Association of Maternal Stature With Offspring Mortality, Underweight, and Stunting in Low- to Middle-Income Countries

Emre Özaltin, Kenneth Hill, S. V. Subramanian
Departments of Global Health and Population (Dr Hill and Mr Özaltin) and Society, Human Development, and Health (Dr Subramanian), Harvard School of Public Health, Boston, Massachusetts.
JAMA. 2010;303(15):1507-1516.- Vol. 303 No. 15, April 21, 2010
URL: http://jama.ama-assn.org/cgi/content/abstract/303/15/1507

 Context
 Although maternal stature has been associated with offspring mortality and health, the extent to which this association is universal across developing countries is unclear.

Objective 
To examine the association between maternal stature and offspring mortality, underweight, stunting, and wasting in infancy and early childhood in 54 low- to middle-income countries.

Design, Setting, and Participants 
Analysis of 109 Demographic and Health Surveys in 54 countries conducted between 1991 and 2008. Study population consisted of a nationally representative cross-sectional sample of children aged 0 to 59 months born to mothers aged 15 to 49 years. Sample sizes were 2 661 519 (mortality), 587 096 (underweight), 558 347 (stunting), and 568 609 (wasting) children.

Main Outcome Measures 
Likelihood of mortality, underweight, stunting, or wasting in children younger than 5 years.

Results 
The mean response rate across surveys in the mortality data set was 92.8%. In adjusted models, a 1-cm increase in maternal height was associated with a decreased risk of child mortality (absolute risk difference [ARD], 0.0014; relative risk [RR], 0.988; 95% confidence interval [CI], 0.987-0.988), underweight (ARD, 0.0068; RR, 0.968; 95% CI, 0.968-0.969), stunting (ARD, 0.0126; RR, 0.968; 95% CI, 0.967-0.968), and wasting (ARD, 0.0005; RR, 0.994; 95% CI, 0.993-0.995). Absolute risk of dying among children born to the tallest mothers (≥160 cm) was 0.073 (95% CI, 0.072-0.074) and to those born to the shortest mothers (<145 cm) was 0.128 (95% CI, 0.126-0.130). Country-specific decrease in the risk for child mortality associated with a 1-cm increase in maternal height varied between 0.978 and 1.011, with the decreased risk being statistically significant in 46 of 54 countries (85%) ({alpha} = .05).

Conclusion 
Among 54 low- to middle-income countries, maternal stature was inversely associated with offspring mortality, underweight, and stunting in infancy and childhood.