# The longitudinal effects of neonatal anthropometry on attention problems in males and females

## TL;DR

The study finds that male children with certain neonatal body measurements are more likely to have attention problems through adolescence, while effects in females are limited to childhood.

## Contribution

The study reveals sex-specific longitudinal relationships between neonatal anthropometry and attention problems, including quadratic associations in males.

## Key findings

- Lower birth weight and head circumference in males are linked to increased attention problems.
- Males show a U-shaped relationship between head-to-abdominal circumference ratio and attention problems.
- Females show a stronger link between head circumference and attention problems in childhood, which weakens with age.

## Abstract

The longitudinal impact of fetal growth on attention problems in males and females is unclear. This study aims to evaluate the impact of fetal growth assessed by neonatal anthropometry throughout childhood and adolescence in males and females separately.

We compared neonatal anthropometry (birth weight (BW), head circumference (HC), proportion of optimal birthweight (POBW)) and asymmetry (head‐to‐abdominal circumference ratio (HC/AC) and ponderal index (PI)) at birth with parental assessment of the child behavior checklist attention‐problem syndrome (CBCL‐AP) raw score measured at ages five, eight, 10, 14 and 17. We used univariable and multivariable linear mixed‐effects modeling. Sensitivity analyses included excluding pre‐term births, teacher ratings and treating the CBCL‐AP as an ordinal variable.

In males, a 1‐SD lower BW, increased CBCL‐AP by 0.234 (95%CI [−0.422, −0.0497]). In males, a 1‐SD lower HC increased CBCL‐AP by 0.316 (95%CI [0.495, 0.133]). In males, there was a U‐shaped relationship between HC/AC and CBCL‐AP throughout childhood and adolescence; a curvilinear relationship was observed between POBW and CBCL‐AP. In females, a 1 SD lower HC increased CBCL‐AP 0.424 (95%CI [0.726, 0.133]), but every increased year of age reduced the effect by 0.027 (95% CI: 0.006–0.05). In females, there was no clear relationship between BW, POBW or HC/AC and CBCL‐AP. In males and females, PI was not significantly associated with CBCL‐AP. The exclusion of pre‐term births and analysis of teacher‐rated attention problems was consistent with the primary results.

Using a longitudinal design, our study suggests a male vulnerability to attention problems throughout childhood and adolescence from neonatal anthropometry. The relationships in females appear to be limited to childhood.

Previous studies have demonstrated sex differences in the relationship between neonatal anthropometry and increased attention problems. Our study demonstrates that the nature of this relationship ‐ quadratic versus linear ‐ varies according to the anthropometric measure used and that the impact of increasing age on these effects differ in males and females.