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

Abstract

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.

Childhood and adolescent nutrition outcomes among girls exposed to gender-based violence: A rapid evidence assessment of quantitative research

“…Most sources sought to quantify associations between specific forms of sexual violence affecting children, including girls, and indicators of subsequent nutrition status in childhood and adolescence. Some studies conducted analyses that permit more nuanced understandings of causal mechanisms including use of community-based comparator groups [ 56 – 59 ]; moderation by cortisol reactivity [ 57 ]; moderation by HPA axis attenuation [ 41 ]; interaction of caregiver abuse and IPV/dating violence [ 60 ]; interaction of child marriage and age at first pregnancy [ 61 ]; and stratification by age [ 62 ] and developmental period [ 56 ].…”

“…The following forms of GBV were measured: child marriage [ 61 , 68 ], sexual assault and rape [ 63 , 65 , 66 ], CSA perpetrated by parents/caregivers [ 41 , 56 – 59 , 62 , 64 , 67 , 69 – 71 ], and dating violence/IPV [ 60 ] ( Table 6 ). Some studies did not use validated survey instruments to measure GBV [ 63 , 65 – 67 , 70 , 71 ], and in some cases relied on a single question to assess girls’ GBV exposure [ 63 , 66 , 67 ].…”

“…In addition, other nutrition indicators that were assessed included height for age, weight for height, height for younger children, leg length, waist circumference, fat mass index, android fat percentage, mid-upper arm circumference (MUAC), and anemia among the older children and adolescents. Height and weight were assessed using either anthropometric measurements [ 41 , 56 – 61 , 64 , 66 , 67 , 69 – 71 ] or self-reported height and weight (which may be affected by recall error or bias based on context dependent body ideals) [ 63 , 69 , 72 ]. Either weight for height or BMI were calculated as appropriate according to participants’ ages and operationalized for analysis using different methods [ 73 , 74 ].…”

“…Only two studies examined child marriage and measures of undernutrition (anemia, MUAC, BMI, chronic energy malnutrition [BMI < 18.5kg/m 2 ]) [ 61 , 68 ]. We found one study reporting an association between girl child marriage and anemia.…”

“…The study did not examine history of childbirth. A second study using data from Nepal, investigated the relationship between age at marriage and age at first pregnancy and the outcomes of BMI, MUAC, and chronic energy deficiency [ 61 ]. The interaction between age at marriage and age at first pregnancy was significant in the BMI outcome model and marginally significant in the MUAC outcome model.…”