Difference in ponderal growth and body composition among pregnant vs. never-pregnant adolescents varies by birth outcomes.

Recently, we showed that following pregnancy and 6 months of lactation, adolescents cease linear growth and have reduced fat and lean mass in rural Bangladesh. Here, we examined whether these changes varied by pregnancy outcomes such as fetal loss, low birthweight (LBW) and neonatal mortality. Anthropometric measurements were taken among 12-19-year-old primigravidae (n = 229) in early pregnancy and at 6 months post-partum. Never-pregnant adolescents (n = 456) matched on age and time since menarche were also measured at the same time. Change in anthropometry among pregnant vs. never-pregnant adolescents was compared by pregnancy outcome adjusting for confounders using mixed effects regression models. Pregnant girls, irrespective of birth outcome, did not gain in stature, while never-pregnant girls increased in height by 0.36 +/- 0.04 cm year(-1) (P < 0.05). Body mass index, mid-upper arm circumference (MUAC) and % body fat among pregnant adolescents whose infants survived the neonatal period had decreased at 6 months post-partum, whereas those who experienced a fetal loss or neonatal death did not change in any of the measurements. Consequently, the difference in change in ponderal size and body composition measures between pregnant and never-pregnant girls was higher among those whose neonates survived vs. those who experienced a fetal loss/neonatal death (BMI: -0.64 +/- 0.11 vs. 0.01 +/- 0.16 kg m(-2) year(-1); MUAC: -0.96 +/- 0.12 vs. -0.35 +/- 0.17 cm year(-1), both P < 0.05). LBW and preterm birth did not have a similar effect modification. Linear growth ceased among pregnant girls regardless of birth outcome. Maternal weight loss and depletion of fat and lean mass at 6 months post-partum were more pronounced when the infants survived through the neonatal period.

Predictors of stunting and thinness in post-menarcheal adolescent girls in rural Bangladesh.

OBJECTIVE: To assess the nutritional status and risk factors of undernutrition in post-menarcheal girls in rural northern Bangladesh. DESIGN: Cross-sectional data on anthropometric measurements, dietary intake, work activity, morbidity and socio-economic status were collected from 12- to 19-year-old primigravidae (n 209) and never-pregnant adolescents (n 456) matched on age and time since menarche. Multiple regression analyses were conducted to determine predictors of stunting, thinness, upper-arm muscle (UAMZ) and fat area Z-scores (UAFZ) among the adolescent girls. RESULTS: A large proportion of adolescents (49 %) were stunted (height-for-age Z-score <-2) and underweight (40 %; weight-for-age Z-score <-2), but not thin (BMI-for-age <5th percentile; approximately 10 %). The mean (sd) UAMZ and UAFZ of the adolescent girls was -0.3 (0.64) and -0.9 (0.40), respectively. Lean mass increased whereas fat mass declined with age. Both stunting and thinness were positively associated with age and time since menarche (P < 0.05). Young age (12-14 years) and literacy were protective against stunting among pregnant adolescents (OR = 0.29, 95 % CI 0.09, 0.88 and OR = 0.50, 95 % CI 0.26, 0.96, respectively). Having symptoms of diarrhoea or dysentery (OR = 7.40, 95 % CI 1.43, 38.29) predicted thinness and was associated with lower UAMZ and UAFZ among never-pregnant girls (both P < 0.05). Performing light-to-moderate activities was protective against thinness among never-pregnant girls (OR = 0.43, 95 % CI 0.22, 0.82), whereas pregnant adolescents who performed high levels of strenuous activities had greater UAMZ (P < 0.05). CONCLUSION: Undernutrition was widespread among this post-menarcheal adolescent population. Younger and literate adolescents were less likely to be stunted, whereas thinness and body composition were associated with morbidity and work activity.

Age of onset, nutritional determinants, and seasonal variations in menarche in rural Bangladesh.

Menarche is an important milestone in the development of female adolescents. The study assessed the age at menarche using recall, its seasonality, and association with marital and nutritional status (using mid-upper arm circumference [MUAC]) among 3,923 female adolescents aged 12-19 years in a rural area of Bangladesh. At the time of assessment, most (88%) adolescents had attained menarche at the mean (standard deviation [SD]) age of 12.8 (1.4) years. Age of onset of menarche among married adolescents (13%) occurred earlier than in those who were unmarried (12.6 +/- 1.3 years vs 12.9 +/- 1.4 years, p < 0.01). Age at menarche was negatively associated with MUAC after adjusting for age and marital status (beta = -0.10, p < 0.01). More than 50% of the adolescents had an onset of menarche during winter (chi2 = 634.97; p < 0.001), with peaks in December and January. In this rural population, the current age at menarche was found to be slightly lower than the previous estimates of 13.0 years in Bangladesh. An early onset of menarche was associated with season and better nutritional status of the female adolescents and may be associated with early marriage.

Pregnancy and lactation hinder growth and nutritional status of adolescent girls in rural Bangladesh.

Adolescent pregnancy is associated with adverse birth outcomes. Less is known about its influence on maternal growth and nutritional status. We determined how pregnancy and lactation during adolescence affects postmenarcheal linear and ponderal growth and body composition of 12-19 y olds in rural Bangladesh. In a prospective cohort study, anthropometric measurements were taken among primigravidae (n = 229) in the early first trimester of pregnancy and at 6 mo postpartum. Randomly selected never-pregnant adolescents (n = 458) of the same age and time since menarche were measured within 1 wk of these assessments. Annual changes in anthropometric measurements were compared between the 2 groups adjusting for confounders using mixed effects regression models. The mean +/- SD age and age at menarche of adolescents were 16.3 +/- 1.6 y and 12.7 +/- 1.2 y, respectively. Unlike pregnant girls who did not grow in height (-0.09 +/- 0.08 cm/y), never-pregnant girls increased in stature by 0.35 +/- 0.05 cm/y. The adjusted mean difference between the 2 groups was 0.43 +/- 0.1cm (P < 0.001). Similarly, whereas never-pregnant girls gained BMI, mid-upper arm circumference, and percent body fat, pregnant girls declined in every measurement by 6 mo postpartum, resulting in adjusted mean +/- SD differences in annual changes of 0.62 +/- 0.11 kg/m(2), 0.89 +/- 0.12 cm, and 1.54 +/- 0.25%, respectively (all P < 0.001). Differences in changes in all anthropometric measurements except height were greater among adolescents whose first pregnancy occurred <24 mo vs. > or =24 mo since menarche (BMI, -1.40 +/- 0.18 vs. -0.60 +/- 0.11 kg/m(2); all interaction terms, P < 0.05). Pregnancy and lactation during adolescence ceased linear growth and resulted in weight loss and depletion of fat and lean body mass of young girls.