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. 2025 Oct;29(10):1479-1487.
doi: 10.1007/s10995-025-04144-0. Epub 2025 Jul 19.

Social, Demographic and Health Risk Factors for Head Growth in Infants in Rural Guatemala: A Prospective Cohort Study

Amy K Connery  1   2   3 , Sylvia Becker-Dreps  4   5 , Diva M Calvimontes  6 , Yannik Roell  7 , Alison M Colbert  8   9 , Daniel Olson  8   7   10 , Edwin J Asturias  8   7   6   10 , Molly M Lamb  7   11
Affiliations

Social, Demographic and Health Risk Factors for Head Growth in Infants in Rural Guatemala: A Prospective Cohort Study

Amy K Connery et al. Matern Child Health J. 2025 Oct.

Abstract

Objectives: We explored social, demographic, and health risk factors for occipitofrontal circumference (OFC) growth in infants living in a rural, low-resource region of Guatemala.

Methods: OFC was measured at enrollment (0.1-2.9 months of age) and one year later (11.5-16.1 months of age) for 430 infants participating in a prospective cohort study conducted between 2017 and 2019. Potential predictors were collected at enrollment or were measured during the year of the study. We performed a two-stage risk factor analysis, using univariate regression modeling to identify potential risk factors, followed by multivariable regression modeling to identify independent, significant risk factors for smaller OFC at birth and 1 year in this low resource setting.

Results: Mean OFC at enrollment was -0.4 (1.2) and at 1 year was -1.1 (0.9). Probable zika exposure in utero and shorter maternal height were independently, significantly associated with smaller OFC at both enrollment and 1 year. Exposure to cigarette smoking in utero was independently significantly associated with smaller OFC at enrollment. Infant complications at birth, microcephaly at enrollment and stunting at enrollment were also independently significantly associated with smaller OFC at 1 year (all p-values < 0.05). No exposures measured during the study were associated with OFC at 1 year.

Conclusions: All the independent predictors of small OFC during the study period were present at enrollment (within the first 3 months of life), including maternal height, and smoking and ZIKV exposure during pregnancy. Exposures after the first three months of life were not predictive of OFC at one year. Continued work to identify specific risk factors and develop targeted prevention programs is warranted.

Keywords: Children; LMICs; Microcephaly; Occipitofrontal growth.

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Conflict of interest statement

Declarations. Conflicts of Interest: None. Ethical Approval: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national guidelines on human experimentation (Institutional Review Board at Baylor College of Medicine, the Colorado Multiple Institutional Review Board) and with the Helsinki Declaration of 1975, as revised in 2008, and has been approved by the institutional committees, the Institutional Review Board at Baylor College of Medicine, the Colorado Multiple Institutional Review Board, and the Ethics Review Committee of the Ministry of Public Health in Guatemala. Consent to Participate: Per local ethics committee requirements, the consent was signed by the mother if at least 18 years old or by a grandparent if the mother was 16–17 years of age. Consent for Publication: Not applicable.

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