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Indian Pediatrics

, Volume 53, Issue 10, pp 871–877 | Cite as

Maternal age at childbirth and perinatal and under-five mortality in a prospective birth cohort from Delhi

  • Sikha Sinha
  • Abha Rani Aggarwal
  • Clive Osmond
  • Caroline H. D. Fall
  • Santosh K. Bhargava
  • Harshpal Singh Sachdev
Research Paper

Abstract

Objective

To evaluate the relationship between maternal age at child birth, and perinatal and under-five mortality.

Design

Prospective birth cohort.

Setting

Urban community.

Participants

9169 pregnancies in the New Delhi Birth Cohort resulted in 8181 live births. These children were followed for survival status and anthropometric measurements at birth (+3 days), 3,6,9 and 12 months (7 days), and every 6 months thereafter until 21 years age. Information on maternal age at child birth and socio-demographic profile was also obtained.

Outcome measures

Offspring mortality from 28 weeks gestation till 5 years age.

Results

Offspring mortality (stillbirths–5 years; n=328) had a U-shaped association with maternal age (P<0.001). Compared to the reference group (20-24 years), younger (≤19 years) and older (≥ 35 years) maternal ages were associated with a higher risk of offspring mortality (HR: 1.68; 95% CI 1.16, 2.43 and HR 1.48; 95% CI 1.01, 2.16, respectively). In young mothers, the increased risk persisted after adjustment for socio-economic confounders (maternal education, household income and wealth; HR 1.51; 95% CI 1.03, 2.20) and further for additional behavioral (place of delivery) and biological mediators (gestation and birthweight) (HR 2.14; 95% CI 1.25,3.64). Similar associations were documented for post-perinatal deaths but for perinatal mortality the higher risk was not statistically significant (P >0.05). In older mothers, the increased mortality risk was not statistically significant (P >0.05) after adjustment for socio-economic confounders.

Conclusion

Young motherhood is associated with an increased risk of post-perinatal mortality and measures to prevent early childbearing should be strengthened.

Key Words

Child mortality Risk factors Teenage pregnancy 

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References

  1. 1.
    You D, Hug L, Ejdemyr S, Idele P, Hogan D, Mathers C, et al. Global, regional, and national levels and trends in under-5 mortality between 1990 and 2015,with scenariobased projections to 2030: A systematic analysis by the UN Inter-agency Group for Child Mortality Estimation. Lancet. 2015;386:2275–86.CrossRefPubMedGoogle Scholar
  2. 2.
    SRS Statistical Report, September 2014, Volume 49 No. 1. Available from: http://censusindia.gov.in/vital_statistics/SRS_Bulletins/SRS%20Bulletin%20-Sepetember%202014.pdf. Accessed March 30, 2016.Google Scholar
  3. 3.
    Paul VK, Sachdev HS, Mavalankar D, Ramachandran P, Sankar MJ, Bhandari N, et al. Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet. 2011;377:332–49.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    IGME Report 2015 Child Mortality Final UNICEF. Available from: http://www.childmortality.org/files_v20/download/IGME%20report%202015%20child% 20mortality%20final.pdf. Accessed March 30, 2016.Google Scholar
  5. 5.
    Lawn JE, Blencowe H, Waiswa P, Amouzou A, Mathers C, Hogan D, et al.; Lancet Ending Preventable Stillbirths Series study group; Lancet Stillbirth Epidemiology investigator group. Stillbirths: rates, risk factors, and acceleration towards 2030. Lancet. 2016;387:587–603.CrossRefPubMedGoogle Scholar
  6. 6.
    Fall CH, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, et al.; COHORTS investigators. 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). Lancet Glob Health. 2015;3:e366–77.CrossRefPubMedGoogle Scholar
  7. 7.
    The State of the World’s Children 2015: Executive Summary. http://www.unicef.org/publications/files/SOWC_2015_Summary_and_Tables.pdf. Accessed June 6, 2016.Google Scholar
  8. 8.
    Markovitz BP, Cook R, Flick LH, Leet TL. Socioeconomic factors and adolescent pregnancy outcomes: Distinctions between neonatal and post-neonatal deaths? BMC Public Health. 2005;5:79.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Chen XK, Wen SW, Fleming N, Yang Q, Walker MC. Increased risks of neonatal and postneonatal mortality associated with teenage pregnancy had different explanations. J Clin Epidemiol. 2008;61:688–94.CrossRefPubMedGoogle Scholar
  10. 10.
    Kapoor RK, Srivastava AK, Misra PK, Sharma B, Thakur S, Srivastava KI, et al. Perinatal mortality in urban slums in Lucknow. Indian Pediatr. 1996;33:19–23.PubMedGoogle Scholar
  11. 11.
    Raj A, Saggurti N, Winter M, Labonte A, Decker MR, Balaiah D, et al. The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample. Br Med J. 2010;340:b4258.CrossRefGoogle Scholar
  12. 12.
    Singh R, Tripathi V. Maternal factors contributing to under-five mortality at birth order 1 to 5 in India: a comprehensive multivariate study. Springerplus. 2013;2:284.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Restrepo-Méndez MC, Barros AJ, Santos IS, Menezes AM, Matijasevich A, Barros FC, et al. Childbearing during adolescence and offspring mortality: findings from three population-based cohorts in southern Brazil. BMC Public Health. 2011;11:781.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Richter LM, Victora CG, Hallal PC, Adair LS, Bhargava SK, Fall CH, et al; COHORTS Group. Cohort profile: the Consortium of Health-Orientated Research in Transitioning Societies. Int J Epidemiol. 2012;41:621–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Bhargava SK, Sachdev HS, Fall CH, Osmond C, Lakshmy R, Barker DJ, et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. 2004;350:865–75.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bradburn MJ, Clark TG, Love SB, Altman DG. Survival analysis part II: multivariate data analysis — an introduction to concepts and methods. Br J Cancer. 2003;89:431–6.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–68.CrossRefPubMedGoogle Scholar
  18. 18.
    Finlay JE, Ozaltin E, Canning D. The association of maternal age with infant mortality, child anthropometric failure, diarrhoea and anemia for first births: evidence from 55 low-and middle-income countries. BMJ Open. 2011;1:e000226.CrossRefGoogle Scholar
  19. 19.
    Haldre K, Rahu K, Karro H, Rahu M. Is a poor pregnancy outcome related to young maternal age? A study of teenagers in stonia during the period of major socioeconomic changes (from 1992 to 2002). Eur J Obstet Gynecol Reprod Biol. 2007;131:45–51.CrossRefPubMedGoogle Scholar
  20. 20.
    Chen XK, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36:368–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Gilbert W, Jandial D, Field N, Bigelow P, Danielsen B. Birth outcomes in teenage pregnancies. J Matern Fetal Neonatal Med. 2004;16:265–70.CrossRefPubMedGoogle Scholar
  22. 22.
    Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and infant mortality. Br J Obstet Gynaecol. 1999;106:116–21.CrossRefPubMedGoogle Scholar
  23. 23.
    Cowden AJ, Funkhouser E. Adolescent pregnancy, infant mortality, and source of payment for birth: Alabama residential live births, 1991-1994. J Adolesc Health. 2001;29:37–45.CrossRefPubMedGoogle Scholar
  24. 24.
    Golding J, Greenwood R, McCaw-Binns A, Thomas P. Associations between social and environmental factors and perinatal mortality in Jamaica. Paediatr Perinat Epidemiol. 1994;8:17–39.CrossRefPubMedGoogle Scholar
  25. 25.
    Were WM, Daelmans B, Bhutta Z, Duke T, Bahl R, Boschi-Pinto C, et al. Children’s health priorities and interventions. Br Med J. 2015;351:h4300.CrossRefGoogle Scholar
  26. 26.
    C-6. Ever Married and Currently Married Population by Age at Marriage, Duration of Marriage and Educational Level- 2011 (India and States/UTs/District level). Available from: http://www.censusindia.gov.in/2011census/C-series/C-6.html(DDW-0000C-06.XLSX). Accessed June 6, 2016.Google Scholar
  27. 27.
    NFHS 4 Factsheet. Available from: http://rchiips.org/NFHS/factsheet_NFHS-4.shtm. Accessed March 30, 2016.Google Scholar

Copyright information

© Indian Academy of Pediatrics 2016

Authors and Affiliations

  • Sikha Sinha
    • 1
    • 2
  • Abha Rani Aggarwal
    • 3
  • Clive Osmond
    • 4
  • Caroline H. D. Fall
    • 4
  • Santosh K. Bhargava
    • 5
  • Harshpal Singh Sachdev
    • 1
    • 6
  1. 1.Sitaram Bhartia Institute of Science and ResearchNew DelhiIndia
  2. 2.University School of Medicine and Para-medical Health SciencesGuru Gobind Singh Indraprastha UniversityDelhiIndia
  3. 3.National Institute of Medical StatisticsIndian Council of Medical ResearchNew DelhiIndia
  4. 4.MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
  5. 5.Sunder Lal Jain HospitalNew DelhiIndia
  6. 6.Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and ResearchNew DelhiIndia

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