Peer-reviewed article
Association Between Low Maternal Body Mass Index (BMI) and the Co-Occurrence of Multiple Forms of Childhood Undernutrition: A Systematic Review and Meta-Analysis.
Biniyam Sahiledengle, Paul Ward, Bereket Duko, Kingsley Agho, Lillian Mwanri ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined the relationship between low maternal body mass index and multiple forms of childhood undernutrition in children under five. The analysis of 19 studies covering over 536,000 mother-child pairs found that children of underweight mothers had 34% higher odds of having anthropometric failure (stunting, wasting, underweight, or combinations). The effect was stronger in Asia than Africa. The findings highlight substantial inequities in undernutrition between children of normal-weight and underweight mothers.
Key points
- Children of underweight mothers had 34% higher odds of composite anthropometric failure compared to children of normal-weight mothers (pooled OR: 1.34, 95% CI: 1.25-1.44)
- Analysis included 19 observational studies with 536,840 mother-child pairs from multiple geographic regions
- Subgroup analysis showed stronger associations in Asia (pooled OR: 1.47) compared to Africa (pooled OR: 1.16)
- Significant relative (PR: 1.32) and absolute inequalities (PD: 0.13) in anthropometric failure prevalence were found between maternal BMI groups
- No publication bias was detected in the analysis
Limitations
This is a meta-analysis of observational studies, so causality cannot be established. The review does not evaluate interventions to address low maternal BMI or test whether maternal nutrition programmes reduce childhood undernutrition.
Abstract
Low maternal Body Mass Index (BMI) is a critical risk factor for child undernutrition. While its association with single anthropometric deficits such as stunting or wasting is well documented, evidence on its relationship with the co-occurrence of multiple forms of undernutrition remains scarce. The Composite Index of Anthropometric Failure (CIAF) is a summary measure that classifies children as having anthropometric failure if they are stunted, wasted, underweight, or any combination of these, thereby capturing both single and concurrent deficits. This systematic review and meta-analysis explored the relationship between maternal underweight and CIAF in children under five, addressing a significant research gap. We systematically searched major databases, including MEDLINE (PubMed), Embase, Scopus, CINAHL, ProQuest (EBSCO), ScienceDirect, Global Index Medicus, and the Cochrane Library, without language or geographic restrictions, to identify relevant observational studies. We pooled extracted confounder-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) using an inverse-variance weighted random-effects meta-analysis, with heterogeneity assessed using the I² statistic. Sensitivity analyses were conducted to evaluate the robustness of the results, and subgroup and meta-regression analyses were performed to explore heterogeneity. Pooled prevalence ratios (PRs) and prevalence differences (PDs) were estimated to quantify the relative and absolute inequalities in CIAF prevalence between children of mothers with normal weight and those with underweight mothers, respectively. A total of 19 studies, comprising 536,840 mother-child pairs, were included in the final analysis. Children of underweight mothers, compared with those of normal-weight mothers, had 34% higher odds of CIAF (pooled OR: 1.34, 95% CI: 1.25-1.44, n = 375,248), with significant relative (pooled PR: 1.32, 95% CI: 1.06-1.64) and absolute inequalities (pooled PD: 0.13, 95% CI: 0.03-0.23). Subgroup analysis by geographic region showed a significant association between low maternal BMI and increased CIAF odds in children under five (pooled OR: 1.47, 95% CI: 1.39-1.56 in Asia; pooled OR: 1.16, 95% CI: 1.12-1.20 in Africa). No significant evidence of publication bias was detected. These findings indicate that low maternal BMI is significantly associated with an increased risk of CIAF in children under five. Substantial inequities in CIAF prevalence exist across maternal BMI groups, with children of underweight mothers disproportionately affected by higher burdens of CIAF. Prioritising nutritional interventions that address maternal underweight during preconception and pregnancy is essential to reduce multiple forms of undernutrition in children. .