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Are small-for-gestational-age preterm infants at increased risk of overweight? Statistical pitfalls in overadjusting for body size measures

Journal of Perinatology volume 41, pages 1845–1851 (2021)Cite this article

Subjects

Abstract

Objective

The objective of this study is to analyze the effect of adjusting for body measures on the association between small for gestational age (SGA) and overweight at 3 years.

Study design

Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). Logistic regression was used, to adjust for confounders with additional adjustments separately for weight and height at 21 months. Marginal structural models (MSMs) estimated the direct effect of SGA on overweight.

Results

The crude and adjusted for confounders models yielded null associations between SGA and overweight. Adjusting for height yielded a positive association (odds ratio (OR): 2.31, 95% CI: 0.52–10.26) and adjusting for weight provided a significantly positive association (OR: 6.60, 95% CI: 1.10–37.14). The MSMs, with height and weight held constant, provided no evidence for a direct effect of SGA on overweight (OR: 0.83, 95% CI: 0.14–5.01, OR: 0.71, 95% CI: 0.18–2.81, respectively).

Conclusion

Adjusting for body measures can change the association between SGA and overweight, providing spurious estimates.

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Authors and Affiliations

  1. Department of Community Health Sciences, O’Brien Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Seham Elmrayed, Amy Metcalfe, Darren Brenner, Krista Wollny & Tanis R. Fenton

  2. Nutrition Services, Alberta Health Services, Calgary, AB, Canada

    Tanis R. Fenton

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Correspondence to Seham Elmrayed.

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Ethics approval was granted by the University of Calgary Conjoint and the former Regina Qu’Appelle Health Region Health Research Ethics Boards. This study was performed in accordance with the Declaration of Helsinki.

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The parents had signed informed consent for their child’s data to be used in research.

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Elmrayed, S., Metcalfe, A., Brenner, D. et al. Are small-for-gestational-age preterm infants at increased risk of overweight? Statistical pitfalls in overadjusting for body size measures. J Perinatol 41, 1845–1851 (2021). https://doi.org/10.1038/s41372-021-01050-5

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