title: 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).
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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Wellcome Trust and the Bill & Melinda Gates Foundation.
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK. Electronic address: chdf@mrc.soton.ac.uk.
authors.forename: Caroline H D
authors.initials: CH
authors.lastname: Fall
authors.affiliation: Sitaram Bhartia Institute of Science and Research, New Delhi, India.
authors.forename: Harshpal Singh
authors.initials: HS
authors.lastname: Sachdev
authors.affiliation: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.affiliation: Universidade Federal de Pelotas, Capão do Leão, Pelotas, Brazil.
authors.forename: Maria Clara
authors.initials: MC
authors.lastname: Restrepo-Mendez
authors.affiliation: Universidade Federal de Pelotas, Capão do Leão, Pelotas, Brazil.
authors.forename: Cesar
authors.initials: C
authors.lastname: Victora
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Martorell
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Aryeh D
authors.initials: AD
authors.lastname: Stein
authors.affiliation: Sitaram Bhartia Institute of Science and Research, New Delhi, India.
authors.forename: Shikha
authors.initials: S
authors.lastname: Sinha
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Adair
authors.affiliation: Office of Population Studies Foundation, University of San Carlos, Cebu, Philippines.
authors.forename: Isabelita
authors.initials: I
authors.lastname: Bas
authors.affiliation: Medical Research Council Developmental Pathways for Health Research Unit, Witwatersrand University, Johannesburg, South Africa.
authors.forename: Shane
authors.initials: S
authors.lastname: Norris
authors.affiliation: Human Sciences Research Council, Durban, South Africa.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D014943:Global Health; D006130:Growth Disorders; D006801:Humans; D007182:Income; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D009035:Mothers; D011247:Pregnancy; D047928:Premature Birth; D011446:Prospective Studies; D012574:Schools; D055815:Young Adult
chemical_list: D001786:Blood Glucose