Ultrasound measurements during the third trimester predict height and stunting at 1 y of age among Vietnamese children
Authors: Casanova Ines Gonzalez , Nguyen Phuong , Young Melissa F. , Ford Nicole D , Nguyen Hieu , Pham Hoa , Truong Truong V , Truong Son V , Ramakrishnan Usha 
Published: November 2023

Early childhood growth faltering is a major public health problem associated with negative short‐and long‐term health and development outcomes. The use of ultrasound technology (US) represents an opportunity for early detection and intervention. The objective of this analysis was to assess if US measurements performed during the second and third trimester of pregnancy predicted child height and stunting at 1 y of age.We used prospective data from women participating in a randomized controlled trial of preconception micronutrient supplementation (PRECONCEPT) in Vietnam (n=1137). Inclusion criteria were having at least one US measurement during the second (n=712) or third trimester (n=798) of pregnancy, singleton birth, and child anthropometric information available at 1 y. Fetal measurements were performed during routine prenatal visits using a portable US machine. US measurements included head circumference, biparietal diameter, abdominal circumference, and femur length which were converted into Z‐scores relative to the INTERGROWTH 21st reference (Zac, Zbp, Zfl, and Zhc respectively). Small for gestational age (SGA) was defined as birth weight below the 10th percentile. Recumbent length was measured at the 1 y postnatal visit and converted into Height for Age Z‐scores (HAZ) relative to the WHO Child Growth Standards and stunting was defined as HAZ < 2 SD. We used multivariate regression models to examine associations between US measurements and stunting/HAZ at 1 y. All models were controlled for socioeconomic status, maternal height, child sex and child age. Results were also stratified by SGA to test if US predictive value was independent of SGA.Mean HAZ at 1 y was −0.85 ± 1.05, and the prevalence of stunting was 13.4%; there were no significant differences by sex. US measurements obtained during the second trimester of pregnancy did not predict HAZ or stunting at 1 y. However, all US measurements obtained during the third trimester were positively associated with HAZ at 1 y. A 1 standard deviation (SD) increase in US z‐scores was associated with 0.12–0.14 SD increase in HAZ (Zac=0.12±0.02; Zbp=0.12±0.03; Zfl=0.14±0.02; Zhc=0.14±0.03, p<0.001). Moreover, all third trimester measurements were also inversely associated with stunting (odds ratios (95% confidence intervals): Zac= 0.76 (0.64–0.91); Zbp =0.81 (0.67–0.97); Zfl= 0.75(0.64–0.88); Zhc=0.82, (0.69–0.98), p<0.05). The prevalence of SGA in this sample was of 15.9%. The association of third trimester US measurements remained unchanged when the sample was restricted to non‐SGA children, indicating the information provided by prenatal measurements was independent of SGA status.In conclusion, US measures could be useful predictors of child growth through 1 y. Prenatal detection of children at risk of growth faltering can contribute to timely implementation of interventions to promote child growth.Support or Funding InformationFunded by the Mathile Institute for the Advancement of Human Nutrition, the Micronutrient Initiative, and Nestle Foundation.