ESPE Abstracts

Background: Globally, 16% of infants are born with small-for-gestational-age (SGA) status. The high risks of cognitive and growth deficits in these infants are well reported; however, the potential link between SGA and mental disorders remains understudied.

Methods: We conducted a thorough search across the MEDLINE, PubMed, Embase, Web of Science, and APA PsycInfo databases, screening 4672 studies. Observational studies that met inclusion criteria for newborns with SGA or intrauterine growth restriction (IUGR) were included. Data were extracted on the development of ASD, ADHD, anxiety disorders, and depression in the postpartum period, including odds ratios (ORs). Newcastle-Ottawa Scale (NOS) was used to assess the quality and risk of bias in the included studies. Two independent assessors evaluated all studies, and fixed-effects or random-effects meta-analysis was used to synthesize the data.

Results: A total of 31 studies were included in the final analysis. Our results indicated that SGA group had higher risks of both ASD (OR = 1.15, 95% CI 1.09-1.22 P = 0.000) and ADHD (OR = 1.63, 95% CI: 1.38–1.92, P = 0.000) compared with AGA (appropriate for gestational age) group. Moreover, SGA children showed a slightly increased risk (OR=1.06, 95% CI: 1.03-1.09) of depression and a significantly higher risk (OR=1.53, 95% CI: 1.27-1.85) of anxiety in adolescents and adults. Furthermore, by performing subgroup meta-analyses based on gestational age, our analysis revealed that children born preterm and SGA had a greater risk of ASD and ADHD compared to those born full-term and SGA.

Conclusions: SGA births were associated with an elevated risk of ASD and ADHD in childhood, as well as depression and anxiety disorders in adulthood. Notably, preterm SGA infants appeared to confront more pronounced risks of mental disorders compared to full-term SGA infants. These results highlighted the significant impact of SGA on mental health, emphasizing the urgent need to focus on the mental health of SGA and to prevent SGA in order to avoid the fetal-origin of mental disorders. Registration number: CRD42023484809

Keywords: small for gestational age, ADHD, ASD, anxiety, depression, meta-analysis