Associations between early marriage and preterm delivery: Evidence from lowland Nepal

Miller, Faith; Marphatia, Akanksha A.; Wells, Jonathan C. K.; Cortina‐Borja, Mario; Manandhar, Dharma S; Saville, Naomi

doi:10.1002/ajhb.23709

Cited by 8 publications

(9 citation statements)

References 106 publications

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“…Mothers married at <18 years had higher odds of PD than those married ≥18 years. Same results have been found in Nepal, authors reported that participants married earlier had higher chance to have PD compared with women who married at ≥18 years 44. Usually, early married mothers are more likely to have early age at first birth, our unadjusted model showed that mothers got first baby at <20 years were more likely to have PD than mothers who had first delivered at ≥2–0 years.…”

Section: Discussionsupporting

confidence: 81%

Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district

et al. 2022

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ObjectivesPreterm delivery (PD) is a worldwide health burden particularly in low-income and middle-income countries such as Bangladesh. It is a key indicator of neonatal mortality and a risk of morbidity in later life. This study aimed to determine the prevalence of PD and its associated factors among mothers in Northern region of Bangladesh.Setting and participantsMultistage sampling technique was used to select samples covering all the population from 9 Upazilas in Rajshahi district with 233 community clinics. A total of 540 mothers and their under-5 children were enrolled for the study. Descriptive statistics, χ2 test and logistic regression model were used to analyse the data.ResultsAmong all live births, the prevalence of PD was found to be 14.6%. Multiple binary logistic regression model suggested five factors of PD: (1) mothers who used contraceptive pill had lower chance of PD (p<0.05); (2) mothers with high fever during pregnancy period were more likely to have PD (p<0.05); (3) mothers who did not receive antenatal care service less than four times during pregnancy period had higher chance of PD (p<0.01); (4) mothers first married before 18 years who were more likely to have PD (p<0.01); (5) PD delivered mothers had more chance to get low birth weight children (p<0.05). In addition, unadjusted model demonstrated that mothers delivered first baby before their age<20 years were more risk to get PD (p<0.05).ConclusionApproximately one in seven infants was born preterm in our study area. Family planning method, number of antenatal care visit, mothers’ age at marriage and high fever during pregnancy were the most important predictors of PD, these factors could be considered to reduce PD among Bangladeshi mothers. PD risk could be reduced by counselling and encouraging women to take antenatal care facilities from trained health providers.

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Section: Discussionsupporting

confidence: 81%

Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district

et al. 2022

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“…However, caste, land ownership, household assets, household location and girls' education in combination explained less than a quarter of the risk of early marriage (Marphatia et al, 2021).…”

Section: Introductionmentioning

confidence: 88%

“…This psychosocial stress may then impact child growth by impairing both placental nutrition and lactation through physiological mechanisms, through the action of hormones such as cortisol (Baker et al, 2018;Dejin-Karlsson et al, 2000;Mohd Shukri et al, 2019). In the same population, for example, we recently showed that early marriage, independent of age at pregnancy, is associated with an increased risk of delivering a baby preterm (Miller et al, 2021). Early marriage has also been associated with shorter maternal height, independent of early reproduction (Marphatia et al, 2021b).…”

Section: Introductionmentioning

confidence: 99%

Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal

Wells

Marphatia

Cortina‐Borja

et al. 2022

American Journal of Biological Anthropology

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Objectives: Maternal factors shape the risk of infant undernutrition, however the contributions of age at marriage versus age at pregnancy are rarely disentangled. We explore these issues in a population from lowland rural Nepal, where median ages at marriage and first pregnancy are 15 and 17 years respectively and marriage almost always precedes pregnancy. Methods:We analyzed data on first-time mothers (n = 3002) from a clusterrandomized trial (2012)(2013)(2014)(2015). Exposures were ages at marriage and pregnancy, categorized into groups. Outcomes were z-scores for weight (WAZ), length (LAZ), head circumference (HCAZ), and weight-for-length (WLZ), and prevalence of wasting and stunting, for neonates (<8 days) and infants (6-12 months). Mixed linear and logistic regression models tested associations of marriage and pregnancy ages with outcomes, adjusting for parental education, household assets, caste, landholding, seasonality, child sex, intervention arm, randomization strata and cluster.Results: For neonates, pregnancy <18 years predicted lower LAZ, and <19 years predicted lower WAZ and HCAZ. Results were largely null for marriage age, however early pregnancy and marriage at 10-13 years independently predicted neonatal stunting. For infants, earlier pregnancy was associated with lower LAZ and HCAZ, with a trend to lower WAZ for marriage 10-13 years. Early pregnancy, but not early marriage, predicted infant stunting.Conclusions: Early marriage and pregnancy were associated with poorer growth, mainly in terms of LAZ and HCAZ. Associations were stronger for neonatal than infant outcomes, suggesting pregnancy is more susceptible to these stresses. Early marriage and pregnancy may index different social and biological factors predicting child undernutrition.

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“…Second, marriage during adolescence may promote maternal psychosocial stress, which may then impair the transfer of nutrients to the foetus [ 26 , 27 ]. In our study population, for example, we found that early marriage was associated with an increased prevalence of delivering the baby preterm [ 28 ]. Third, women married young may be especially low in the marital household hierarchy, in turn limiting their access to food.…”

Section: Introductionmentioning

confidence: 99%

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

Wells

Marphatia

Manandhar

et al. 2022

Evolution, Medicine, and Public Health

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Background and objectives Women’s nutritional status is important for their health and reproductive fitness. In a population where early marriage is common, we investigated how women’s nutritional status is associated with their age at marriage (marking a geographical transfer between households), and at first pregnancy. Methodology We used data from a cluster randomised control trial from lowland Nepal (n = 4,071). Outcomes including body mass index (BMI) were measured in early pregnancy and trial endpoint, after delivery. We fitted mixed-effects linear and logistic regression models to estimate associations of age at marriage and age at pregnancy with outcomes, and with odds of chronic energy deficiency (CED, BMI <18.5 kg/m2), at both timepoints. Results BMI in early pregnancy averaged 20.9 kg/m2, with CED prevalence 12.5%. In 750 women measured twice, BMI declined 1.2 (95%CI 1.1, 1.3) kg/m2 between early pregnancy and endpoint, when CED prevalence was 35.5%. Early pregnancy was associated in dose-response manner with poorer nutritional status. Early marriage was independently associated with poorer nutritional status among those pregnant ≤15 years, but with better nutritional status among those pregnant ≥19 years. Conclusions and implications The primary determinant of nutritional status was age at pregnancy, but this association also varied by marriage age. Our results suggest that natal households may marry their daughters earlier if food insecure, but that their nutritional status can improve in the marital household if pregnancy is delayed. Marriage age therefore determines which household funds adolescent weight gain, with implications for Darwinian fitness of the members of both households. Lay Summary In lowland Nepal, the primary determinant of women’s nutritional status was age at pregnancy. However, among those pregnant early, those married earlier had poorer nutritional status, suggesting they were married to ameliorate food insecurity. Marriage age determines which household funds adolescent weight gain, with fitness implications for members of both households.

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Associations between early marriage and preterm delivery: Evidence from lowland Nepal

Cited by 8 publications

References 106 publications

Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district

Preterm delivery and its associated factors among mothers in Bangladesh: survey in Rajshahi district

Associations of maternal age at marriage and pregnancy with infant undernutrition: Evidence from first‐time mothers in rural lowland Nepal

Associations of age at marriage and first pregnancy with maternal nutritional status in Nepal

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