Introduced in , ultrasound is the most widely used diagnostic modality today. Ultrasound in orthodontics has been used as diagnostic tool for the dynamic functional analysis of the tongue [ 7 - 10 ] and temporomandibular joint dysfunction [ 11 ] and for the measurement of muscle thickness. Orthodontics includes the study of the growth of the face which cannot be studied without understanding body growth.
In the past, various methods such as a bimetric test, vital staining, radioisotopes, implants, natural markers, and anthropometric measurements have been used to measure growth. The aim of this study is to evaluate overall body proportion and cephalocaudal growth gradient at different stages using ultrasound.
This study included subjects reporting to the department of obstetrics and gynecology of our university hospital for routine antenatal checkups. The purpose of the study and protocol was explained to the patients and informed consent was obtained before the study. Normal singleton pregnancy with no maternal medical diseases at the time of gestation was included as the subjects. A fetus with congenital anomalies, twin pregnancy, oligohydramnios, and intrauterine growth restriction was excluded from the study.
Ten subjects were followed up for the study. All the subjects were examined by a single examiner. Transabdominal ultrasound was performed using a GE logic P3 ultrasound machine with 4 MHz convex probe. The imaging system provided conventional two-dimensional ultrasonographic images, generated within seconds.
Images were captured and stored. Both established and new parameters were used for the study. New parameters used to assess cephalocaudal growth and overall body proportions were defined and standardized. New parameters added in the study were 1 head to chin H-C , 2 neck to hip N-H , 3 hip to knee H-K , 4 knee to foot K-F , 5 shoulder to elbow, and 6 elbow to wrist. Anthropometric measurements of neonates were evaluated within 24 h of birth obtained by an infantometer, calibrated electronic weighing scale, nonstretchable tape, and with a flexible scale.
This is the distance between the parietal eminences [ Figure 1a ] which was measured from the outer edge of the nearerparietal bone to the inner edge of the more distant parietal bone. OFD was measured in a plane perpendicular to BPD between the anterior edge of the frontal bone and the outer border of the occiput [ 6 , 23 , 26 ] [ Figure 2a ]. To measure HC [ Figure 3a ], the correct plane of a section is the third ventricle and thalamus in the central portion of the brain.
This is the linear distance between the ossifi ed portions of the femur [ Figure 4 ]. Then, the cursor is placed properly at the correct endpoints of the bone. A normal body ratio can be correlated using FL. AC can be measured ultrasonographically at the position where the transverse diameter of the liver is largest and both the right and left portal veins are continuous with one another. Many formulae and nomograms have been developed for the estimation of fetal weight.
The predicted growth at birth was compared with the actual birth weight [ Figure 6 ] after EFW was adjusted adding average growth for each day between the last scan and delivery. The deviation between predicted birth weight and actual birth weight was considered as the estimating error, which was calculated on the basis of the following formula: [ 30 - 32 ]. H-C is the linear distance between the head and the chin [ Figure 7a and b ].
To measure this, one end of the cursor was placed at the vertex the highest point on the head and the other end on the inferior portion of the chin. A midcoronal plane was taken for the measurement.
N-H is the linear distance measured between the first cervical vertebra and the last vertebra [ Figure 8a and b ]. Since the vertebral column is not straight, curvilinear measurements were taken in segments [ Figure 8a ]. As the gestational age increases, an N-H measurement recorded at two planes.
The measurements were then added together. All the above-mentioned parameters were measured at the 20 th , 28 th , 32 nd , 36 th weeks of pregnancy and also at birth. New parameters were derived for measuring cephalocaudal growth. Body proportions were measured and compared. A cephalocaudal growth gradient was calculated and compared at different intervals.
Data were recorded at different intervals of the fetal period and at birth. Microsoft Excel was used to compile the data. Mean and standard deviations of each parameter were calculated. Based on the sphericity, Greenhouse-Geisser comparison test was used within the subjects.
Measurements were taken at different intervals of pregnancy and also at birth are listed in Table 1. The per day growth of the fetus is calculated and presented in Table 2. The growth rate of EFW was at maximum between the 28 th and 32 nd week of the fetal life Cephalocaudal growth gradient decreased from 20 th week 0.
The growth of all the parameters at birth was predicted and compared with the actual growth. The percentage error between two is calculated and listed in Table 5. H-C, a new parameter used in this study, can be compared with H-C measurement at birth with the percentage error of 0. The assessment of growth is important for treatment planning and timing of orthodontic therapy.
Although many studies have been conducted in the past to understand the relationship between prenatal and postnatal growth, no study has been conducted to date using ultrasound in orthodontics. Six established parameters and six new parameters were used to evaluate prenatal growth.
These parameters were used as indicators and predictors to evaluate growth [ Table 2 and 3 ]. The per day growth of the fetus was evaluated using all the parameters. All analyses were carried out for males and females separately with the use of SAS software version 8. In regression analysis, effect size can be defined as the absolute change in SD units in the outcome variable per 1-SD change in a predictor Effect size is a useful concept both for presenting results and for performing power analyses.
Although 2 predictors, such as BL and L 2y , have the same units, it is difficult to compare relative effects directly from the variables estimated changes in the outcome per 1-unit change in the predictor from the model because their SDs differ eg, 1 SD for males: BL, 2. Expressing effects in SD units eliminates this problem. Furthermore, using effect size allowed us to compare not only effects on the same outcome of predictors with similar units but different SDs eg, BL compared with L 2y but also effects on the same outcome of predictors with different units eg, length compared with head circumference or even effects on different outcomes eg, effects on adult height compared with effects on FFM.
In power analysis, effect sizes of magnitudes 0. The characteristics of the study participants are summarized in Table 2. The males and the females were equally stunted and did not differ significantly in any variable during early childhood. Age at follow-up was between 21 and 27 y for both the males and the females. The subjects who were excluded from the analysis 41 males and 48 females did not differ significantly from our analytic population males and females in size at birth, at 2 y of age, and during adulthood; in factors in early childhood gestational age, maternal height, and socioeconomic status during childhood ; in factors during adulthood age at follow-up, physical activity, residency, and smoking status ; and in the percentage of males data not shown.
Subjects who had imputed L 2y data 15 males and 10 females also did not differ significantly from those with measured L 2y males and females in any of the variables selected data not shown. Results are presented in 2 parts: 1 associations of growth during early childhood with adult body size and composition and 2 relative contributions of the prenatal and postnatal components. Selected characteristics by sex of subjects in 4 Guatemalan villages who were studied at birth and during childhood and adulthood 1.
There were no significant differences between the males and the females in early childhood variables and age at follow-up. The absolute changes in adult body size and composition associated with sample-specific, 1-SD increments in growth during early childhood indicated by L 2y or during the prenatal period indicated by BW, BL, and ponderal index are presented in Table 3.
The corresponding effect sizes are shown in Table 4. Absolute changes in adult body size and composition per sample-specific 1-SD increments in size at 2 y of age or at birth 1. Adjusted for socioeconomic status during early childhood, maternal height, and gestational age. Adjusted for socioeconomic status during early childhood, maternal height, gestational age, age at follow-up, physical activity, smoking status, and residency. Effect sizes for adult body size and composition per sample-specific 1-SD increments in size at birth or at 2 y of age 1.
Corresponding relations between BW or BL and these adult measures were also positive, but not all of these relations were significant. The effect sizes of BW and BL were similar in magnitude. Ponderal index was not a significant predictor of any outcome presented. Specific absolute changes in adult outcomes associated with sample-specific 1-SD increments in prenatal BL or postnatal residual components are presented in Table 5.
For adult height, weight, and FFM, both the prenatal and postnatal components had positive, medium effect sizes in both the males and the females. Absolute changes in adult body size and composition per sample-specific 1-SD increments in prenatal or postnatal 0—2 y of age components 1. Sample-specific SDs were as follows: prenatal component birth length , 2. Height was adjusted for socioeconomic status during early childhood, maternal height, and gestational age.
All other adult outcome variables were adjusted for socioeconomic status during early childhood, maternal height, gestational age, age at follow-up, physical activity, smoking, and residency. Findings from the comparisons of adult body size and composition between the 4 groups categorized by BL and postnatal increment in length [SS, SL, LS, and LL the reference group ] are shown in Table 6.
Effects of size at birth and of growth during early childhood 0—2 y of age on adult body size and composition 1. The analyses described above were also carried out by using only nonimputed data subjects; data not shown.
The results were similar in both direction and magnitude to those obtained with subjects, including 25 for whom values were imputed. The current study used follow-up data from —, when all the subjects were adults.
Therefore, no adjustment for maturity was required, which was not the case in the previous follow-up study of —, when many of the subjects were adolescents However, we did adjust for dietary and lifestyle factors that are known to influence adult body composition. The current study also used more appropriate methods and statistical techniques than were used in the previous study First, the recently revised CDC Growth Charts 26 were used to characterize growth in this study.
These charts are considered more appropriate because they were developed on the basis of recently available comprehensive national data and improved statistical procedures Third, compared with the analyses in the earlier study, the analyses in the current study were based on linear regression with BW and BL as continuous variables, which increased statistical power. Finally, we used two-stage least-squares analyses to appropriately evaluate the relative contribution of prenatal and postnatal growth to adult outcomes.
The findings from the current study about the importance of stunting in early childhood for adult body size and composition are consistent with those of the previous follow-up study Stunting resulted from growth retardation in utero and during the first 2 y after birth. Our study suggests that a 1-SD increment in L 2y 3. Correspondingly, the effect sizes were around 0.
Our results do not show that retardation in length during early childhood increases fatness later in life, as some have reported 20 , 34 — Rather, our findings suggest that subjects, particularly females, who are growth retarded during early childhood are thinner as adults.
Among children with better growth in early childhood, the possible tradeoffs between increased fatness and increased height and FFM in adulthood need to be considered.
This is more of an issue among women. In the current study, the effects of growth during early childhood on adult fatness were greater and more consistent among the women than among the men. The tradeoff for women would pit the health risks of overweight against the benefits of greater stature and FFM for reproductive outcomes. In addition, survival to adulthood, which is enhanced by greater growth during early childhood, needs to be considered We also found that the prenatal and postnatal first 2 y of life periods are equally important for adult height, weight, and FFM and that these effects are of medium size.
Among the men, only the postnatal component showed these associations with fatness. In other words, the prenatal component had no effect on fatness in the men.
Our findings suggest that growth retardation during gestation and the first 2 y of life has powerful influences on adult body size and composition. The men who were below the median in growth in length during both the prenatal and postnatal periods ie, the SS group were 9 cm shorter and 6. For the women, the corresponding differences were 5 cm in height, These differences are very large and are likely to have important functional implications.
All of the difference in weight between the men who were growth retarded during gestation and early childhood and those who were not was accounted for by FFM, whereas in the women, the difference was attributable to both FFM and FM. On the basis of the work edited by Barker 21 , one would predict greater fatness in subjects with consistently poor growth during prenatal and postnatal periods or with poor prenatal growth and good postnatal growth than in those with consistently good growth the SS or SL group compared with the LL group, Table 6.
However, we found no differences among the males in either comparison but less fatness among the females in the SS and SL groups than in the LL group. Our findings support the notion that in countries where maternal and child malnutrition are common, pregnant women and young children should be the priority groups for program targeting and interventions.
We are grateful to the Guatemalan participants in this study for their cooperation and to Morgen Hickey for her contribution to data management. This article is an extension and refinement of previous work performed by a group led by RM. There are many studies on the relationship between child anthropometry and cognition and schooling.
To properly assess the relative importance of growth during specific periods and thus identify critical windows for cognitive development, one must generate uncorrelated measures of growth for the analyses. Another problem is that not all studies controlled for confounding using such variables as socioeconomic status and parental education; this is necessary because family characteristics predict deficits in both growth and cognition.
After selecting articles with appropriate methods, a recent review 1 concluded that. The study's contributions include the identification of sensitive windows for development using cohort data, methods that rely on appropriate statistical techniques, and control for confounding.
Breast-fed infants aged 4 to 6 months were randomly assigned to receive daily oral supplementation of iron, zinc, iron plus zinc, or a placebo for 6 months. Details of the original study are provided elsewhere. The intervention had no impact on IQ at follow-up. Raw scores from each subtest were transformed to the scaled scores and then to the age-adjusted full-scale, verbal, and performance IQ scores according to the Thai norms.
The nonverbal Raven's Colored Progressive Matrices RCPM; Pearson 6 were also performed; the raw scores for all items were summed, and the total score was used in the analysis. The tests were performed in a quiet environment.
All children received a snack and milk before the administration of the test. Weight, length, and head circumference HC at birth and at the beginning age range, 3. Methods of measurement are given elsewhere.
Thus, only weight and length at birth were used. The z scores for age were generated for weight, height, and HC based on the World Health Organization growth standard for children 0 to 5 years old. Sociodemographic data the child's age and sex, the mother's educational level, the availability of the mother at home, household socioeconomic status, and the location of the school were obtained using a pretested questionnaire.
The mother's educational level was categorized as 1 ie, lower than or equal to grade 6 or 2 ie, higher than grade 6. The location of the school was coded as urban or rural. Standardized household socioeconomic status scores were generated using principal component analysis.
The mother's height was measured during recruitment ie, when the child was an infant. Statistical analyses were performed using SAS for Windows version 9. An independent t test or an analysis of variance with the Tukey post hoc test was used to assess differences in the main outcomes by sociodemographic variables. Ordinary least squares regression analyses were performed to assess associations between growth measures and outcomes, adjusting for sociodemographic variables and maternal height.
The growth measures used in the regressions were standard deviation scores, obtained by subtracting individual measurements by the mean of that measurement and then dividing by its standard deviation. Prenatal growth was defined as size at birth. Infancy was partitioned into early infancy growth from birth to 4 months and late infancy growth from 4 months to 1 year.
Late postnatal growth was defined as growth from 1 to 9 years. Multiple-stage least squares analyses were used to assess associations between growth and intellectual functioning at 9 years, as done in a study 12 that assessed the relative importance of prenatal and postnatal growth on women's educational achievement.
A 4-stage least squares analysis was used to estimate the effect of prenatal growth and the independent effects of early infancy, late infancy, and late postnatal growth. First, size at 4 months was modeled on birth size to estimate predicted size at 4 months. Then, the residual, interpreted to represent early infancy growth R1 , was calculated by subtracting the predicted size from the observed size at 4 months.
Then, size at 1 year was modeled on size at birth and the R1 to obtain the predicted size at 1 year of age. As before, the late infancy residual R2 was calculated by subtracting the predicted size at 1 year from the observed size.
Finally, size at 9 years was modeled on birth size, R1, and R2 to generate the predicted size at 9 years. The third residual, R3, was calculated by subtracting the predicted size at 9 years from the observed size.
By design, birth size and all residuals were uncorrelated with each other. Only HC measurements at 4 months, 1 year, and 9 years were included in the analysis.
The mean age of the children at follow-up was 9. The percentage of boys and the percentage of girls were similar. The mean SD birth weight was 3. There were no differences in outcomes by supplementation group at infancy. Full-scale and verbal IQ scores were higher for children of better educated mothers, and verbal IQ scores were higher in children whose mothers were available at home, compared with all other children.
All outcomes were significantly higher for children of better socioeconomic status and whose schools were located in urban areas.
In a 4-stage least squares analysis, a 1 SD gain in early infancy weight was associated with increased scores of 1. During Pregnancy. A schedule of visits may involve seeing your doctor: every month in the first six months you are pregnant every two weeks in the seventh and eighth months you are pregnant every week during your ninth month of pregnancy During these visits, your doctor will check your health and the health of your baby.
Your doctor may also offer special classes at different stages of your pregnancy. These classes will: discuss what to expect when you are pregnant prepare you for the birth teach you basic skills for caring for your baby If your pregnancy is considered high risk because of your age or health conditions, you may require more frequent visits and special care. Postpartum Care. Getting Enough Rest Rest is crucial for new mothers who need to rebuild their strength.
You may experience: vaginal soreness f you had a tear during delivery urination problems like pain or a frequent urge to urinate discharge, including small blood clots contractions during the first few days after delivery Schedule a checkup with your doctor about six weeks after delivery to discuss symptoms and receive proper treatment.
The Takeaway. Parenthood Pregnancy Pregnancy Health. Complications During Pregnancy and Delivery. Read this next. Medically reviewed by Debra Rose Wilson, Ph. Medically reviewed by Fernando Mariz, MD.
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