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Bone Abstracts (2017) 6 LB8 | DOI: 10.1530/boneabs.6.LB8

ICCBH2017 Late Breaking Oral Communication Abstracts (1) (21 abstracts)

Breech presentation is associated with neonatal and early childhood deficits in bone mass and size

Alex Ireland 1 , Sarah Crozier 2 , Alexander Heazell 3 , Kate Ward 2 , Keith Godfrey 2, , Hazel Inskip 2, , Cyrus Cooper 2, & Nicholas Harvey 2

1School of Healthcare Science, Manchester Metropolitan University, Manchester, UK; 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; 3Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; 4NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; 5National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, UK.

Animal studies suggest that fetal movements are key to healthy skeletal development, but evidence in humans is limited. Breech presentation occurs in 3% of term births and is associated with reduced fetal movement and higher incidence of hip dysplasias, but more general effects on bone development have not been explored.

Offspring whole body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) at mean(SD) 6(5) days after birth in 993 individuals (513 male) from the longitudinal Southampton Women’s Survey. Of these, 41 children (20 male) had a breech presentation at birth. To examine whether group differences were evident in later childhood, total body, hip and spine bone outcomes were examined by DXA at 4.12(0.06) years of age in 1015 individuals (524 male) of whom 39 (20 male) had been breech presentation.

Adjusting for maternal parity, social class, smoking, ethnicity, and offspring age at time of scan, infants with breech presentation had 11.0g lower neonatal total body bone mineral content (BMC; 95% CI −16.0g to −5.9g, P<0.001), 18.5 cm2 lower bone area (BA; 95% CI −26.9 cm2 to −10.2 cm2, P<0.001) and 6.7g/ cm2 lower bone mineral density (BMD; 95% CI −10.1g/cm2 to −3.3g/cm2, P=0.041). At four years, in similarly adjusted models breech presentation was associated with lower hip BMC (−5.3g, 95% CI −10.3g to 0.4g, P=0.036) and BA (−0.78 cm2, 95%CI −1.40 cm2 to −0.15 cm2, P=0.015) but not BMD (P=0.466); there were no associations between breech presentation and total body or spine bone outcomes. Additional adjustment for gestational age partially attenuated associations between breech presentation and bone outcomes e.g. neonatal BA (−6.7 cm2, 95%CI −14.2 cm2 to 0.3 cm2, P=0.083) and four year hip BA (−0.61 cm2, 95%CI −1.17 cm2 to −0.04 cm2, P=0.035).

These results suggest that breech presentation is associated with lower neonatal whole body BMC, BA and BMD, and with lower hip BMC and BA at 4 years. These associations are in part explained by differences in gestational age. The associations with hip bone parameters at age 4 years correspond to the location of dysplasias found commonly in breech presentation.

Disclosure: The authors declared no competing interests.

Volume 6

8th International Conference on Children's Bone Health


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