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)

Caroline H D Fall, Harshpal Singh Sachdev, Clive Osmond, Maria Clara Restrepo-Mendez, Cesar Victora, Reynaldo Martorell, Aryeh D. Stein, Shikha Sinha, Nikhil Tandon, Linda Adair, Isabelita Bas, Shane Norris, Linda M. Richter, Fernando C. Barros, Denise Gigante, Pedro C. Hallal, Bernardo L. Horta, Manual Ramirez-Zea, Santosh K. Bhargava, Lakshmi RamakrishnanDorairaj Prabhakaran, K. Srinath Reddy, Anita Khalil, Poornima Prabhakaran, S. K. Dey Biswas, Siddarth Ramji, Judith Borja, Nanette Lee, Darren L. Dahly, Christopher W. Kuzawa, Alan Stein

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)e366-e377
JournalThe Lancet Global Health
Volume3
Issue number7
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

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Maternal Age
Mothers
Parturition
Prospective Studies
Health
Research
Growth Disorders
Social Adjustment
Premature Birth
Nutritional Status
Glucose
Gestational Age
Fasting
Odds Ratio
Guatemala
Philippines
Waist Circumference
Vulnerable Populations
South Africa
Parity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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). / Fall, Caroline H D; Sachdev, Harshpal Singh; Osmond, Clive; Restrepo-Mendez, Maria Clara; Victora, Cesar; Martorell, Reynaldo; Stein, Aryeh D.; Sinha, Shikha; Tandon, Nikhil; Adair, Linda; Bas, Isabelita; Norris, Shane; Richter, Linda M.; Barros, Fernando C.; Gigante, Denise; Hallal, Pedro C.; Horta, Bernardo L.; Ramirez-Zea, Manual; Bhargava, Santosh K.; Ramakrishnan, Lakshmi; Prabhakaran, Dorairaj; Reddy, K. Srinath; Khalil, Anita; Prabhakaran, Poornima; Dey Biswas, S. K.; Ramji, Siddarth; Borja, Judith; Lee, Nanette; Dahly, Darren L.; Kuzawa, Christopher W.; Stein, Alan.

In: The Lancet Global Health, Vol. 3, No. 7, 01.07.2015, p. e366-e377.

Research output: Contribution to journalArticle

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, Barros, FC, Gigante, D, Hallal, PC, Horta, BL, Ramirez-Zea, M, Bhargava, SK, Ramakrishnan, L, Prabhakaran, D, Reddy, KS, Khalil, A, Prabhakaran, P, Dey Biswas, SK, Ramji, S, Borja, J, Lee, N, Dahly, DL, Kuzawa, CW & Stein, A 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, vol. 3, no. 7, pp. e366-e377. https://doi.org/10.1016/S2214-109X(15)00038-8
Fall, Caroline H D ; Sachdev, Harshpal Singh ; Osmond, Clive ; Restrepo-Mendez, Maria Clara ; Victora, Cesar ; Martorell, Reynaldo ; Stein, Aryeh D. ; Sinha, Shikha ; Tandon, Nikhil ; Adair, Linda ; Bas, Isabelita ; Norris, Shane ; Richter, Linda M. ; Barros, Fernando C. ; Gigante, Denise ; Hallal, Pedro C. ; Horta, Bernardo L. ; Ramirez-Zea, Manual ; Bhargava, Santosh K. ; Ramakrishnan, Lakshmi ; Prabhakaran, Dorairaj ; Reddy, K. Srinath ; Khalil, Anita ; Prabhakaran, Poornima ; Dey Biswas, S. K. ; Ramji, Siddarth ; Borja, Judith ; Lee, Nanette ; Dahly, Darren L. ; Kuzawa, Christopher W. ; Stein, Alan. / 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). In: The Lancet Global Health. 2015 ; Vol. 3, No. 7. pp. e366-e377.
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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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TY - JOUR

T1 - Association between maternal age at childbirth and child and adult outcomes in the offspring

T2 - A prospective study in five low-income and middle-income countries (COHORTS collaboration)

AU - Fall, Caroline H D

AU - Sachdev, Harshpal Singh

AU - Osmond, Clive

AU - Restrepo-Mendez, Maria Clara

AU - Victora, Cesar

AU - Martorell, Reynaldo

AU - Stein, Aryeh D.

AU - Sinha, Shikha

AU - Tandon, Nikhil

AU - Adair, Linda

AU - Bas, Isabelita

AU - Norris, Shane

AU - Richter, Linda M.

AU - Barros, Fernando C.

AU - Gigante, Denise

AU - Hallal, Pedro C.

AU - Horta, Bernardo L.

AU - Ramirez-Zea, Manual

AU - Bhargava, Santosh K.

AU - Ramakrishnan, Lakshmi

AU - Prabhakaran, Dorairaj

AU - Reddy, K. Srinath

AU - Khalil, Anita

AU - Prabhakaran, Poornima

AU - Dey Biswas, S. K.

AU - Ramji, Siddarth

AU - Borja, Judith

AU - Lee, Nanette

AU - Dahly, Darren L.

AU - Kuzawa, Christopher W.

AU - Stein, Alan

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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.

AB - 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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