Relationship of maternal short stature with coexisting forms of malnutrition in Pakistan

‘Co-existing forms of malnutrition’ (CFM) involves a combination of two or more malnutrition indicators in an individual and is associated with a fourfold higher risk of mortality in children. Additionally, a child's nutritional status is significantly influenced by various maternal factors, with maternal height being a key predictor of offspring growth. This study explores the association between maternal short stature and CFM among mother–child dyads in Pakistan. Using Pakistan Demographic Health Survey data from 2012–2013 and 2017–2018, a panel cross-sectional analysis was conducted on 6,194 mother–child dyads aged 15–49 years and 0–59 months, respectively.

Maternal overweight and obesity increased by over 10% between the two survey periods, while prevalence of CFM among mothers remained below 5%. In children, CFM prevalence decreased from 30.7% to 20.7% across the survey periods. Coexisting underweight and stunting were consistently the most prevalent type of CFM. The presence of CFM in the mother–child dyad was 1.1% in 2012–13 and decreased to 0.5% in 2017–18.

Two maternal height categories were defined: Short stature (<145cm) and normal stature (≥145cm). The study reveals a significant association between short maternal stature and various forms of child undernutrition, including coexisting undernutrition. It found at least twofold higher odds of stunting, underweight, and various coexisting forms of undernutrition in children of short-statured mothers compared to those of normal stature (p < 0.041). However, no association was observed with wasting, overweight/obesity, and coexisting stunting and overweight/obesity.

The 2017–2018 survey reported a higher prevalence of coexisting underweight with wasting compared to the 2012–2013 survey. Maternal employment and caesarean section significantly reduced the odds of coexisting underweight with wasting, while an increase in family size raised the odds of coexisting underweight with both wasting and stunting (by 1.07). Between the 2 survey years, the odds of stunting with overweight/obesity significantly decreased to 0.28 in 2017–2018.

Despite national coverage and representative sample sizes in each demographic health survey, this study has limitations impacting internal validity. The cross-sectional design hinders establishing causation between maternal and child malnutrition. Missing data on variables like birthweight, birth size, and maternal health interventions further hinder a comprehensive assessment. Nutritional status relied solely on anthropometry, lacking biochemical tests, physical examinations, and dietary investigations. Anthropometric data had measurement errors and exclusions, impacting the study's representativeness. Acknowledging these limitations is crucial when interpreting these findings.

The study does however affirm the heightened vulnerability of children born to short stature mothers to various forms of undernutrition. Further exploration of the relationship between maternal health, infant feeding, and child undernutrition, including coexisting forms of undernutrition, is needed to identify effective strategies for interrupting the intergenerational transmission of malnutrition and CFM in children.