Association between umbilical cord arterial pH and neurodevelopment of offspring at the age of 3 years: The Japan environment and Children's study.

Abstract

Objective: To evaluate the association between umbilical cord pH at birth and neurodevelopment in 3-year-old offspring.

Methods: In this prospective cohort study, we identified 71 680 term deliveries in Japanese women recruited to the Japan Environment and Children's Study (JECS) between January 2011 and March 2014. Data on singleton pregnancies involving live-term births between 2011 and 2014 were extracted from the JECS database. Participants were stratified into umbilical cord artery pH (UmA-pH) quintiles (G1: pH ≥7.30 and G5: pH <7.00) and sex. G1 acted as a reference for the multiple logistic regression model used to estimate the effect of UmA-pH on impaired neurodevelopment at 3 years of age using the Age and Stages Questionnaire, third edition. The main outcome measure was neurodevelopmental state of 3-year-old children.

Results: We obtained 71 680 maternal and neonatal paired records (36 499 male and 35 181 female offspring). This study found that male offspring in the G5 group had an increased risk of communication, gross motor, and fine motor skill impairments. The adjusted odds ratios (aOR) for G5 male offspring were 2.60 (95% confidence interval [CI] 1.23-5.53), 4.22 (95% CI 2.17-8.20), and 1.94 (95% CI 1.00-3.76) for communication, gross motor, and fine motor skills impairment, respectively. The aOR for G5 female offspring was 4.15 (95% CI 1.27-13.61) for social skills impairment.

Conclusion: Low UmA-pH, less than 7.00, was associated with neurodevelopmental outcomes in the offspring, and sex differences were observed, indicating the need for individual follow up of newborns with low UmA-pH.