Marphatia Akanksha A, Wells Jonathan C K, Reid Alice M, Bhalerao Aboli, Yajnik Chittaranjan S
Population, Policy and Practice Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
Department of Geography, University of Cambridge, Cambridge, United Kingdom.
Front Glob Womens Health. 2025 Jan 20;5:1174646. doi: 10.3389/fgwh.2024.1174646. eCollection 2024.
Maternal nutrition promotes maternal and child health. However, most interventions to address undernutrition are only implemented once pregnancy is known, and cannot address broader risk factors preceding conception. Poverty and socio-economic status are considered systemic risk factors, but both economic growth and cash transfers have had limited success improving undernutrition. Another generic risk factor is low human capital, referring to inadequate skills, knowledge and autonomy, and represented by traits such as low educational attainment and women's early marriage. Few studies have evaluated whether maternal human and socio-economic capital at conception are independently associated with maternal and offspring outcomes.
Using data on 651 mother-child dyads from the prospective Pune Maternal Nutrition Study in rural India, composite markers were generated of "maternal human capital" using maternal marriage age and maternal and husband's education, and 'socio-economic capital' using household wealth and caste. Linear and logistic regression models investigated associations of maternal low/mid human capital, relative to high capital, with her own nutrition and offspring size at birth, postnatal growth, education, age at marriage and reproduction, and cardiometabolic risk at 18 years. Models controlled for socio-economic capital, maternal age and parity.
Independent of socio-economic capital, and relative to high maternal human capital, low human capital was associated with shorter maternal stature, lower adiposity and folate deficiency but higher vitamin B status. In offspring, low maternal human capital was reflected in shorter gestation, smaller birth head girth, being breastfed for longer, poor postnatal growth, less schooling, lower fat mass and insulin secretion at 18 years. Daughters married and had children at an early age.
Separating maternal human and socio-economic capital is important for identifying the aspects which are most relevant for future interventions. Low maternal human capital, independent of socio-economic capital, was a systemic risk factor contributing to an intergenerational cycle of disadvantage, perpetuated through undernutrition, low education and daughters' early marriage and reproduction. Future interventions should target maternal and child human capital. Increasing education and delaying girls' marriage may lead to sustained intergenerational improvements across Sustainable Development Goals 1 to 5, relating to poverty, hunger, health, education and gender equality.
孕产妇营养对母婴健康有益。然而，大多数解决营养不良问题的干预措施仅在确认怀孕后才实施，无法解决受孕前更广泛的风险因素。贫困和社会经济地位被视为系统性风险因素，但经济增长和现金转移在改善营养不良方面成效有限。另一个常见的风险因素是人力资本低下，指技能、知识和自主权不足，表现为教育程度低和女性早婚等特征。很少有研究评估受孕时孕产妇的人力和社会经济资本是否与孕产妇及后代结局独立相关。
利用印度农村地区前瞻性浦那孕产妇营养研究中651对母婴的数据，用孕产妇结婚年龄、孕产妇及丈夫的教育程度生成“孕产妇人力资本”的综合指标，用家庭财富和种姓生成“社会经济资本”的综合指标。线性和逻辑回归模型研究了相对于高资本，孕产妇低/中等人力资本与其自身营养、出生时后代大小、产后生长、教育、结婚和生育年龄以及18岁时的心脏代谢风险之间的关联。模型控制了社会经济资本、孕产妇年龄和胎次。
独立于社会经济资本，相对于高孕产妇人力资本，低人力资本与孕产妇身高较短、肥胖程度较低和叶酸缺乏有关，但维生素B水平较高。在后代中，孕产妇低人力资本表现为妊娠期较短、出生时头围较小、母乳喂养时间较长、产后生长不良、受教育较少、18岁时体脂和胰岛素分泌较低。女儿结婚和生育年龄较早。
区分孕产妇的人力和社会经济资本对于确定未来干预措施最相关的方面很重要。独立于社会经济资本的孕产妇低人力资本是一个系统性风险因素，导致代际劣势循环，通过营养不良、低教育以及女儿早婚和早育而持续存在。未来的干预措施应针对孕产妇和儿童的人力资本。增加教育和推迟女孩结婚可能会在与贫困、饥饿、健康、教育和性别平等相关的可持续发展目标1至5方面带来持续的代际改善。
