title: Maternal Age at Childbirth and Perinatal and Under five Mortality in a Prospective Birth Cohort from Delhi.
abstract: OBJECTIVE
  To evaluate the relationship between maternal age at child birth, and perinatal and under-five mortality.
  
  
  METHODS
  Prospective birth cohort.
  
  
  METHODS
  Urban community.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Young motherhood is associated with an increased risk of post-perinatal mortality and measures to prevent early childbearing should be strengthened.
authors.affiliation: Sitaram 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.
authors.forename: Sikha
authors.initials: S
authors.lastname: Sinha
authors.forename: Abha Rani
authors.initials: AR
authors.lastname: Aggarwal
authors.forename: Clive
authors.initials: C
authors.lastname: Osmond
authors.forename: Caroline Hd
authors.initials: CH
authors.lastname: Fall
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Bhargava
authors.forename: Harshpal Singh
authors.initials: HS
authors.lastname: Sachdev
mesh_terms: D000293:Adolescent; D046688:Child Mortality; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008423:Maternal Age; D054238:Perinatal Mortality; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D012307:Risk Factors; D012959:Socioeconomic Factors