The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis

BMC Public Health

Review

Aroonsri Mongkolchati¹  Ayesha Sania²  Lieven Huybregts³  Robert E Black⁴  Joanne Katz⁴  James Tielsch⁴  Laura E Caulfield⁴  Naoko Kozuki⁴  Parul Christian⁴  Anne CC Lee⁵  Jean Humphrey⁶  Wafaie Fawzi⁷  David Osrin⁸  Anjana Vaidya⁸  Mariangela F Silveira⁹  Fernando Barros^1,10  Joshua P Vogel^1,11  Linda Adair^1,12  Dominique Roberfroid^1,13  Robert Ntozini^1,14 

[1] ASEAN Institute for Health Development, Mahidol University, 999 Phuttamonthon 4 Rd, 73170, Salaya, Nakhon Pathom, Thailand;Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, 02115, Boston, MA, USA;Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, B – 9000, Ghent, Belgium;Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerpen, Belgium;Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, 21205, Baltimore, MD, USA;Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, 21205, Baltimore, MD, USA;Brigham and Women’s Hospital, 75 Francis Street, 02115, Boston, MA, USA;Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, 21205, Baltimore, MD, USA;Zvitambo, No 1 Borrowdale Road, Borrowdale, Harare, Zimbabwe;Departments of Nutrition, Epidemiology, and Global Health and Population, Harvard School of Public Health, 677 Huntington Ave, 02115, Boston, MA, USA;Institute for Global Health, UCL Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK;Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3o piso, Centro, CEP 96020-220, Pelotas, RS, Brazil;Programa de Pós-graduacao em Epidemiologia, Universidade Federal de Pelotas, Rua Marechal Deodoro 1160, 3o piso, Centro, CEP 96020-220, Pelotas, RS, Brazil;Programa de Pós-graduação em Saúde e Comportamento, Univertsidade Católica de Pelotas, Félix da Cunha, 412, CEP 96010-000, Centro, Pelotas, RS, Brazil;School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Highway, 6009, Crawley, Perth, WA, Australia;UNDP/UNFPA/UNICEF/WHO/Word Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland;University of North Carolina School of Public Health, 135 Dauer Drive, 27599, Chapel Hill, NC, USA;Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerpen, Belgium;Zvitambo, No 1 Borrowdale Road, Borrowdale, Harare, Zimbabwe;

关键词: Preterm Birth;    Infant Mortality;    Risk Category;    Neonatal Mortality;    Nulliparous Woman;   

DOI  :  10.1186/1471-2458-13-S3-S2

来源: Springer

【 摘 要 】

BackgroundPrevious 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).MethodsData 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.ResultsNulliparous, 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.ConclusionsNulliparous 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.FundingFunding 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.

【 授权许可】

Unknown   
© Kozuki et al; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.