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Low birth weight and elevated head-to-abdominal circumference ratio are associated with elevated fetal glycated serum protein concentrations

Li, Jiana; Wang, Zi-Nenga; Schlemm, Ludwigc,d; Pfab, Thiemod,e; Xiao, Xiao-Mina; Chen, You-Pengb; Hocher, Bertholdc,d,e,*

doi: 10.1097/HJH.0b013e328349a2e6
Original papers: Epidemiology

Objective To analyze the association between low birth weight, head-to-abdominal circumference ratio, and insulin resistance in early life.

Method and results Glycated serum proteins (GSPs) were quantified at delivery in 612 Chinese mother/child pairs serving as a surrogate of maternal and fetal glycemia. Differential ultrasound examination of the fetal's body (head circumference, biparietal diameter, pectoral diameter, abdominal circumference, and femur length) was done in average 1 week prior to delivery. Multivariable regression analysis considering gestational age at delivery, the child's sex, maternal BMI, maternal age at delivery, maternal body weight, and pregnancy-induced hypertension revealed that fetal GSP was inversely associated with birth weight (R 2 = 0.416; P < 0.001). Fetal GSP was furthermore positively associated with the head-to-abdominal circumference ratio, whereas the maternal GSP was negatively correlated with the offspring's head-to-abdominal circumference ratio (R 2 = 0.285; P = 0.010 and R 2 = 0.261; P = 0.020, respectively). The increased head-to-abdominal circumference ratio in newborns with higher fetal GSP is mainly due to a reduced abdominal circumference rather than reduced growth of the brain.

Conclusion The disproportional intrauterine growth is in line with the concept of so-called brain sparing, a mechanism maintaining the intrauterine growth of the brain at the expense of trunk growth. Our data suggest that the low birth weight phenotype, linked to cardiovascular diseases like hypertension in later life, might be a phenotype of disproportional intrauterine growth retardation and early life insulin resistance.

aDepartment of Obstetrics and Gynecology

bDepartment of Infectious Diseases, First Affiliated Hospital of Jinan University, Guangzhou, China

cInstitute of Nutritional Science, University of Potsdam, Potsdam

dCenter for Cardiovascular Research, Institute of Pharmacology

eDepartment of Internal Medicine/Nephrology (UKBF), Berlin, Germany

*For Asia and especially China readers, the corresponding author is Dr. You-Peng Chen; E-mail:

Correspondence to Professor Berthold Hocher, MD, PhD, Institute of Nutritional Science, University of Potsdam, D-14558 Nuthetal, Potsdam, Germany E-mail:

Abbreviations: GSP, glycated serum protein; IUGR, intrauterine growth retardation; TGH, total glycated hemoglobin

Received 10 March, 2011

Revised 30 May, 2011

Accepted 7 June, 2011

© 2011 Lippincott Williams & Wilkins, Inc.