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Cited by 481Birth, Development, and HealthGlobal Maternal and Child HealthMaternal and Neonatal Healthcare

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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Fall, Caroline H D, Sachdev, Harshpal Singh, Osmond, Clive, Restrepo-Mendez, Maria Clara, Victora, Cesar, Martorell, Reynaldo, Stein, Aryeh D, Sinha, Shikha +5 more·2015·The Lancet Global Health
DOI 10.1016/s2214-109x(15)00038-8PMC PMC4547329
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Abstract

BACKGROUND: 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. METHODS: 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. FINDINGS: 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). INTERPRETATION: 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. FUNDING: Wellcome Trust and the Bill & Melinda Gates Foundation.

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  • Advanced female age is linked to the social determinants of education and gender equality, since both may delay acting on fertility desires and opportunities for procreation.

    “For example, advanced female age is linked to the social determinants of education and gender equality, since both may delay acting on fertility desires and opportunities for procreation (Broekmans et al., 2009; Fall et al., 2015; Van Roode et al., 2017; Cedars, 2022; Choi et al., 2023).”

    From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Fall et al., 2015

    The Introduction says that in some settings older mothers are educated women who delayed pregnancy for career reasons, supporting a qualified link between education and later childbearing. It does not say that gender equality delays childbearing or discuss delays in acting on fertility desires and opportunities; the Results also report that older mothers in these cohorts had less schooling. Page numbers were not supplied in our copy. (LLM, conf=0.85)

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  • Maternal and child health can be improved if each child has access to more resources and parental time.

    “Maternal and child health can be improved if each child has access to more resources and parental time, but potentially negatively if many children have no siblings (Fall et al., 2015).”

    From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Fall et al., 2015

    The Results (Parity; page unavailable) associate higher parity with poorer child growth and fewer years of schooling, which partly supports a benefit to children when there are fewer siblings. The paper does not establish that greater resources or parental time cause that benefit, or that maternal health improves; it also does not report harms from having no siblings. (LLM, conf=0.82)

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  • Maternal and child health can be negatively affected if many children have no siblings.

    “Maternal and child health can be improved if each child has access to more resources and parental time, but potentially negatively if many children have no siblings (Fall et al., 2015).”

    From Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature (2024) · cites this paper as Fall et al., 2015

    The Methods (Statistical Methods; page unavailable) say that some cohorts included no sibling pairs in the study sample, not that participants had no siblings. The Results (Parity; page unavailable) examine birth weight, child growth and schooling by maternal parity, but do not establish whether having no siblings harms maternal or child health. Searches for only children, siblings and parity found no passage addressing that claim. (LLM, conf=0.78)

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Authors
Fall, C. H. D., Sachdev, H. S., Osmond, C., Restrepo-Mendez, M. C., Victora, C., Martorell, R., Stein, A. D., Sinha, S., Tandon, N., Adair, L., Bas, I., Norris, S., & Richter, L. M.
Affiliations
  • MRC Lifecourse Epidemiology Unit (GB)
  • Sitaram Bhartia Institute of Science and Research (IN)
  • Universidade Federal de Pelotas (BR)
  • Emory University (US)
  • All India Institute of Medical Sciences (IN)
  • University of North Carolina at Chapel Hill (US)
  • University of San Carlos (PH)
  • University of the Witwatersrand (ZA)
  • Human Sciences Research Council (ZA)
Corresponding author
Fall, Caroline H D
ORCID
Venue
The Lancet Global Health
Publisher
Elsevier BV
Published
2015-07
Volume
3
Issue
7
Pages
e366-e377
ISSN
2214-109X (ISSN-L)
DOI
10.1016/s2214-109x(15)00038-8
PMC
PMC4547329
OpenAlex
W2124834953
Cited by
481
References
46
Citations by year
2026: 33 · 2025: 50 · 2024: 47 · 2023: 58 · 2022: 55 · 2021: 52 · 2020: 49 · 2019: 37 · 2018: 34 · 2017: 39 · 2016: 21 · 2015: 5 · 2014: 1
FWCI
32.87
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Global Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bushehr University of Medical Sciences Repository (Bushehr University of Medical Sciences) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion, cc-by)
  • Explore Bristol Research (submittedVersion, cc-by)
Funders
  • Wellcome Trust (UK)
  • Bill & Melinda Gates Foundation
  • US National Institutes of Health
  • US National Science Foundation
  • Wellcome Trust
  • Indian Council of Medical Research
  • US National Center for Health Statistics
  • Medical Research Council [UK]
  • British Heart Foundation
  • Human Sciences Research Council
  • South African Medical Research Council
  • Mellon Foundation
  • South-African Netherlands Programme on Alternative Development
  • Anglo American Chairman's Fund
  • University of the Witwatersrand
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
maternal age at birth, advanced maternal age, birth weight, preterm birth, stunting, child nutritional status, adult height, body composition, cardiometabolic risk factors, educational attainment, low- and middle-income countries, birth cohort, socioeconomic status, breastfeeding duration, parity, coming of age, Brazil, Guatemala, India, Philippines, South Africa
MeSH terms
Adolescent, Adult, Age Factors, Birth Weight, Blood Glucose, Child, Child, Preschool, Developing Countries, Educational Status, Female, Gestational Age, Growth Disorders, Humans, Income, Infant, Newborn, Male, Maternal Age, Mothers, Pregnancy, Prospective Studies, Schools, Global Health, Premature Birth, Young Adult

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