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Breech presentation is associated with lower adolescent tibial bone strength

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Abstract

Summary

We compared bone outcomes in adolescents with breech and cephalic presentation. Tibia bone mineral content, density, periosteal circumference, and cross-sectional moment of inertia were lower in breech presentation, and females with breech presentation had lower hip CSA. These findings suggest that prenatal loading may exert long-lasting influences on skeletal development.

Introduction

Breech position during pregnancy is associated with reduced range of fetal movement, and with lower limb joint stresses. Breech presentation at birth is associated with lower neonatal bone mineral content (BMC) and area, but it is unknown whether these associations persist into later life.

Methods

We examined associations between presentation at onset of labor, and tibia and hip bone outcomes at age 17 years in 1971 participants (1062 females) from a UK prospective birth cohort that recruited > 15,000 pregnant women in 1991–1992. Cortical BMC, cross-sectional area (CSA) and bone mineral density (BMD), periosteal circumference, and cross-sectional moment of inertia (CSMI) were measured by peripheral quantitative computed tomography (pQCT) at 50% tibia length. Total hip BMC, bone area, BMD, and CSMI were measured by dual-energy X-ray absorptiometry (DXA).

Results

In models adjusted for sex, age, maternal education, smoking, parity, and age, singleton/multiple births, breech presentation (n = 102) was associated with lower tibial cortical BMC (− 0.14SD, 95% CI − 0.29 to 0.00), CSA (− 0.12SD, − 0.26 to 0.02), BMD (− 0.16SD, − 0.31 to − 0.01), periosteal circumference (− 0.14SD, − 0.27 to − 0.01), and CSMI (− 0.11SD, − 0.24 to 0.01). In females only, breech presentation was associated with lower hip CSA (− 0.24SD, − 0.43 to 0.00) but not with other hip outcomes. Additional adjustment for potential mediators (delivery method, birthweight, gestational age, childhood motor competence and adolescent height and body composition) did not substantially affect associations with either tibia or hip outcomes.

Conclusions

These findings suggest that prenatal skeletal loading may exert long-lasting influences on skeletal size and strength but require replication.

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Acknowledgements

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses.

Funding

The UK Medical Research Council and Wellcome (Grant ref.: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. DXA and pQCT scans were funded by Wellcome grant WT084632. A comprehensive list of ALSPAC grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). DAL works in a Unit that receives support from the UK Medical Research Council (MC_UU_00011/6) and the University of Bristol and in the Bristol National Institute for Health Research funded Biomedical Research Centre. DAL is a National Institute for Health Research Senior Investigator (NF-SI-0611-10196). Jon Tobias and Alex Ireland will serve as guarantors for the contents of this paper.

Author information

Authors and Affiliations

  1. Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

    J.H. Tobias, A. Sayers & K.C. Deere

  2. Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    A.E.P. Heazell

  3. MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK

    D.A. Lawlor

  4. Population Health Science, Bristol Medical School, Bristol University, Bristol, UK

    D.A. Lawlor

  5. Bristol NIHR Biomedical Research Centre, Bristol, UK

    D.A. Lawlor

  6. School of Healthcare Science, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, M1 5GD, UK

    A. Ireland

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  1. J.H. Tobias
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Correspondence to A. Ireland.

Ethics declarations

Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. Written informed consent was provided by parents, and young people provided written assent.

Conflicts of interest

Debbie A Lawlor declares that she has received research support from several national and international government and charitable funders, and Roche Diagnostics and Medtronic for research unrelated to that presented in this paper. Jon H Tobias, Adrian Sayers, Kevin C Deere, Alexander EP Heazell, and Alex Ireland declare that they have no conflict of interest.

No funders had any role in data collection, analyses, or interpretation of findings. This publication is the work of the authors and the opinions expressed here do not necessarily reflect those of the funders.

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Tobias, J., Sayers, A., Deere, K. et al. Breech presentation is associated with lower adolescent tibial bone strength. Osteoporos Int 30, 1423–1432 (2019). https://doi.org/10.1007/s00198-019-04945-4

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