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

被引:297
作者
Fall, Caroline H. D. [1 ]
Sachdev, Harshpal Singh [2 ]
Osmond, Clive [1 ]
Restrepo-Mendez, Maria Clara [3 ]
Victora, Cesar [3 ]
Martorell, Reynaldo [4 ]
Stein, Aryeh D. [4 ]
Sinha, Shikha [2 ]
Tandon, Nikhil [5 ]
Adair, Linda [6 ]
Bas, Isabelita [7 ]
Norris, Shane [8 ]
Richter, Linda M. [9 ]
机构
[1] Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton SO16 6YD, Hants, England
[2] Sitaram Bhartia Inst Sci & Res, New Delhi, India
[3] Univ Fed Pelotas, Capao Do Leao, Pelotas, Brazil
[4] Emory Univ, Rollins Sch Publ Hlth, Hubert Dept Global Hlth, Atlanta, GA 30322 USA
[5] All India Inst Med Sci, New Delhi, India
[6] Univ N Carolina, Dept Nutr, Chapel Hill, NC USA
[7] Univ San Carlos, Off Populat Studies Fdn, Cebu, Philippines
[8] Univ Witwatersrand, Med Res Council Dev Pathways Hlth Res Unit, Johannesburg, South Africa
[9] Human Sci Res Council, Durban, South Africa
来源
LANCET GLOBAL HEALTH | 2015年 / 3卷 / 07期
基金
英国惠康基金; 美国安德鲁·梅隆基金会; 比尔及梅琳达.盖茨基金会; 英国医学研究理事会; 美国国家科学基金会; 美国国家卫生研究院;
关键词
ADVERSE PERINATAL OUTCOMES; POPULATION-BASED COHORT; BLOOD-PRESSURE; ADOLESCENT PREGNANCY; TEENAGE PREGNANCY; BIRTH-WEIGHT; MORTALITY; HEALTH; RISK; MOTHERHOOD;
D O I
10.1016/S2214-109X(15)00038-8
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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 off spring. 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 off spring 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 off spring (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. Off spring 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 off spring glucose metabolism.
引用
收藏
页码:E366 / E377
页数:12
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