Publications & Reports

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

Naoko Kozuki, Anne C C Lee, Mariangela F Silveira, Ayesha Sania, Joshua P Vogel, Linda Adair, Fernando Barros, Laura E Caulfield, Parul Christian, Wafaie Fawzi, Jean Humphrey, Lieven Huybregts, Aroonsri Mongkolchati, Robert Ntozini, David Osrin, Dominique Roberfroid, James Tielsch, Anjana Vaidya, Robert E Black, Joanne Katz

Abstract

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.

Publication

  • Journal: BMC Public Health
  • Published: 17/09/2013
  • Volume: 13 Suppl 3
  • Pagination: S2

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