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).
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).
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DOI：
10.1016/s2214-109x(15)00038-8
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
COHORTS investigators
中科院分区：
文献类型：
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作者：
Fall CH;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;COHORTS investigators
年轻和高龄产妇都与不良的分娩和儿童结局有关。很少有研究在低收入和中等收入国家（LMIC）研究这些关联，也没有研究后代的成年结果。我们的目的是检查儿童和成人的结果在五个低收入国家。在这项前瞻性研究中，我们汇总了来自COHORTS（转型社会健康导向研究联盟）的数据-这是来自LMIC（巴西，危地马拉，印度，菲律宾和南非）的五个出生队列的合作，其中母亲在怀孕前或怀孕期间被招募，儿童随访至成年。我们研究了母亲年龄与子女出生体重、出生时的胎龄、儿童期的年龄别身高和身高别体重Z评分、受教育程度、成人身高、身体成分（体重指数、腰围、脂肪和瘦体重）和心脏代谢危险因素（血压和空腹血糖浓度）之间的关系，以及沿着来自这些因素的二元变量。分析未调整和调整母亲的社会经济地位，身高和产次，母乳喂养时间。我们从五个队列中获得了22188名母亲的数据，这些母亲在1969年至1989年的不同时间入学。 19403名后代（87%）的母亲年龄和至少一种结局数据可用。 在未校正的分析中，年轻（≤19岁）和年长（≥35岁）的母亲年龄与较低的出生体重、胎龄、儿童营养状况和学校教育相关。调整后，与母亲年龄较小的关联仍然是低出生体重（比值比[OR] 1.18（95%CI 1.02 - 1.36）），早产（1·26 [1·03-1·53]），发育迟缓2年（1.46 [1.25 - 1.70]）和未能完成中学教育（1.38 [1.18 - 1.62]）。调整后，高龄产妇的年龄仍然与早产风险增加相关（OR 1.33 [95%CI 1.05 - 1.67]），但高龄产妇的孩子2年发育迟缓（0.64 [0.54 - 0.77]）和未能完成中学教育（0.59 [0.48 - 0.71]）的情况比母亲年龄在20-24岁的孩子要少。年轻和年长母亲的后代具有较高的成人空腹血糖浓度（约0.05 mmol/L）。中低收入国家年轻母亲的子女在出生时、在儿童营养和上学方面处于不利地位。要加强预防早育工作。调整混杂因素后，大龄母亲的子女在营养状况和受教育方面具有优势。母亲年龄的极端可能与后代葡萄糖代谢紊乱有关。Wellcome Trust和Bill & Melinda Gates Foundation。
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. 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. 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). 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. Wellcome Trust and the Bill & Melinda Gates Foundation.