time by exposure group (+/− shaded 95% confidence limits). (A) Predictive Mean Weight-for-Age z-score (WAZ) over 12-months, and (B) 24-months. (C) Predictive Mean Body Weight (kg) over 12-months, and (D) 24-months.