Social, Demographic and Health Risk Factors for Head Growth in Infants in Rural Guatemala: A Prospective Cohort Study.

OBJECTIVES

We explored social, demographic, and health risk factors for occipitofrontal circumference (OFC) growth in infants living in a rural, low-resource region of Guatemala.

METHODS

OFC was measured at enrollment (0.1-2.9 months of age) and one year later (11.5-16.1 months of age) for 430 infants participating in a prospective cohort study conducted between 2017 and 2019. Potential predictors were collected at enrollment or were measured during the year of the study. We performed a two-stage risk factor analysis, using univariate regression modeling to identify potential risk factors, followed by multivariable regression modeling to identify independent, significant risk factors for smaller OFC at birth and 1 year in this low resource setting.

RESULTS

Mean OFC at enrollment was -0.4 (1.2) and at 1 year was -1.1 (0.9). Probable zika exposure in utero and shorter maternal height were independently, significantly associated with smaller OFC at both enrollment and 1 year. Exposure to cigarette smoking in utero was independently significantly associated with smaller OFC at enrollment. Infant complications at birth, microcephaly at enrollment and stunting at enrollment were also independently significantly associated with smaller OFC at 1 year (all p-values < 0.05). No exposures measured during the study were associated with OFC at 1 year.

CONCLUSIONS

All the independent predictors of small OFC during the study period were present at enrollment (within the first 3 months of life), including maternal height, and smoking and ZIKV exposure during pregnancy. Exposures after the first three months of life were not predictive of OFC at one year. Continued work to identify specific risk factors and develop targeted prevention programs is warranted.