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Maternal Age at Childbirth and Perinatal and Under five Mortality in a Prospective Birth Cohort from Delhi
Sikha Sinha1, Abha Rani Aggarwal, Clive Osmond
1Sitaram Bhartia Institute of Science and Research, New Delhi, India; #University School of Medicine and Para-medical Health Sciences, Guru Gobind Singh Indraprastha University, Delhi, India; National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, India; ‡MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; and ^Sunder Lal Jain Hospital, New Delhi, India. Correspondence to: Prof HPS Sachdev, Senior Consultant Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, B-16 Qutab Institutional Area, New Delhi 110 016, India. hpssachdev@gmail.com.
Insights
Young motherhood significantly increases the risk of post-perinatal mortality. Strengthening measures to prevent early childbearing is crucial for improving child survival rates.
Area of Science:
- Public Health
- Epidemiology
- Demography
Background:
- Maternal age at childbirth is a critical determinant of offspring health outcomes.
- Understanding the association between maternal age and child mortality is vital for public health interventions.
- Previous studies have shown varied associations, necessitating further investigation in diverse populations.
Purpose of the Study:
- To investigate the relationship between maternal age at childbirth and perinatal and under-five mortality.
- To quantify the risk of offspring mortality associated with young and advanced maternal ages.
Main Methods:
- A prospective birth cohort study was conducted in an urban community.
- Data from 8181 live births in the New Delhi Birth Cohort were analyzed.
- Offspring survival status was tracked from 28 weeks gestation up to 5 years of age.
Main Results:
- A U-shaped association was observed between maternal age and offspring mortality (stillbirths to 5 years).
- Younger mothers (≤19 years) and older mothers (≥35 years) faced a higher risk of offspring mortality compared to the 20-24 year age group.
- The increased mortality risk in young mothers persisted after adjusting for socio-economic, behavioral, and biological factors.
Conclusions:
- Young motherhood is significantly linked to an elevated risk of post-perinatal mortality.
- Interventions aimed at preventing early childbearing should be reinforced to enhance child survival.
- While older maternal age showed a trend towards higher mortality, it was not statistically significant after adjustments.
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.
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