Differential effects of young maternal age on child growth

Abstract

Background: The association of early maternal birthing age with smaller children has been widely observed. However, it is unclear if this is due to confounding by factors such as socioeconomic status, or the age at which child growth restriction first occurs.

Objective: To examine the effect of early maternal birthing age on the first-born child's height-for-age in a sample of developing countries in Africa, Asia, and Latin America.

Design: Cross-sectional data from Demographic Health Surveys from 18 countries were used, to select the first-born child of mothers aged 15-24 years and a range of potential confounding factors, including maternal height. Child length/height-for-age z-scores (HAZs) was estimated in age bands of 0-11, 12-23, 24-35, 36-47, and 48-59 months; HAZ was first compared between maternal age groups of 15-17, 18-19, and 20-24 years.

Results: 1) There were significant bivariate associations between low child HAZ and young maternal age (71 of 180 possible cases; at p<0.10), but the majority of these did not persist when controlling for confounders (41 cases, 23% of the 180). 2) For children <12 months, when controlling for confounders, three out of seven Asian countries showed a significant association between lower infant HAZ and low maternal age, as did six out of nine African countries (15-17 or 15-19 years vs. the older group). 3) The association (adjusted) continued after 24 months in 12 of the 18 countries, in Africa, Asia, and Latin America. 4) The stunting differences for children between maternal age groups were around 9 percentage points (ppts) in Asia, 14 ppts in Africa, and 10 ppts in Latin America. These data do not show whether this is due to, for example, socioeconomic factors that were not included, an emerging effect of intrauterine growth restriction, or the child feeding or caring behaviors of young mothers. The latter is considered to be the most likely.

Conclusions: The effect of low maternal age on child height restriction from 0 to 11 months occurred in half the countries studied after adjusting for confounders. Poorer growth continuing after 24 months in children of younger mothers was observed in all regions, but needs further research to determine the causes. The effects were about double (in stunting prevalence terms) in Africa, where there was an increase in 10 ppts in stunting for children of young mothers.

Keywords: Demographic Health Surveys; adolescent pregnancy; age at first childbirth; child malnutrition; growth.

Fig. 1

Height-for-age (HAZ) by age band by region from data analyzed. (a) African countries. (b) Asian countries. (c) Latin American countries.

Fig. 2

Linear growth patterns (height-for-age (HAZ), 0–59 months) by maternal age at first birth: the results from the bivariate analysis (Tanzania, Bangladesh, and India). (a) Tanzania (2010): HAZ by age at first birth and age of child. (b) Tanzania (2010): prevalence of stunting (HAZ<−2 SDs) by age at first birth and age of child. (c) Bangladesh (2011): HAZ by age at first birth and age of child. (d) Bangladesh (2011): prevalence of stunting (HAZ<−2 SDs) by age at first birth and age of child. (e) India (2005–2006): HAZ by age at first birth and age of child. (f) India (2005–2006): prevalence of stunting (HAZ<−2 SDs) by age at first birth and age of child.

Fig. 3

Bangladesh, India, Burkina Faso, and Mozambique: change in stunting levels (calculated from height-for-age z-score (HAZ) coefficients) with maternal age, controlling for confounders (Data taken from Tables 1 and 2).