Association of maternal pre-pregnancy malnutrition with offspring growth trajectories: A secondary data analysis of the Women First Trial

BACKGROUND: As co-existing forms of maternal malnutrition increase globally, understanding their impact on children's linear growth is vital. OBJECTIVE: Examine the association between maternal pre-pregnancy malnutrition, both single and co-existent forms, and their offspring's linear growth across the first 24 months of life. METHODS: This study is a secondary data analysis using data on mother-child pairs from the Women First Trial, a randomized controlled trial evaluating maternal nutrition supplementation conducted in the Democratic Republic of the Congo, Guatemala, India, and Pakistan. Using measured height and weight indicators, maternal pre-pregnancy malnutrition was classified as normal, underweight, short stature, overweight/obesity, underweight and short stature, or short stature and overweight/obesity. Latent class growth analysis was employed to identify offspring's linear growth trajectories using length-for-age z-score from birth to 24 months. Poisson regression assessed the association between maternal pre-pregnancy malnutrition and offspring growth trajectories. RESULTS: We analyzed data from 2,228 mother-child pairs. Pre-pregnancy, 63% of mothers presented malnutrition: 17% underweight, 22% short stature, 6% overweight/obesity, 6% underweight and short stature, and 11% short stature and overweight/obesity. Two offspring growth trajectories emerged: no/mild growth faltering (n=1,238) and severe growth faltering (n=990). Compared with children of mothers with a pre-pregnancy normal anthropometric status, those born to mothers with underweight (aRR: 1.09; 95%CI: 1.02, 1.15), short-stature (aRR: 1.17; 95%CI: 1.11, 1.24), underweight and short stature (aRR: 1.18; 95%CI: 1.09, 1.27), and short stature and overweight/obesity (aRR: 1.17; 95%CI: 1.08, 1.27) had higher risks of severe growth faltering. CONCLUSION: Maternal pre-pregnancy short stature, alone or combined with underweight or overweight/obesity, was associated with an increased risk of suboptimal linear growth in children during the first 24 months. These findings underscore the importance of addressing maternal nutritional status before pregnancy as part of broader efforts to improve child growth outcomes in low-resource settings. STUDY REGISTRATION: ClinicalTrials.gov: NCT01883193; https://clinicaltrials.gov/study/NCT01883193.