title: Short Maternal Stature Increases Risk of Small-for-Gestational-Age and Preterm Births in Low- and Middle-Income Countries: Individual Participant Data Meta-Analysis and Population Attributable Fraction.
abstract: BACKGROUND
  Small-for-gestational-age (SGA) and preterm births are associated with adverse health consequences, including neonatal and infant mortality, childhood undernutrition, and adulthood chronic disease.
  
  
  OBJECTIVE
  The specific aims of this study were to estimate the association between short maternal stature and outcomes of SGA alone, preterm birth alone, or both, and to calculate the population attributable fraction of SGA and preterm birth associated with short maternal stature.
  
  
  METHODS
  We conducted an individual participant data meta-analysis with the use of data sets from 12 population-based cohort studies and the WHO Global Survey on Maternal and Perinatal Health (13 of 24 available data sets used) from low- and middle-income countries (LMIC). We included those with weight taken within 72 h of birth, gestational age, and maternal height data (n = 177,000). For each of these studies, we individually calculated RRs between height exposure categories of < 145 cm, 145 to < 150 cm, and 150 to < 155 cm (reference: ≥ 155 cm) and outcomes of SGA, preterm birth, and their combination categories. SGA was defined with the use of both the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) birth weight standard and the 1991 US birth weight reference. The associations were then meta-analyzed.
  
  
  RESULTS
  All short stature categories were statistically significantly associated with term SGA, preterm appropriate-for-gestational-age (AGA), and preterm SGA births (reference: term AGA). When using the INTERGROWTH-21st standard to define SGA, women < 145 cm had the highest adjusted risk ratios (aRRs) (term SGA-aRR: 2.03; 95% CI: 1.76, 2.35; preterm AGA-aRR: 1.45; 95% CI: 1.26, 1.66; preterm SGA-aRR: 2.13; 95% CI: 1.42, 3.21). Similar associations were seen for SGA defined by the US reference. Annually, 5.5 million term SGA (18.6% of the global total), 550,800 preterm AGA (5.0% of the global total), and 458,000 preterm SGA (16.5% of the global total) births may be associated with maternal short stature.
  
  
  CONCLUSIONS
  Approximately 6.5 million SGA and/or preterm births in LMIC may be associated with short maternal stature annually. A reduction in this burden requires primary prevention of SGA, improvement in postnatal growth through early childhood, and possibly further intervention in late childhood and adolescence. It is vital for researchers to broaden the evidence base for addressing chronic malnutrition through multiple life stages, and for program implementers to explore effective, sustainable ways of reaching the most vulnerable populations.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Naoko
authors.initials: N
authors.lastname: Kozuki
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; jkatz1@jhu.edu.
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.affiliation: Department of Newborn Medicine, Brigham and Women's Hospital, Boston, MA;
authors.forename: Anne C C
authors.initials: AC
authors.lastname: Lee
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia; UN Development Programme/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Vogel
authors.affiliation: Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil;
authors.forename: Mariangela F
authors.initials: MF
authors.lastname: Silveira
authors.affiliation: Department of Global Health and Population.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Sania
authors.affiliation: Department of Health Statistics and Information Systems, and.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Stevens
authors.affiliation: Maternal Reproductive and Child Health Center, and.
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Laura E
authors.initials: LE
authors.lastname: Caulfield
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.affiliation: Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Poverty, Nutrition and Health Division, International Food Policy Research Institute, Washington, DC;
authors.forename: Lieven
authors.initials: L
authors.lastname: Huybregts
authors.affiliation: Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium;
authors.forename: Dominique
authors.initials: D
authors.lastname: Roberfroid
authors.affiliation: Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark;
authors.forename: Christentze
authors.initials: C
authors.lastname: Schmiegelow
authors.affiliation: University of North Carolina School of Public Health, Chapel Hill, NC;
authors.forename: Linda S
authors.initials: LS
authors.lastname: Adair
authors.affiliation: Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil;
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Barros
authors.affiliation: Prevention of Noncommunicable Diseases Department, WHO, Geneva, Switzerland;
authors.forename: Melanie
authors.initials: M
authors.lastname: Cowan
authors.affiliation: Department of Global Health and Population, Department of Nutrition, and Department of Epidemiology, Harvard School of Public Health, Boston, MA;
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.affiliation: Department of Food Safety and Food Quality, Ghent University, Ghent, Belgium; Woman and Child Health Research Center, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium;
authors.forename: Patrick
authors.initials: P
authors.lastname: Kolsteren
authors.affiliation: UN Development Programme/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, BD, Franklin Lakes, NJ;
authors.forename: Mario
authors.initials: M
authors.lastname: Merialdi
authors.affiliation: ASEAN Institute for Health Development, Mahidol University, Salaya, Nakhon Pathom, Thailand;
authors.forename: Aroonsri
authors.initials: A
authors.lastname: Mongkolchati
authors.affiliation: Institute for Global Health, Institute of Child Health, University College London, London, United Kingdom; Mother and Infant Research Activities, Kathmandu, Nepal;
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
authors.affiliation: Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil;
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.affiliation: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Center for Global Child Health, Hospital for Sick Children, Toronto, Canada;
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Maternal Reproductive and Child Health Center, and Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom;
authors.forename: Hannah
authors.initials: H
authors.lastname: Blencowe
authors.affiliation: Medical Research Council - Public Health England (MRC-PHE) Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom;
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.affiliation: Maternal Reproductive and Child Health Center, and Saving Newborn Lives/Save the Children USA, Washington, DC; and Research and Evidence Division, UK Aid, London, United Kingdom.
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D001827:Body Height; D001835:Body Weight; D002657:Child Development; D003906:Developing Countries; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D009035:Mothers; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D047929:Term Birth; D055815:Young Adult
keywords: chronic malnutrition; maternal health; maternal height; neonatal health; small-for-gestational-age