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Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).

Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).
Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration).
Background

Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low-income and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. We aimed to examine both child and adult outcomes in five LMICs.

Methods

In this prospective study, we pooled data from COHORTS (Consortium for Health Orientated Research in Transitioning Societies)—a collaboration of five birth cohorts from LMICs (Brazil, Guatemala, India, the Philippines, and South Africa), in which mothers were recruited before or during pregnancy, and the children followed up to adulthood. We examined associations between maternal age and offspring birthweight, gestational age at birth, height-for-age and weight-for-height Z scores in childhood, attained schooling, and adult height, body composition (body-mass index, waist circumference, fat, and lean mass), and cardiometabolic risk factors (blood pressure and fasting plasma glucose concentration), along with binary variables derived from these. Analyses were unadjusted and adjusted for maternal socioeconomic status, height and parity, and breastfeeding duration.

Findings

We obtained data for 22?188 mothers from the five cohorts, enrolment into which took place at various times between 1969 and 1989. Data for maternal age and at least one outcome were available for 19?403 offspring (87%). In unadjusted analyses, younger (?19 years) and older (?35 years) maternal age were associated with lower birthweight, gestational age, child nutritional status, and schooling. After adjustment, associations with younger maternal age remained for low birthweight (odds ratio [OR] 1·18 (95% CI 1·02–1·36)], preterm birth (1·26 [1·03–1·53]), 2-year stunting (1·46 [1·25–1·70]), and failure to complete secondary schooling (1·38 [1·18–1·62]) compared with mothers aged 20–24 years. After adjustment, older maternal age remained associated with increased risk of preterm birth (OR 1·33 [95% CI 1·05–1·67]), but children of older mothers had less 2-year stunting (0·64 [0·54–0·77]) and failure to complete secondary schooling (0·59 [0·48–0·71]) than did those with mothers aged 20–24 years. Offspring of both younger and older mothers had higher adult fasting glucose concentrations (roughly 0·05 mmol/L).

Interpretation

Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.

Funding

Wellcome Trust and the Bill & Melinda Gates Foundation.
2214-109X
e366-e377
Fall, C.H.
7171a105-34f5-4131-89d7-1aa639893b18
Sachdev, H.S.
9c9c8153-4c13-4e32-a1e9-798872efe4cb
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Restrepo-Mendez, M.C.
2615e963-d7af-47eb-9a11-82a5c5d002a8
Victora, C.
461fb18b-0688-4971-b1df-3ef9f4c3d809
Martorell, R.
9ee73323-0528-4eff-93e3-c96fb1067356
Stein, A.D.
9120fff8-4ef6-4c07-a69f-ebe55dcb1243
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Tandon, N.
22a63117-5ee8-4c6b-9db6-0f696755d50f
Adair, L.
77c37ed0-84f6-4ada-91f6-0f8c50b6b48a
Bas, I.
3057747e-023b-4d76-8b7c-597f6e16eb89
Norris, S.
8c711796-0237-4b3d-9cf1-a5bce12c995d
Richter, L.M.
c76cf803-b586-4bc9-b82a-1dd6f16b65f4
COHORTS investigators
Fall, C.H.
7171a105-34f5-4131-89d7-1aa639893b18
Sachdev, H.S.
9c9c8153-4c13-4e32-a1e9-798872efe4cb
Osmond, C.
2677bf85-494f-4a78-adf8-580e1b8acb81
Restrepo-Mendez, M.C.
2615e963-d7af-47eb-9a11-82a5c5d002a8
Victora, C.
461fb18b-0688-4971-b1df-3ef9f4c3d809
Martorell, R.
9ee73323-0528-4eff-93e3-c96fb1067356
Stein, A.D.
9120fff8-4ef6-4c07-a69f-ebe55dcb1243
Sinha, S.
8c214f61-b994-48ae-9f1f-535a46fd9c93
Tandon, N.
22a63117-5ee8-4c6b-9db6-0f696755d50f
Adair, L.
77c37ed0-84f6-4ada-91f6-0f8c50b6b48a
Bas, I.
3057747e-023b-4d76-8b7c-597f6e16eb89
Norris, S.
8c711796-0237-4b3d-9cf1-a5bce12c995d
Richter, L.M.
c76cf803-b586-4bc9-b82a-1dd6f16b65f4

Fall, C.H., Sachdev, H.S., Osmond, C., Restrepo-Mendez, M.C., Victora, C., Martorell, R., Stein, A.D., Sinha, S., Tandon, N., Adair, L., Bas, I., Norris, S. and Richter, L.M. , COHORTS investigators (2015) Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). The Lancet Global Health, 3 (7), e366-e377. (doi:10.1016/S2214-109X(15)00038-8). (PMID:25999096)

Record type: Article

Abstract

Background

Both young and advanced maternal age is associated with adverse birth and child outcomes. Few studies have examined these associations in low-income and middle-income countries (LMICs) and none have studied adult outcomes in the offspring. We aimed to examine both child and adult outcomes in five LMICs.

Methods

In this prospective study, we pooled data from COHORTS (Consortium for Health Orientated Research in Transitioning Societies)—a collaboration of five birth cohorts from LMICs (Brazil, Guatemala, India, the Philippines, and South Africa), in which mothers were recruited before or during pregnancy, and the children followed up to adulthood. We examined associations between maternal age and offspring birthweight, gestational age at birth, height-for-age and weight-for-height Z scores in childhood, attained schooling, and adult height, body composition (body-mass index, waist circumference, fat, and lean mass), and cardiometabolic risk factors (blood pressure and fasting plasma glucose concentration), along with binary variables derived from these. Analyses were unadjusted and adjusted for maternal socioeconomic status, height and parity, and breastfeeding duration.

Findings

We obtained data for 22?188 mothers from the five cohorts, enrolment into which took place at various times between 1969 and 1989. Data for maternal age and at least one outcome were available for 19?403 offspring (87%). In unadjusted analyses, younger (?19 years) and older (?35 years) maternal age were associated with lower birthweight, gestational age, child nutritional status, and schooling. After adjustment, associations with younger maternal age remained for low birthweight (odds ratio [OR] 1·18 (95% CI 1·02–1·36)], preterm birth (1·26 [1·03–1·53]), 2-year stunting (1·46 [1·25–1·70]), and failure to complete secondary schooling (1·38 [1·18–1·62]) compared with mothers aged 20–24 years. After adjustment, older maternal age remained associated with increased risk of preterm birth (OR 1·33 [95% CI 1·05–1·67]), but children of older mothers had less 2-year stunting (0·64 [0·54–0·77]) and failure to complete secondary schooling (0·59 [0·48–0·71]) than did those with mothers aged 20–24 years. Offspring of both younger and older mothers had higher adult fasting glucose concentrations (roughly 0·05 mmol/L).

Interpretation

Children of young mothers in LMICs are disadvantaged at birth and in childhood nutrition and schooling. Efforts to prevent early childbearing should be strengthened. After adjustment for confounders, children of older mothers have advantages in nutritional status and schooling. Extremes of maternal age could be associated with disturbed offspring glucose metabolism.

Funding

Wellcome Trust and the Bill & Melinda Gates Foundation.

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More information

e-pub ahead of print date: 18 May 2015
Published date: July 2015
Organisations: MRC Life-Course Epidemiology Unit

Identifiers

Local EPrints ID: 379167
URI: http://eprints.soton.ac.uk/id/eprint/379167
ISSN: 2214-109X
PURE UUID: 7ba6c4e8-0b9e-4214-9757-04e1e017af63
ORCID for C.H. Fall: ORCID iD orcid.org/0000-0003-4402-5552
ORCID for C. Osmond: ORCID iD orcid.org/0000-0002-9054-4655

Catalogue record

Date deposited: 24 Jul 2015 11:01
Last modified: 15 Mar 2024 02:50

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Contributors

Author: C.H. Fall ORCID iD
Author: H.S. Sachdev
Author: C. Osmond ORCID iD
Author: M.C. Restrepo-Mendez
Author: C. Victora
Author: R. Martorell
Author: A.D. Stein
Author: S. Sinha
Author: N. Tandon
Author: L. Adair
Author: I. Bas
Author: S. Norris
Author: L.M. Richter
Corporate Author: COHORTS investigators

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