Association of maternal stature with offspring mortality, underweight, and stunting in low- to middle-income countries

Abstract

Context: Although maternal stature has been associated with offspring mortality and health, the extent to which this association is universal across developing countries is unclear.

Objective: To examine the association between maternal stature and offspring mortality, underweight, stunting, and wasting in infancy and early childhood in 54 low- to middle-income countries.

Design, setting, and participants: Analysis of 109 Demographic and Health Surveys in 54 countries conducted between 1991 and 2008. Study population consisted of a nationally representative cross-sectional sample of children aged 0 to 59 months born to mothers aged 15 to 49 years. Sample sizes were 2,661,519 (mortality), 587,096 (underweight), 558,347 (stunting), and 568,609 (wasting) children.

Main outcome measures: Likelihood of mortality, underweight, stunting, or wasting in children younger than 5 years.

Results: The mean response rate across surveys in the mortality data set was 92.8%. In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (absolute risk difference [ARD], 0.0014; relative risk [RR], 0.988; 95% confidence interval [CI], 0.987-0.988), underweight (ARD, 0.0068; RR, 0.968; 95% CI, 0.968-0.969), stunting (ARD, 0.0126; RR, 0.968; 95% CI, 0.967-0.968), and wasting (ARD, 0.0005; RR, 0.994; 95% CI, 0.993-0.995). Absolute risk of dying among children born to the tallest mothers (> or = 160 cm) was 0.073 (95% CI, 0.072-0.074) and to those born to the shortest mothers (< 145 cm) was 0.128 (95% CI, 0.126-0.130). Country-specific decrease in the risk for child mortality associated with a 1-cm increase in maternal height varied between 0.978 and 1.011, with the decreased risk being statistically significant in 46 of 54 countries (85%) (alpha = .05).

Conclusion: Among 54 low- to middle-income countries, maternal stature was inversely associated with offspring mortality, underweight, and stunting in infancy and childhood.

Figures

Figure 1

Country-Specific Adjusted Change in Offspring Mortality Risks for 1-cm Increase in Maternal Height Among Children Younger Than 5 Years Plotted on log scale; error bars are 95% confidence intervals (CIs). Wald test for equivalence of coefficients rejected (χ2=165.37, P<.001). See eTable 5 for relative risks and CIs by country. Tanzania refers to the United Republic of Tanzania and Guinea refers to the Republic of Guinea. An interactive information graphic is available at http://www.jama.com.

Figure 2

Box Plots of Relative Risk for the Association Between 1-cm Increase in Maternal Height and Offspring Mortality Among Children by World Bank Income Classification and WHO Regional Classification of Countries WHO, World Health Organization; IQR, interquartile range. Plotted on log scale. For World Bank income classification, low income indicates $975 or less; lower middle income, $976–$3855; upper middle income, $3856–$11 905 (2008) gross national income per capita. Boxes indicate first and third quartiles with median lines; whiskers indicate first quartile minus 1.5 × IQR and third quartile + 1.5 × IQR; all values outside the whiskers are shown as filled circles (outliers). An interactive information graphic is available at http://www.jama.com.