Early life undernutrition and adolescent pregnancy outcome in rural India.
Background: In poor communities of the Third World, adolescent pregnancy outcomes are likely to be worse in view of the prevailing chronic undernutrition. Aim: The study examined the confounding effect of early life undernutrition on adolescent pregnancy outcome in rural India. Subjects and methods: Retrospective information on socio-economic, demographic and anthropometric variables, gynaecological and obstetric history, pregnancy outcome and birth weight was obtained on 326 primigravid young married rural girls during 1998-2001. Results: Prevalence of pregnancy wastage (stillbirths and abortions) reduced significantly (p <0.01) with increase in age at first conception. The risk for pregnancy wastage observed (OR = 1.95, 95% CI = 0.91-4.21) in mothers with early conception (<17.25 years) increased significantly to 4.24 (95% CI = 1.4-12.86) in case of girls with delayed menarcheal age (>=14.5 years) or to 14.2 (95% CI = 1.17-173.2) if they had higher post-menarcheal stature growth (>=4 cm). Similarly, risk for preterm delivery (OR 2.18, 95% CI = 0.88-5.42) observed among mothers with early conception increased to 36.6 (95% CI = 3.57-374.0) if they had significant post-menarche gain in height. Our findings thus indicate that pregnancy outcome was adversely affected by early conception and prolonged adolescent growth, which are the features of biological immaturity in undernourished populations. Conclusion: Our findings indicate that in view of prevailing socio-cultural conditions, good nutrition in early life for girls is essential to prevent post-menarcheal height growth while health education programmes are essential to prevent early conception in rural India. These observations have wider implications for similar rural settings especially in other developing countries.