Study investigates potential long-term effects of maternal stature on offspring mortality

Among 54 low- to middle-income countries, a mother's shorter height is associated with a higher rate of death for her children and a greater likelihood of these children being underweight and having a reduced rate of growth, according to a study in the April 21 issue of JAMA.

Emre Ozaltin, M.Sc., Kenneth Hill, Ph.D., and S. V. Subramanian, Ph.D., of the Harvard School of Public Health, Boston, investigated the potential long-term effects of maternal stature on offspring mortality, underweight, stunting, and wasting in infancy and early childhood. The study included an analysis of 109 Demographic and Health Surveys in 54 low- to middle-income countries, conducted between 1991 and 2008. The study population consisted of a nationally representative cross-sectional sample of children ages 0 to 59 months born to mothers ages 15 to 49 years. Sample sizes were 2,661,519 (mortality), 587,096 (underweight), 558,347 (stunting), and 568,609 (wasting) children. The average response rate across surveys in the mortality data set was 92.8 percent.

Of the more than 2.6 million children in the study, 11.7 percent died before reaching 5 years of age. The prevalence of child mortality ranged from 24.7 percent in Niger to 3.3 percent in Jordan.

In adjusted models, a 0.4 inch increase in maternal height was associated with a decreased risk of offspring mortality, underweight, stunting, and wasting. Compared with the tallest mothers (5'3" or taller), each lower height category had substantially higher risk of child mortality, with children born to mothers of height shorter than 4'9" having an increased risk of death of nearly 40 percent. Mortality risk associated with increased height was decreased in 52 of 54 countries and was statistically significant in 46 of 54 countries.

"Underscoring the policy significance of this association, for child mortality, the effect of being in the lowest height category (relative to the tallest) was approximately 70 percent and 80 percent of the size of the effect of having no education or being in the poorest income quintile, respectively. For childhood underweight and stunting, maternal height was the most important factor, with an effect size about twice that of being in the lowest education category and 1.5 times that of being in the poorest quintile," the authors write.

"This suggests the presence of an intergenerational transmission from mother's own nutrition, disease, and socioeconomic circumstances during her childhood to her offspring's health and mortality in their infancy and childhood."