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Padhani ZA, Rahim KA, Tessema GA, Avery JC, Damabi NM, Castleton P, Salam RA, Meherali S, Lassi ZS. Exploring preconception health in adolescents and young adults: Identifying risk factors and interventions to prevent adverse maternal, perinatal, and child health outcomes-A scoping review. PLoS One 2024; 19:e0300177. [PMID: 38630699 PMCID: PMC11023205 DOI: 10.1371/journal.pone.0300177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Preconception health provides an opportunity to examine a woman's health status and address modifiable risk factors that can impact both a woman's and her child's health once pregnant. In this review, we aimed to investigate the preconception risk factors and interventions of early pregnancy and its impact on adverse maternal, perinatal and child health outcomes. METHODS We conducted a scoping review following the PRISMA-ScR guidelines to include relevant literature identified from electronic databases. We included reviews that studied preconception risk factors and interventions among adolescents and young adults, and their impact on maternal, perinatal, and child health outcomes. All identified studies were screened for eligibility, followed by data extraction, and descriptive and thematic analysis. FINDINGS We identified a total of 10 reviews. The findings suggest an increase in odds of maternal anaemia and maternal deaths among young mothers (up to 17 years) and low birth weight (LBW), preterm birth, stillbirths, and neonatal and perinatal mortality among babies born to mothers up to 17 years compared to those aged 19-25 years in high-income countries. It also suggested an increase in the odds of congenital anomalies among children born to mothers aged 20-24 years. Furthermore, cancer treatment during childhood or young adulthood was associated with an increased risk of preterm birth, LBW, and stillbirths. Interventions such as youth-friendly family planning services showed a significant decrease in abortion rates. Micronutrient supplementation contributed to reducing anaemia among adolescent mothers; however, human papillomavirus (HPV) and herpes simplex virus (HSV) vaccination had little to no impact on stillbirths, ectopic pregnancies, and congenital anomalies. However, one review reported an increased risk of miscarriages among young adults associated with these vaccinations. CONCLUSION The scoping review identified a scarcity of evidence on preconception risk factors and interventions among adolescents and young adults. This underscores the crucial need for additional research on the subject.
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Affiliation(s)
- Zahra Ali Padhani
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Komal Abdul Rahim
- Centre of Excellence in Trauma and Emergencies (CETE), Aga Khan University Hospital, Karachi, Pakistan
- Dean’s Office, Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Gizachew A. Tessema
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jodie C. Avery
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Negin Mirzaei Damabi
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Patience Castleton
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Rehana A. Salam
- Centre of Research Excellence, Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | - Salima Meherali
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Zohra S. Lassi
- School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Sparrow R, Agustina R, Bras H, Sheila G, Rieger M, Yumna A, Feskens E, Melse-Boonstra A. Adolescent Nutrition-Developing a Research Agenda for the Second Window of Opportunity in Indonesia. Food Nutr Bull 2021; 42:S9-S20. [PMID: 34282651 PMCID: PMC8293760 DOI: 10.1177/0379572120983668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recently, adolescence has been identified as a second window of opportunity for the correction of nutritional inadequacies. However, there is a lack of knowledge on evidence-based integrated nutrition strategies for adolescents in Indonesia. OBJECTIVE To provide a research agenda and the prioritization of research actions to tackle outstanding knowledge gaps on adolescent nutrition in Indonesia. METHODS A preliminary set of research topics was listed based on a desk study of the academic literature and policy documents. Second, a stakeholder meeting was held to further identify and discuss research topics related to adolescent nutrition in Indonesia. Third, an online survey was conducted in which respondents were asked to indicate priority research themes for the next 3 to 5 years and to rank a total of 23 research questions. RESULTS Most (52%) of the respondents who returned the survey (n = 27) prioritize research on implementation and program evaluation, while 30% prefer descriptive and explanatory research, and 19% place priority with intervention and discovery research. However, when we followed up with specific topics for each of these broad research areas, a more nuanced picture emerged, with intervention and discovery research taking a more prominent standing. CONCLUSIONS In order to support the design, implementation, and effectiveness of integrated nutrition programs for Indonesian adolescents, in-depth studies should question the best intervention strategies, modes of delivery, and long-term outcomes, while nationwide and disaggregated data should investigate associations and trends over time and identify vulnerable groups.
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Affiliation(s)
- Robert Sparrow
- Development Economics Group, Wageningen University, the Netherlands.,International Institute of Social Studies, Erasmus University Rotterdam, the Netherlands
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,Human Nutrition Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hilde Bras
- Economic and Social History, 3647University of Groningen, the Netherlands
| | - Grace Sheila
- Human Nutrition Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Matthias Rieger
- International Institute of Social Studies, Erasmus University Rotterdam, the Netherlands
| | - Athia Yumna
- The 391969SMERU Research Institute, Jakarta, Indonesia
| | - Edith Feskens
- Division of Human Nutrition and Health, Wageningen University, the Netherlands
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Maravilla JC, Betts K, Adair L, Alati R. Stunting of children under two from repeated pregnancy among young mothers. Sci Rep 2020; 10:14265. [PMID: 32868833 PMCID: PMC7459341 DOI: 10.1038/s41598-020-71106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/05/2020] [Indexed: 11/08/2022] Open
Abstract
Repeated pregnancy leaves young mothers nutritionally deprived which may in turn lead to poor infant growth. We measure the occurrence and persistence of stunting among offspring of young mothers who experienced repeated pregnancies using data from the Cebu Longitudinal Health and Nutrition Survey. We selected mothers aged 14-24 years (n = 1,033) with singleton birth. We determined the length-for-age z scores (LAZ) at 12 and 24 months of the index child using the World Health Organisation 2007 growth standard. We fitted LAZ, stunting occurrence (i.e. LAZ < - 2) and persistence from 12 to 24 months into regression models and tested for the mediating effect of low birthweight and feeding practices. In these models, repeated pregnancy was analysed in an ordinal approach using number of past pregnancies of young mothers at birth of the index child. Compared to infants born to young mothers aged 14-24 years who had no previous pregnancies, those born to young mothers with repeated pregnancies have at least 0.15 (95% CI - 0.23, - 0.08) LAZ lower and are at higher chance of stunting by at least 40% (95% CI 1.19, 1.67) at 12 and 24 months. Similar cohorts of infants showed an elevated risk of persistent stunting from 12 through 24 months with a relative risk ratio of 1.51 (95% CI 1.21, 1.88). Optimal feeding practices substantially mediated stunting outcomes by further reducing the effects of repeated pregnancy to stunting occurrence and persistence by 19.95% and 18.09% respectively. Mediation tests also showed low birthweight in the causal pathway between repeated pregnancy and stunting. Repeated pregnancy in young mothers is a predictor of stunting among children under 2 years. Secondary pregnancy prevention measures and addressing suboptimal feeding practices are beneficial to mitigate the negative impact of repeated adolescent pregnancy on children.
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Affiliation(s)
- Joemer Calderon Maravilla
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia.
- Life Course Centre, Australian Research Council Centre of Excellence for Children and Families Over the Life Course, Brisbane, Australia.
- Institute of Nursing, Far Eastern University, Manila, Philippines.
| | - Kim Betts
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Linda Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rosa Alati
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
- Life Course Centre, Australian Research Council Centre of Excellence for Children and Families Over the Life Course, Brisbane, Australia
- School of Public Health, Curtin University, Perth, Australia
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Workicho A, Belachew T, Argaw A, Roba A, Ghosh S, Kershaw M, Lachat C, Kolsteren P. Maternal nutritional status mediates the association between maternal age and birth outcomes. MATERNAL AND CHILD NUTRITION 2020; 16:e13015. [PMID: 32351001 PMCID: PMC7507459 DOI: 10.1111/mcn.13015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022]
Abstract
Young maternal age during pregnancy is linked with adverse birth outcomes. This study examined the role of maternal nutritional status in the association between maternal age and small for gestational age (SGA) delivery and birth length. We used data from a birth cohort study in Ethiopia, involving women who were 15–24 years of age and their newborns. A mediation analysis was fitted in a sample of 1,422 mother infant dyads for whom data on birth length were available, and 777 dyads for whom gestational age and birth weight was measured. We used commands, medeff for the mediation analysis and medsens for sensitivity analysis in STATA 14. Maternal nutritional status, measured by mid‐upper arm circumference, mediated 21% of the association between maternal age and birth length and 14% of the association with SGA delivery. The average direct effect (ADE) of maternal age on birth length was (β = 0.45, 95% CI [0.17, 0.99]) and the average causal mediated effect (ACME) was (β = 0.12, 95% CI [0.02, 0.15]). We also found an ADE (β = 0.31, 95% CI [0.09, 0.47]) and an ACME of (β = 0.05, 95% CI [0.003, 0.205]) of maternal age on SGA delivery. The sensitivity analysis suggests an unmeasured confounder with a positive correlation of 0.15 and 0.20 between the mediator and the outcome could explain the observed ACME for birth length and SGA, respectively. We cannot make strong causal assertions as the findings suggest the mediator partly explained the total effect of maternal age on both outcomes.
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Affiliation(s)
- Abdulhalik Workicho
- Institute of Health, Department of Epidemiology, Jimma University, Jimma, Ethiopia.,Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Tefera Belachew
- Institute of Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Alemayehu Argaw
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.,Institute of Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
| | - Alemzewed Roba
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium.,Department of Nutrition, Food Science and Technology, Hawassa University, Hawassa, Ethiopia
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Meghan Kershaw
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
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Burkill S, Vattulainen P, Geissbuehler Y, Sabido Espin M, Popescu C, Suzart-Woischnik K, Hillert J, Artama M, Verkkoniemi-Ahola A, Myhr KM, Cnattingius S, Korhonen P, Montgomery S, Bahmanyar S. The association between exposure to interferon-beta during pregnancy and birth measurements in offspring of women with multiple sclerosis. PLoS One 2019; 14:e0227120. [PMID: 31887199 PMCID: PMC6936848 DOI: 10.1371/journal.pone.0227120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Interferon-beta (IFN-beta) is a commonly used treatment for multiple sclerosis (MS). Current guidelines recommend cessation of treatment during pregnancy, however the results of past studies on the safety of prenatal exposure to IFN-beta have been conflicting. A large scale study of a population of MS women is therefore warranted. Objectives To assess whether, among those born to women with MS, infants prenatally exposed to IFN-beta show evidence of smaller size at birth relative to infants which were not prenatally exposed to any MS disease modifying drugs. Methods Swedish and Finnish register data was used. Births to women with MS in Sweden and Finland between 2005–2014 for which a birth measurement for weight, height, and head circumference was available were included. The exposure window was from 6 months prior to LMP to the end of pregnancy. Results In Sweden, 411 pregnancies were identified as exposed to IFN-beta during the exposure window, and 835 pregnancies were counted as unexposed to any MS DMD. The corresponding numbers for Finland were 232 and 331 respectively. Infants prenatally exposed to interferon-beta were on average 28 grams heavier (p = 0.17), 0.01 cm longer (p = 0.95), and had head circumferences 0.14 cm larger (p = 0.13) in Sweden. In Finland, infants were 50 grams lighter (p = 0.27), 0.02 cm shorter (p = 0.92) and had head circumferences 0.22 cm smaller (p = 0.15) relative to those unexposed. Conclusions This study provides evidence that exposure to IFN-beta during pregnancy does not influence birth weight, length, or head circumference.
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Affiliation(s)
- Sarah Burkill
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | | | | | | | | | | | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Miia Artama
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Kjell-Morten Myhr
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sven Cnattingius
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Scott Montgomery
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Workicho A, Belachew T, Argaw A, Ghosh S, Kershaw M, Lachat C, Kolsteren P. Adolescent pregnancy and linear growth of infants: a birth cohort study in rural Ethiopia. Nutr J 2019; 18:22. [PMID: 30940147 PMCID: PMC6806577 DOI: 10.1186/s12937-019-0448-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidences indicate that the risk of linear growth faltering is higher among children born from young mothers. Although such findings have been documented in various studies, they mainly originate from cross-sectional data and demographic and health surveys which are not designed to capture the growth trajectories of the same group of children. This study aimed to assess the association between young maternal age and linear growth of infants using data from a birth cohort study in Ethiopia. METHODS A total of 1423 mother-infant pairs, from a birth cohort study in rural Ethiopia were included in this study. They were followed for five time points, with three months interval until the infants were 12 months old. However, the analysis was based on 1378 subjects with at least one additional follow-up measurement to the baseline. A team of data collectors including nurses collected questionnaire based data and anthropometric measurements from the dyads. We fitted linear mixed-effects model with random intercept and random slope to determine associations of young maternal age and linear growth of infants over the follow-up period after adjusting for potential confounders. RESULTS Overall, 27.2% of the mothers were adolescents (15-19 years) and the mean ± SD age of the mothers was 20 ± 2 years. Infant Length for Age Z score (LAZ) at birth was negatively associated with maternal age of 15-19 years (β = - 0.24, P = 0.032). However, young maternal age had no significant association with linear growth of the infants over the follow-up time (P = 0.105). Linear growth of infants was associated positively with improved maternal education and iron-folate intake during pregnancy and negatively with infant illness (P < 0.05). CONCLUSION Young maternal age had a significant negative association with LAZ score of infants at birth while its association over time was not influential on their linear growth. The fact that wide spread socio economic and environmental inequalities exist among mothers of all ages may have contributed to the non-significant association between young maternal age and linear growth faltering of infants. This leaves an opportunity to develop comprehensive interventions targeting for the infants to attain optimal catch-up growth.
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Affiliation(s)
- Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, P.O.Box 378, Jimma, Ethiopia. .,Department of Food Technology, Safety and Health, Ghent University, Coupure links 653, B 9000, Ghent, Belgium.
| | - Tefera Belachew
- Department of Population and Family Health, Institute of Health, Jimma University, P.O.Box 378, Jimma, Ethiopia
| | - Alemayehu Argaw
- Department of Population and Family Health, Institute of Health, Jimma University, P.O.Box 378, Jimma, Ethiopia.,Department of Food Technology, Safety and Health, Ghent University, Coupure links 653, B 9000, Ghent, Belgium
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, USA
| | - Meghan Kershaw
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, USA
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Coupure links 653, B 9000, Ghent, Belgium
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Coupure links 653, B 9000, Ghent, Belgium
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Widiyanto J, Lismawati G. Maternal age and anemia are risk factors of low birthweight of newborn. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Low birth weight in Iran: Implications from a systematic review of the literature and meta-analysis in the period 1999-2017. Med J Islam Repub Iran 2018; 32:13. [PMID: 30159264 PMCID: PMC6108244 DOI: 10.14196/mjiri.32.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 01/22/2023] Open
Abstract
Background: Low birth weight (LBW), a crucial determinant of neonatal complications, represents a major public health concern worldwide. Epidemiological research is of crucial importance for designing and implementing ad hoc interventions for this issue, helping and guiding decision- and policy-makers in each country to prevent the increased prevalence of LBW in infants through estimating the prevalence rate, identifying and controlling major risk factors. The present investigation aimed to systematically assess LBW prevalence rate in Iran and its determinants. Methods: PubMed/Medline via Ovid, Embase, Web of Science and Scopus as well as Magiran, SID and Irandoc were searched from inception until November 2016. Also, the grey literature (via Google Scholar) was mined. The DerSimonian-Laird model was exploited. The I2 and Q-test tests were used to investigate heterogeneity between the studies. Sensitivity and subgroup analyses were performed to ensure the robustness and validity of our findings. Different cumulative meta-analyses were conducted stratifying according to the year of publication and sample size. Any potential bias in publication was assessed carrying out the Egger's test. Results: LBW prevalence rate was estimated to be 8% (95%CI: 7-9) in Iran. Sensitivity analysis confirmed the stability of finding. Studies were cumulated by the year of publication, and the results did not change pre- and post-cumulative meta-analysis. No publication bias could be observed. Conclusion: LBW prevalence rate in Iran is well comparable with the prevalence figures of both developed and developing countries. This could be due to the health reforms implemented in Iran throughout the years.
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Yu SH, Mason J, Crum J, Cappa C, Hotchkiss DR. Differential effects of young maternal age on child growth. Glob Health Action 2016; 9:31171. [PMID: 27852422 PMCID: PMC5112350 DOI: 10.3402/gha.v9.31171] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 01/21/2023] Open
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.
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Affiliation(s)
- Soo Hyun Yu
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - John Mason
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA;
| | - Jennifer Crum
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Claudia Cappa
- Data and Analytics Section, Division of Data, Research and Policy, UNICEF, New York, NY, USA
| | - David R Hotchkiss
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Mullan Z. African children in the spotlight. LANCET GLOBAL HEALTH 2015; 3:e341. [PMID: 26087974 DOI: 10.1016/s2214-109x(15)00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Fall CHD, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, Stein AD, Sinha S, Tandon N, Adair L, Bas I, Norris S, Richter LM. 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). LANCET GLOBAL HEALTH 2015; 3:e366-77. [PMID: 25999096 PMCID: PMC4547329 DOI: 10.1016/s2214-109x(15)00038-8] [Citation(s) in RCA: 245] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/30/2015] [Accepted: 03/06/2015] [Indexed: 01/06/2023]
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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Affiliation(s)
- Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
| | | | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | - Cesar Victora
- Universidade Federal de Pelotas, Capão do Leão, Pelotas, Brazil
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Shikha Sinha
- Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Linda Adair
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabelita Bas
- Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines
| | - Shane Norris
- Medical Research Council Developmental Pathways for Health Research Unit, Witwatersrand University, Johannesburg, South Africa
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12
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Deeluea J, Sirichotiyakul S, Weerakiet S, Arora R, Patumanond J. Fundal height growth curve for underweight and overweight and obese pregnant women in Thai population. ISRN OBSTETRICS AND GYNECOLOGY 2013; 2013:657692. [PMID: 24455289 PMCID: PMC3880769 DOI: 10.1155/2013/657692] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
Objectives. To develop fundal height growth curves for underweight and overweight and obese pregnant women based on gestational age from last menstrual period and/or ultrasound. Methods. A retrospective study was conducted at four hospitals in the northern part of Thailand between January 2009 and March 2011. Fundal height, gestational age, height, and prepregnancy weight were extracted from antenatal care and delivery records. Fundal height growth curves were presented as smoothed function of the 10th, 50th, and 90th percentiles between 20 and 40 weeks of gestation, derived from multilevel models. Results. Fundal height growth curve of the underweight was derived from 1,486 measurements (208 women) and the overweight and obese curve was derived from 1,281 measurements (169 women). The 50th percentile line of the underweight was 0.1-0.4 cm below the normal weight at weeks 23-31 and 0.5-0.8 cm at weeks 32-40. The overweight and obese line was 0.1-0.4 cm above the normal weight at weeks 22-29 and 0.6-0.8 cm at weeks 30-40. Conclusions. Fundal height growth curves of the underweight and overweight and obese pregnant women were different from the normal weight. In monitoring or screening for abnormal intrauterine growth in these women, fundal height growth curves specifically developed for such women should be applied.
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Affiliation(s)
- Jirawan Deeluea
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Obstetrics and Gynecology Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Supatra Sirichotiyakul
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Sawaek Weerakiet
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Rajin Arora
- Department of Obstetrics and Gynecology, Lampang Regional Hospital, Lampang 52000, Thailand
| | - Jayanton Patumanond
- Clinical Epidemiology Unit & Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand
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Al-Hinai M, Al-Muqbali M, Al-Moqbali A, Gowri V, Al-Maniri A. Effects of Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Low Birth Weight in Omani Infants: A case-control study. Sultan Qaboos Univ Med J 2013; 13:386-91. [PMID: 23984023 DOI: 10.12816/0003260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 12/24/2012] [Accepted: 03/30/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the association between pre-pregnancy maternal body mass index (BMI), gestational weight gain and low birth weight (LBW) in babies born to a sample population of Omani women. METHODS A case-control study was carried out among deliveries registered between 1(st) May 2010 and 30(th) April 2011 at Sultan Qaboos University Hospital, Muscat, Oman. A case was defined as a woman who delivered a low birth weight baby (<2,500 g); a control was a woman delivering a baby weighing between 2,500 and 4,000 g. A random selection of 150 cases and 300 controls was carried out using the hospital information system. Maternal, pre-natal, and delivery data were extracted from the mothers' follow-up cards. Bivariate and multivariate logistic regression analyses were executed to examine the association between pre-pregnancy maternal BMI and LBW. RESULTS The percentage of underweight mothers (BMI <18.5) was higher among the cases compared to the controls (17.3% versus 6%; P <0.001). The proportion of mothers with less-than-recommended weight gain was also higher among the cases compared to the controls (57.7% versus 33%; P <0.001). After adjustment for potential confounders, infants of underweight mothers had more than twice the risk of LBW compared to those of mothers with normal weight (odds ratio = 2.27; 95% confidence interval 1.09-4.71). CONCLUSION Underweight Omani women as well as women with less-than-recommended gestational weight gain were at higher risk of delivering LBW babies. Maternal health promotion programmes should be directed towards improving mothers' nutrition before and during pregnancies.
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Affiliation(s)
- Mustafa Al-Hinai
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital
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14
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Wells JCK, DeSilva JM, Stock JT. The obstetric dilemma: an ancient game of Russian roulette, or a variable dilemma sensitive to ecology? AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2012; 149 Suppl 55:40-71. [PMID: 23138755 DOI: 10.1002/ajpa.22160] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The difficult birth process of humans, often described as the "obstetric dilemma," is commonly assumed to reflect antagonistic selective pressures favoring neonatal encephalization and maternal bipedal locomotion. However, cephalo-pelvic disproportion is not exclusive to humans, and is present in some primate species of smaller body size. The fossil record indicates mosaic evolution of the obstetric dilemma, involving a number of different evolutionary processes, and it appears to have shifted in magnitude between Australopithecus, Pleistocene Homo, and recent human populations. Most attention to date has focused on its generic nature, rather than on its variability between populations. We re-evaluate the nature of the human obstetric dilemma using updated hominin and primate literature, and then consider the contribution of phenotypic plasticity to variability in its magnitude. Both maternal pelvic dimensions and fetal growth patterns are sensitive to ecological factors such as diet and the thermal environment. Neonatal head girth has low plasticity, whereas neonatal mass and maternal stature have higher plasticity. Secular trends in body size may therefore exacerbate or decrease the obstetric dilemma. The emergence of agriculture may have exacerbated the dilemma, by decreasing maternal stature and increasing neonatal growth and adiposity due to dietary shifts. Paleodemographic comparisons between foragers and agriculturalists suggest that foragers have considerably lower rates of perinatal mortality. In contemporary populations, maternal stature remains strongly associated with perinatal mortality in many populations. Long-term improvements in nutrition across future generations may relieve the dilemma, but in the meantime, variability in its magnitude is likely to persist.
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Affiliation(s)
- Jonathan C K Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London WC1N 1EH, UK.
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Lalys L, Grangé G, Pineau JC. Estimation du poids de naissance de fœtus de petit poids (≤2500g) et de gros poids (≥4000g) à partir des données échographiques. ACTA ACUST UNITED AC 2012; 41:566-73. [DOI: 10.1016/j.jgyn.2012.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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16
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Shrim A, Ates S, Mallozzi A, Brown R, Ponette V, Levin I, Shehata F, Almog B. Is young maternal age really a risk factor for adverse pregnancy outcome in a canadian tertiary referral hospital? J Pediatr Adolesc Gynecol 2011; 24:218-22. [PMID: 21620742 DOI: 10.1016/j.jpag.2011.02.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 02/06/2011] [Accepted: 02/15/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the risk of adverse pregnancy outcome among teenage mothers within a large tertiary referral center in Canada. METHODS All nulliparous singleton births in the McGill University Health Centre during 2001-2007 were retrieved using the "MOND" database. Patients were divided according to maternal age: <20 years (teenage), and between 20 and 39 years. Obstetric and neonatal complications were compared. RESULTS 9744 nulliparous women were included; 250 (2.6%) were teenage and 9494 (97.4%) were 20-39 years old. Teenage mothers tended to deliver earlier (38.0 vs 39.2 weeks gestation, P < 0.001) and had higher rates of extreme prematurity (OR 4.5, 95% CI 2.5-8.1). Babies of teenage mothers had lower birth weights (3014 g vs 3326 g, P < 0.001), higher rates of NICU admission (OR 2.1, 95% CI 1.5-3.0), congenital anomalies (OR 1.8, 95% CI 1.2-2.6) and combined perinatal and neonatal mortality (OR 3.8, 95% CI 1.9-7.5). Logistic regression analysis showed an association between young maternal age and the risk to have at least one adverse outcome (P < 0.001). CONCLUSIONS Even within a large tertiary referral hospital, teenage mothers carry a greater risk of adverse pregnancy outcome, mainly due to preterm births.
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Affiliation(s)
- Alon Shrim
- Department of Obstetrics and Gynaecology, McGill University - Royal Victoria Hospital, Montreal, Quebec, Canada.
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Adair LS, Popkin BM, Akin JS, Guilkey DK, Gultiano S, Borja J, Perez L, Kuzawa CW, McDade T, Hindin MJ. Cohort profile: the Cebu longitudinal health and nutrition survey. Int J Epidemiol 2011; 40:619-25. [PMID: 20507864 PMCID: PMC3147061 DOI: 10.1093/ije/dyq085] [Citation(s) in RCA: 176] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2010] [Indexed: 11/13/2022] Open
Affiliation(s)
- Linda S Adair
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill NC, USA.
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Lalys L, Pineau JC, Guihard-Costa AM. Small and large foetuses: Identification and estimation of foetal weight at delivery from third-trimester ultrasound data. Early Hum Dev 2010; 86:753-7. [PMID: 20826073 DOI: 10.1016/j.earlhumdev.2010.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 07/08/2010] [Accepted: 07/11/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND The estimation of foetal weight (EFW) at delivery is crucial to assess the risk of foetal and neonatal morbidity and mortality, most notably when the foetus is small or large. AIM To accurately predict the EFW at delivery of small foetuses (birth weight [BW]≤2500g) and large foetuses (BW≥4000g) identified with third-trimester ultrasound data. METHODS We included 1309 foetuses whose age and weight at birth were known and for whom standard data were available from third-trimester ultrasound scans. Small and large foetuses were identified by extrapolation to full term of the estimated foetal weight obtained using Hadlock's equation. We built two regression models for predicting the birth weights of small and large foetuses, respectively. The results obtained with these models were compared to those obtained with Hadlock's equation. RESULTS Third-trimester sonograms were obtained at 33.6±1.3 weeks gestational age [WGA] and birth occurred at 38.7±1.2WGA. EFW of small foetuses predicted using the regression model showed significantly less systematic bias than the Hadlock estimate (2.3% vs. 7.2%, respectively), whereas random errors were similar. EFW of large foetuses predicted using the regression model showed significantly less random error than the Hadlock estimate (6.2% vs. 10.1%, respectively), whereas systematic bias was similar. Data from an independent validation sample indicate that our regression models are accurate. CONCLUSIONS To apply distinct models for accurately predicting the EFWs at delivery of small and large foetuses should prevent adverse events related to newborn size.
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Affiliation(s)
- L Lalys
- CNRS UPR 2147, “Dynamique de l'Evolution Humaine”, 44 rue de l'Amiral Mouchez, 75014 Paris, France.
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Nettle D, Coall DA, Dickins TE. Birthweight and paternal involvement predict early reproduction in British women: evidence from the National Child Development Study. Am J Hum Biol 2010; 22:172-9. [PMID: 19670389 DOI: 10.1002/ajhb.20970] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is considerable interest in the mechanisms maintaining early reproduction in the most socioeconomically disadvantaged groups in developed countries. Previous research has suggested that differential exposure to early-life factors such as low birthweight and lack of paternal involvement during childhood may be relevant. Here, we used longitudinal data on the female cohort members from the UK National Child Development Study (n = 3,014-4,482 depending upon variables analyzed) to investigate predictors of early reproduction. Our main outcome measures were having a child by age 20, and stating at age 16 an intended age of reproduction of 20 years or lower. Low paternal involvement during childhood was associated with increased likelihood of early reproduction (O.R. 1.79-2.25) and increased likelihood of early intended reproduction (O.R. 1.38-2.50). Low birthweight for gestational age also increased the odds of early reproduction (O.R. for each additional s.d. 0.88) and early intended reproduction (O.R. for each additional s.d. 0.81). Intended early reproduction strongly predicted actual early reproduction (O.R. 5.39, 95% CI 3.71-7.83). The results suggest that early-life factors such as low birthweight for gestational age, and low paternal involvement during childhood, may affect women's reproductive development, leading to earlier target and achieved ages for reproduction. Differential exposure to these factors may be part of the reason that early fertility persists in socioeconomically disadvantaged groups. We discuss our results with respect to the kinds of interventions likely to affect the rate of teen pregnancy.
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Affiliation(s)
- Daniel Nettle
- Centre for Behavior and Evolution, Institute of Neuroscience, Newcastle University, United Kingdom.
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20
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Nettle D. Dying young and living fast: variation in life history across English neighborhoods. Behav Ecol 2010. [DOI: 10.1093/beheco/arp202] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schell LM, Gallo MV, Ravenscroft J. Environmental influences on human growth and development: historical review and case study of contemporary influences. Ann Hum Biol 2009; 36:459-77. [PMID: 19626483 DOI: 10.1080/03014460903067159] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Over the past 100 years, the study of environmental influences on human physical growth and development has focused on the influences of social and economic factors; family and household characteristics; urbanization/modernization; nutrition; and features of the physical environment such as altitude, temperature and climate. Continuing in this tradition are current investigations into the roles of pollutants and other aspects of the human-made environment in affecting patterns of human growth and development, specifically the timing of sexual maturation and the development of obesity. Some of the methodological problems in conducting such studies are presented, as are results from an ongoing investigation among one Native American community that show relationships of pollutants to sexual maturation, overweight/obesity and thyroid system function which can impact growth and maturation.
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Affiliation(s)
- Lawrence M Schell
- Department of Anthropology, University at Albany, State University of New York, Albany, NY 12222, USA.
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Abstract
OBJECTIVES To investigate the rates of cesarean deliveries in two different hospitals, which serve different populations in Turkey. METHODS The study was conducted at two centers, one of which is a university hospital in a rural area and the other a community hospital in capital city, for 5 years (1999-2003). The subjects were < 18 years old adolescent mothers. The adult controls ( 18 years) were further divided in two age groups: 18-35 years and > 35 years. RESULTS A total of 40,391 pregnant women were evaluated in both hospitals. Cesarean delivery rates in adolescent pregnancies were not higher than adults. Moreover, in community hospital, cesarean delivery rate in adolescents was significantly lower (17.12% vs. 28.84%). CONCLUSIONS We concluded that, the cesarean deliveries are not increased, and even decreased in adolescent pregnancies and biological immaturity is not a significant problem in adolescent pregnancy.
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Affiliation(s)
- S Zeteroglu
- Department of Obstetrics and Gynecology, Yuzuncuyil University Faculty of Medicine, Van, Turkey
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Badshah S, Mason L, McKelvie K, Payne R, Lisboa PJ. Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health 2008; 8:197. [PMID: 18533023 PMCID: PMC2435119 DOI: 10.1186/1471-2458-8-197] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 06/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low birthweight is a widely used indicator of newborn health. This study investigates the association of birthweight <2.5 kg (LBW) with a wide range of factors related to geo-demographics, maternal health and pregnancy history in public hospitals at Peshawar, North West Frontier Province (NWFP) Pakistan. It is noted that that Low birthweight may arise for two different reasons, one related to gestational age and the other corresponding to births that are small for gestational age (SGA). METHODS Data on geo-demographics, maternal health indicators, pregnancy history and outcome scores for newborn babies and their families (n = 1039) were collected prospectively between August and November 2003 in a cross-sectional survey of four public hospitals in Peshawar, NWFP-Pakistan. Crude and adjusted odds ratios were used to investigate the factors affecting incidence of LBW, by multivariate logistic regression. Gestational age was included as an explanatory variable therefore the additional covariates identified by model selection are expected to account for SGA. RESULTS The main geo-demographic risk factors for SGA identified in this study, controlling for gestational age of less than 37 weeks, are maternal age, nationality and consanguinity. Presentation with anaemia and the history of previous abortion/miscarriage were also found to be significant independent factors. The adjusted odds ratio for gestational age showed the largest effect in explaining the incidence of LBW. The next highest odds ratio was for maternal age below 20 years. The explanatory model included two pairwise interactions, for which the predicted incidence figures for LBW show an increase among the Tribal area with presentation of anaemia, and among full term babies with their mothers having a previous history of abortion/miscarriage. CONCLUSION In addition to gestational age, specific factors related to geo-demographics (maternal age, consanguinity and nationality), maternal health (anaemia) and pregnancy history (abortion/miscarriage) were significantly associated with the incidence of LBW observed at the four hospitals surveyed in Peshawar. These results indicate that cultural factors can adversely affect the incidence of SGA in this area of Pakistan.
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Affiliation(s)
- Sareer Badshah
- Deprtment of Statistics, Islamia College, University of Peshawar, Pakistan.
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