TY - JOUR
T1 - The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality
T2 - A meta-analysis
AU - Kozuki, Naoko
AU - Lee, Anne Cc
AU - Silveira, Mariangela F.
AU - Sania, Ayesha
AU - Vogel, Joshua P.
AU - Adair, Linda
AU - Barros, Fernando
AU - Caulfield, Laura E.
AU - Christian, Parul
AU - Fawzi, Wafaie
AU - Humphrey, Jean
AU - Huybregts, Lieven
AU - Mongkolchati, Aroonsri
AU - Ntozini, Robert
AU - Osrin, David
AU - Roberfroid, Dominique
AU - Tielsch, James
AU - Vaidya, Anjana
AU - Black, Robert E.
AU - Katz, Joanne
N1 - Funding Information:
We would like to thank Neff Walker for his invaluable contributions to the study design, interpretation of findings, and to the writing of a manuscript, and the CHERG SGA-Preterm Birth working group for their feedback. The individual studies would like to acknowledge the following individuals: Ramesh Adhikari, Christian Coles, Gary Darmstadt, Sheela Devi, Subarna Khatry, Hermann Lanou, Steve LeClerq, Gernard I Msamanga, R.D. Thulariraj, Laeticia Celine Toe, Willy Urassa, Cesar G Victora, Keith West, and Nelly Zavaleta. Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group. Investigators were offered financial support for analysis via subcontracts by the US Fund for UNICEF. The funding sources of the individual studies are as follows: India (2000) - Center for Human Nutrition (Johns Hopkins School of Public Health), Office of Health and Nutrition (USAID), Bill and Melinda Gates Foundation (BMGF), Task Force Sight and Life; Nepal (1999) - USAID, UNICEF Country Office (Kathmandu, Nepal), BMGF; Nepal (2003) - Wellcome Trust; Nepal (2004) – National Institutes of Health (NIH), BMGF, USAID, Proctor and Gamble; Philippines (1983) - NIH, Nestle’s Coordinating Center for Nutritional Research, Wyeth International, Ford Foundation, US National Academy of Science, World Health Organization (WHO), Carolina Population Center, USAID; Thailand (2001) - Thailand Research Fund, Health System Research Office, Ministry of Public Health, Thailand; Burkina Faso (2004) - Nutrition Third World, Belgian Ministry of Development; Burkina Faso (2006) - Flemish University Council, Nutrition Third World, Belgian Ministry of Development, Nutriset; Tanzania (2001) – National Institute of Child Health and Human Development; Zimbabwe (1997) – Canadian International Development Agency, USAID, BMGF, Rockefeller Foundation, BASF; Brazil (1982) - International Development Research Center for Canada, WHO, UK Overseas Development Administration; Brazil (1993) - UN Development Fund for Women; Brazil (2004) – Wellcome Trust; Peru (1995) – Office of Health and Nutrition (USAID). The funders played no role in the manuscript.
Funding Information:
The publication costs for this supplement were funded by a grant from the Bill & Melinda Gates Foundation to the US Fund for UNICEF (grant 43386 to “Promote evidence-based decision making in designing maternal, neonatal, and child health interventions in low-and middle-income countries”). The Supplement Editor is the principle investigator and lead in the development of the Lives Saved Tool (LiST), supported by grant 43386. He declares that he has no competing interests. This article has been published as part of BMC Public Health Volume 13 Supplement 3, 2013: The Lives Saved Tool in 2013: new capabilities and applications. The full contents of the supplement are available online at http://www.biomedcentral.com/bmcpublichealth/supplements/13/S3.
Funding Information:
Conclusions: Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman’s reproductive period. Funding: Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group.
PY - 2013
Y1 - 2013
N2 - Background: Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Methods. Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Results: Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years. Conclusions: Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman's reproductive period. Funding. Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group.
AB - Background: Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC). Methods. Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed. Results: Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years. Conclusions: Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman's reproductive period. Funding. Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group.
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U2 - 10.1186/1471-2458-13-S3-S2
DO - 10.1186/1471-2458-13-S3-S2
M3 - Review article
C2 - 24564800
AN - SCOPUS:84884391520
SN - 1471-2458
VL - 13
JO - BMC public health
JF - BMC public health
IS - SUPPL.3
M1 - S2
ER -