In developing countries, shorter maternal height associated with higher death rates for children

April 20, 2010

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."

(JAMA. 2010;303[15]:1507-1516. Available pre-embargo to the media at

Editor's Note: Please see the article for interactive graphs and additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Maternal Height and Risk of Child Mortality and Undernutrition

Parul Christian, Dr.P.H., M.Sc., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, writes in an accompanying editorial that maternal stature, overall maternal nutritional status, and the factors that give rise to them needs more emphasis, especially because early growth failure is known to track into childhood and beyond. She calls attention to the challenge and potential public health value of addressing maternal undernutrition and maternal short stature as an approach to reducing child mortality in low- and middle-income countries.

Christian writes, "The speculation by Ozaltin et al that the intergenerational transmission from the mother's environmental milieu during her own childhood (and also fetal life) to her offspring's growth and survival may be plausible in explaining the relationship between maternal stature and child mortality and undernutrition, although further investigation of this phenomenon in cohort studies is needed. Also, because short maternal stature is less common in sub-Saharan Africa, the risk of child mortality and undernutrition attributable to maternal height may be expected to be correspondingly lower in this region. This needs examination as does the independent and adjusted association of maternal body mass index to childhood outcomes."

(JAMA. 2010;303[15]:1539-1540. Available pre-embargo to the media at's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.

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