Adolescent pregnancy and childundernutrition: A meta-analysis
This is a summary of the following paper: Welch C, Wong C,
Lelijveld N et al (2023) Adolescent pregnancy is associated with childundernutrition: Systematic review and meta-analysis. Maternal &Child Nutrition, 20, 1, e13569. https://doi.org/10.1111/mcn.13569

A

dolescent pregnancy is linked to foetal growth issues, raising concerns
about childhood wasting and underweight. However, little is known
about how young maternal age influences childhood anthropometry after the neonatal stage.
This review and meta-analysis explored the association between adolescent pregnancy and childwasting and underweight, delving into possible
social and biological factors.
Peer-reviewed literature from 1990 onwards
were systematically reviewed for studies reporting wasting and/or underweight in children
aged under five years born to adolescent mothers(aged 10–19, or ≤24 where relevant) in low- andmiddle-income countries. Of a total of 92 studies identified, 57 were included for meta-analysis,
while all underwent qualitative synthesis. Flexibility in inclusion criteria was extended to include
infants aged under one month and mothers aged
20–24 years, subject to meeting all other eligibility
criteria. This was due to their being limited studies focusing solely on infants aged one month andmothers under 20 years.
Results from the meta‐analysis showed thatchildren born to adolescent mothers (≤24 years)

compared with adult mothers were associatedwith 1.12 times greater odds of moderate underweight (p = 0.04) and 1.21 times greater odds ofsevere underweight (p < 0.01) in children aged
1–59 months. Pooled analysis for child wasting, presented as odds ratios, showed no statistically significant association between adolescentpregnancy (≤24 years) and moderate wasting(OR 1.05, p=0.17) or severe wasting (OR 1.16,p=0.59) in children aged 1–59 months compared to adult pregnancy.
While the pooled OR indicated associations
between the subgroup of adolescents aged 10–
19 years versus adult pregnancy and moderateand severe wasting, findings were not significant(moderate wasting, OR p = 0.08; severe wasting,OR 1.15; p = 0.83).
In Asia, adolescent pregnancy (≤24 years)was found to be associated with a 16% higher
likelihood of moderate underweight (p = 0.02)
and a 9% higher likelihood of moderate wasting(p = 0.04) in children aged 1–59 months compared to pregnancies among adults. Additionally, for severely underweight children in Asia,
there was a 23% higher likelihood for those bornto adolescent mothers (p = 0.03). However, noBangladesh: Experiences of adolescentmothers in caring for their preterm babies
This is a summary of the following paper: Shumona S, Ahmad E, Shema M et al (2024)
Perception and experiences of adolescent mothers and communities in caring for their preterm
babies: Findings from an in-depth study in rural Bangladesh. BMJ Pregnancy and Childbirth,
24, 1, 145. https://doi.org/10.1186/s12884-024-06345-x

B

older mothers who had experienced preterm
birth in the same timeframe were included tocompare perceptions and experiences. Secondary participants included the immediate family
members of preterm infants, community members, and healthcare providers.

To address this gap, a qualitative study wasconducted in rural villages of central Bangladesh
to understand both mother and community perspectives on preterm birth and preterm care. Thestudy focused primarily on adolescent mothers
aged 15-19 years who had delivered preterm babies within the previous six months. Additionally, adolescent mothers of full-term babies andFindings revealed diverse perceptions of theideal gestation period – described in months,
rather than weeks. Most participants reliedheavily on dates provided during hospital visits to estimate their due dates, underscoring thecritical role of antenatal care. Although participants’ understanding of causes of preterm birth
was generally limited, “poor nutritional status of
the mother or inadequate eating” was one of themost mentioned causes for premature birth. All
participants described preterm infants as “undernourished”, “small”, and/or “weak”, with “lowweight” and having a “frail appearance” or “longand thin hands and legs” also a focus. Despite
both adolescent and adult mothers mentioning
the need for the provision of extra care to pre-angladesh has one of the highest incidences of preterm births globally. The
country also has a high prevalence ofearly marriage and adolescent pregnancy. According to the Bangladesh Demographic and Health Survey (2017-2018), 71% of
women aged 20-49 years were married by the ageof 18. The survey also highlights that 28% of adolescent girls aged 15-19 years have begun childbearing. However, despite high rates of adolescent pregnancy and preterm birth, there is a lackof documentation regarding adolescent mothers’
experiences and the interventions needed to assist them in preterm infant care.

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FIELD EXCHANGE ISSUE 73, July 2024 www.ennonline.net/fex

A midwife provides health care toan adolescent girl at Dhamainagar
community clinic in Bangladesh© UNICEF / Suman Paul Himu

Research Snapshots

effect of adolescent pregnancy on severe wasting was found. In sub-Saharan Africa, adolescent pregnancy showed no effects on moderate
underweight or moderate to severe wasting. No
data was presented on severely underweight.
The study’s strengths were a systematic approach, broad geographical coverage, and thelarge number of papers included in the review.
That said, using numerous cross-sectional studies and open-source datasets does introduce limitations. Efforts were made to validate and remove duplicates, but some datasets may havebeen overrepresented in the meta-analysis – impacting reliability. Certain countries like Bangladesh and India were overrepresented, influencing stronger associations in Asia.
This review shows that being born to an adolescent mother, compared to an adult, increases
the risk of child underweight and, in Asia specifically, moderate wasting. Reviewed evidence suggests that maternal nutritional status may play anintermediary role. This underscores the importance of interventions to delay adolescent pregnancy and improve adolescent nutritional status,
aiming to mitigate childhood undernutrition andbreak the intergenerational cycle of malnutrition.
term babies, adolescent mothers faced challenges pointing to what this care entailed. Adolescentmothers were found to have low decision-making abilities and often consulted family members, depending on female family members for
caregiving and emotional support.
Traditional practices persisted, including
bathing children after birth and non-exclusive
breastfeeding by giving honey and warm water.
Participants in the study widely shared the view
that, for undernourished and weak preterm babies to grow, they must be fed well. For severely preterm babies unable to breastfeed, milk was
expressed and the baby then fed with a spoon.
None of the participants demonstrated awareness of the significance of regular weight monitoring for infants.
Various factors – including local knowledge, socio-cultural practices, and health system limitations – shaped the understanding ofand care practices for preterm infants among
both adolescent and adult mothers. Improving birth outcomes requires increased awareness among adolescents, women, and families
regarding preterm birth, alongside improvements in the quality of preterm birth services
offered at healthcare facilities.

The Field Exchange editorial team would
also like to highlight the importance ofstrengthening interventions to delay
early marriage as a root cause.