530 - Maternal IGF-1 and folate status at 34-wk gestation are positively associated with crown rump length at 24 months in participants of the Women First trial in Pakistan, Guatemala and India.

Poster Number: 530
Publication Number: 530.318

Kinzie L. Matz, University of Colorado School of Medicine, Aurora, CO, United States; Gabrielle Glime, University of Colorado School of Medicine, Aurora, CO, United States; Jennifer F. Kemp, University of Colorado School of Medicine, Aurora, CO, United States; Jamie Westcott, University of Colorado School of Medicine, Aurora, CO, United States; Shivaprasad S. Goudar, KLE Academy of Higher Education and Research J N Medical College Belgaum India, Belgaum, Karnataka, India; Ana L. Garces, INCAP, Guatemala, Alta Verapaz, Guatemala; Lester F. Figueroa, University of Colorado School of Medicine, Guatemala, Chimaltenango, Guatemala; Sarah Saleem, Aga Khan University, Karachi, Sindh, Pakistan; Sumera Aziz, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Manjunath S. Somannavar, KLE Academy of Higher Education and Research's J N Medical College, Belgaum, Karnataka, India; Minghua Tang, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, United States; kenneth m. hambidge, University of Colorado School of Medicine, DENVER, CO, United States; Nancy F. Krebs, University of Colorado School of Medicine, Aurora, CO, United States

Background: Measurements of crown rump length (CRL), or truncal growth, in the postnatal period are limited. With stunting, leg length (LL) is thought to be the more nutritionally responsive component of height; thus it is of interest to compare LL to CRL. Maternal folate status has been reported to impact CRL at 24 mo; it and other maternal biomarkers may also impact CRL:LL.

Objective: To examine the effect of maternal IGF-1 and folate status at 34-wk gestation on infant CRL and LL at 24-mo in the Women First Preconception Maternal Nutrition trial (WF).

Design/Methods: The WF trial is a randomized, longitudinal, non-masked, 3-armed intervention of a comprehensive nutritional supplement commencing at least 3 mo prior to pregnancy (Arm 1), at ~12 wk gestation (Arm 2), or not at all (Arm 3). For this report, participants from three of four WF research sites (Guatemala, India, Pakistan) are included; maternal Arm 3 data from India were unavailable. Child length and CRL measurements were obtained at age 24 mo and used to calculate LL (length-CRL) and CRL:LL ratio. At 34-wk gestation maternal serum folate was measured using a chemiluminescence immunoassay and IGF-1 by ELISA. Linear regression was used to model the relationship between IGF-1 and folate status, CRL, and CRL:LL, controlling for maternal BMI, height, parity, socioeconomic status, site, and arm. Analyses were completed using GraphPad Prism 9.

Results: Data from 725 maternal-child dyads (Guatemala n=275, India n=162, Pakistan n=288) with 34-wk maternal biomarkers and 24 mo child anthropometry were used for statistical analyses. Anthropometric data did not vary by arm within sites and were combined for subsequent analysis. Statistically significant differences (p < 0.005) among all three sites were observed in CRL:LL, however CRL was significantly different only in Pakistan (Table). In the combined sites, higher maternal folate (p < 0.0001) and IGF-1 (p < 0.05) were associated with longer CRL but not CRL:LL, suggesting that the maternal biomarkers affected CRL and LL proportionately.Conclusion(s): These findings from low and middle-income countries suggest a role of maternal folate and IGF-1 status at 34-wk gestation in postpartum linear growth, aligning with previous data from a well-nourished population. The findings suggest persistence of gestational influences on postnatal linear growth and may reflect fetal programming effects. Examination of both CRL and LL in studies of early childhood stunting may better inform impact of nutritional interventions.
Table: Crown-rump length (CRL) and CRL:leg length (LL) ratio of children from the Women First Maternal Preconception Nutrition Trial at 24 mo of age.Data presented as mean ± SD; Different superscripts within a row indicates statistically significantly difference at p < 0.0001