Abstract
The relationship between health status at birth and short-term health has been established; however, the relationship with long-term health remains unclear, particularly in Japan. This study investigates the effect of birth weight on child development using data from the Longitudinal Survey of Newborns in the twenty-firstst Century—a nationwide birth cohort study conducted by the Ministry of Health, Labour and Welfare. We employ twin fixed-effects estimation to examine the effects of birth weight on physical development, using measures including weight, height, percentage of overweight indexes, and hospitalization, with a focus on how the effects vary with age up to 12 years. The results show that for all ages, lower birth weight negatively affects body size but does not affect probability of hospitalization or overweight/underweight status, indicating a limited impact. However, lower birth weight shows larger adverse effects on body size and the probability of hospitalization when the sample is limited to birth weight < 2300 g compared with the full sample, suggesting the importance of considering heterogeneity. Japanese public policy for perinatal care may have contributed to this limited impact of birth weight. Additional care aimed at preventing low birth weight and greater focus on smaller babies would be more beneficial.
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The World Health Organization defines an infant weighing less than 2500 g at birth as a low birth weight baby. In Japan, more than 65% of twins are low birth weight, compared with 7% for singletons.
It is not clear how the difference in birth weight between twins is determined; the most common determinants of twin birth weight differences are the location in the uterus and the size of the placenta (Victoria, Mora, and Arias 2001). Since these are considered to be determined at random, we consider the difference in birth weight exogenous. However, when the birth weight difference is large, we cannot deny the possibility that one fetus had a congenital disorder. Therefore, we repeated our analyses using only twin pairs whose birth weight differences is less than 500 g and obtained similar results.
The Childbirth and Childcare Lump-sum Grant covers the delivery cost for health insurance holders; accordingly, essentially everyone in Japan has universal health insurance (Japan Health Insurance Association webpage).
Medical Care Benefits for Premature Babies is a system that bears the medical expenses necessary for the hospitalization and medical treatment, at a designated medical institution, of a premature baby for whom a doctor recognizes the need for medical attention (Ministry of Health, Labour and Welfare webpage).
Newborn baby (up to 4 months old) home visits by midwives and community healthcare workers (nurses in the case of Japan) are carried out by most local governments. Moreover, municipalities are obligated to provide medical checkups for 1.5-year-old and 3-year-old children (Ministry of Health, Labour and Welfare webpage). These examinations are, basically, available free of charge.
In Japan, each municipality provides medical expenses for children. The age of children eligible for the grant and whether there are income restrictions differ depending on the municipality. Currently, most municipalities provide grants for hospitalized children of at least 12 years of age, which is the target age of this study.
Percentage of overweight (%) = [(measured weight—standard weight)/standard weight] × 100. The criterion for overweight is POW \(\ge\) 20% and for underweight is POW − \(\le\)20% and the normal range is between − 20% and 20%. POW is a common indicator of obesity and underweight in Japan. This indicator is used not only in the medical field but also in schools. Dobashi (2015) argues that the POW method is more appropriate than BMI for school-aged children because there is no set standard value for BMI, which changes during growth. For the average child, 20% POW is equivalent to 90th BMI%.
We also use Kaup’s and Rohrer’s indexes to measure overweight and underweight. Kaup’s index (= weight (kg) ÷ height (m)2) is used for infants, and Rohrer’s index (= weight (kg) ÷ height (m)3 × 10) is used for school-aged children. Since the standard value of Kaup’s and Rohrer’s indexes change depending on the age, it is not appropriate to analyze the effect of each age. Therefore, we report the results obtained using Kaup’s and Rohrer’s indexes as supplementary material.
If both twins are overweight or underweight, the dummy variable takes 0.
Previous studies have reported that low birth weight increases BMI and the probability of developing metabolic syndrome in adulthood (Desai, Beall, and Ross 2013; Valsamakis, Kanaka-Gantenbein, Malamitsi-Puchner, and Mastorakos 2006). However, Hirschler, Bugna, Roque, Gilligan, and Gonzalez (2008) reported that low birth weight is not associated with the probability of being overweight among elementary school children. The effect of low birth weight is likely to differ between childhood and adulthood; thus, we cannot exclude potential effects of low birth weight during adulthood.
Similar results are obtained when we use the Kaup’s and Rohrer’s indexes instead of POW to capture overweight and underweight.
In twin pairs of the opposite sex, female weights are often lower than male weights.
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Acknowledgements
The authors wish to thank Dr. Noguchi and the anonymous reviewers for helpful comments on earlier version of this paper. This work was supported by a JSPS KAKENHI Grant-in-Aid for Young Scientists (B) (No.15K17082) and Early-Career Scientists (No. 19K13704).
Funding
This work was supported by a JSPS KAKENHI Grant-in-Aid for Young Scientists (B) (No. 15K17082) and Early-Career Scientists (No. 19K13704).
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Nakayama, M., Matsushima, M. Age-related changes in the effect of birth weight on child development: findings from a Japanese Longitudinal Survey. JER 74, 177–197 (2023). https://doi.org/10.1007/s42973-021-00073-z
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DOI: https://doi.org/10.1007/s42973-021-00073-z