Breech presentation is associated with lower bone mass and area: findings from the Southampton Women’s Survey



We compared bone outcomes in children with breech and cephalic presentation at delivery. Neonatal whole-body bone mineral content (BMC) and area were lower in children with breech presentation. At 4 years, no differences in whole-body or spine measures were found, but hip BMC and area were lower after breech presentation.


Breech presentation is associated with altered joint shape and hip dysplasias, but effects on bone mineral content (BMC), area (BA) and density (BMD) are unknown.


In the prospective Southampton Women’s Survey mother-offspring cohort, whole-body bone outcomes were measured using dual-energy X-ray absorptiometry (DXA) in 1430 offspring, as neonates (mean age 6 days, n = 965, 39 with a breech presentation at birth) and/or at age 4.1 years (n = 999, 39 breech). Hip and spine bone outcomes were also measured at age 4 years.


Neonates with breech presentation had 4.2 g lower whole-body BMC (95% CI −7.4 to − 0.9 g, P = 0.012) and 5.9 cm2 lower BA (− 10.8 to − 1.0 cm2, P = 0.019), but BMD was similar between groups (mean difference − 0.007, − 0.016 to 0.002 g/cm2, P = 0.146) adjusting for sex, maternal smoking, gestational diabetes, mode of delivery, social class, parity, ethnicity, age at scan, birthweight, gestational age and crown-heel length. There were no associations between breech presentation and whole-body outcomes at age 4 years, but, in similarly adjusted models, regional DXA (not available in infants) showed that breech presentation was associated with lower hip BMC (− 0.51, − 0.98 to − 0.04 g, P = 0.034) and BA (− 0.67, − 1.28 to − 0.07 cm2, P = 0.03) but not with BMD (− 0.009, − 0.029 to 0.012 g, P = 0.408), or spine outcomes.


These results suggest that breech presentation is associated with lower neonatal whole-body BMC and BA, which may relate to altered prenatal loading in babies occupying a breech position; these differences did not persist into later childhood. Modest differences in 4-year hip BMC and BA require further investigation.

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KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (as an NIHR Senior Investigator (NF-SI-0515-10042) and through the NIHR Southampton Biomedical Research Centre) and the European Union’s Erasmus+ Capacity-Building ENeASEA Project. The work was supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), projects EarlyNutrition and ODIN under grant agreement numbers 289346 and 613977, and the ALPHABET project [an award made through the ERA-Net on Biomarkers for Nutrition and Health (ERA HDHL)], Horizon 2020 grant agreement number 696295 (UK component: BBSRC: BB/P028179/1). HMI is supported by the UK Medical Research Council (MC_UU_12011.4). This work was supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Nestec and NIHR Biomedical Research Centre, University of Oxford.

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Correspondence to N. C. Harvey.

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The study was approved by Southampton and Southwest Hampshire Local Research Ethics Committee (approval numbers 267/97, 307/97, 153/99 and 005/03/t) and parental informed consent was given at both scan timepoints.

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Ireland, A., Crozier, S.R., Heazell, A.E.P. et al. Breech presentation is associated with lower bone mass and area: findings from the Southampton Women’s Survey. Osteoporos Int 29, 2275–2281 (2018).

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  • Bone mass
  • Epidemiology
  • Foetal growth
  • Osteoporosis
  • Pregnancy