Peer-reviewed article
Prenatal and postnatal environmental influences on child growth trajectories across a rural-urban gradient: an analysis of the ECoMiD longitudinal birth cohort.
Caitlin Hemlock, Gwenyth O Lee, Benjamin F Arnold, Jesse D Contreras, Molly K Miller-Petrie et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study followed 401 children from birth to 24 months across four sites in coastal Ecuador ranging from urban to remote rural areas to understand how environmental factors affect child growth. Children born to taller mothers and in food-secure households had better birth size, but postnatal growth faltered most dramatically in remote river villages, where over half the children were stunted by 24 months compared to 5-14% elsewhere. Poor household conditions, male sex, and exposure to animal feces were associated with slower postnatal growth, and these patterns differed by location and child age.
Key points
- Prenatal growth was associated with maternal height and nutrition, while postnatal growth was more strongly influenced by environmental and household conditions
- Growth faltering was most severe in rural river villages (51% stunted at 24 months) compared to urban (8%), intermediate (14%), and rural road sites (5%)
- Male children, those from poorer households, with shorter mothers, and exposed to animals and animal feces had slower postnatal growth
- Environmental influences on growth varied by child age and community context, with notable effects emerging after six months of age
- Community setting modified the associations between environmental conditions and child growth outcomes
Limitations
The study is observational, so associations cannot establish causation. The findings are specific to coastal Ecuador and may not generalise to other regions or populations with different environmental and socioeconomic contexts.
Abstract
BACKGROUND: Early childhood growth, a key indicator of child well-being, is shaped by both the prenatal and postnatal environment. To understand where and when environmental factors influence growth most, we analyzed size at birth, postnatal growth trajectories, and associations with environmental factors across a rural-urban gradient in the ECoMiD longitudinal birth cohort. METHODS AND FINDINGS: Between 2021-2022, pregnant women were enrolled from four sites in northwest coastal Ecuador (urban city, intermediate town, rural villages connected by road, rural villages connected by river) and children were visited shortly after birth and quarterly thereafter for 24 months. We selected exposure variables using UNICEF's Conceptual Framework on Maternal and Child Malnutrition, including demographics, maternal characteristics, household infrastructure, and environmental factors. We used multivariable linear models and generalized estimating equations to analyze associations between exposures and length-for-gestational-age Z-score (LGAZ) and postnatal change in 3-month length-for-age Z-score (3-month ΔLAZ) and explored effect measure modification by site and child age (0-6 versus 7-24 months). Among 401 children, LGAZ was higher among children born to taller mothers, in households with higher food security, and in the rural river site. However, the postnatal growth of children in rural river sites faltered most rapidly, particularly after six months, resulting in 51% of children stunted (LAZ < -2 SD) at 24 months, compared to urban (8%), intermediate (14%), rural road (5%). Over the 0-24 month postnatal period, 3-month ΔLAZ was negatively associated with children who were male, from poorer households, had shorter mothers, and had greater exposure to animals and animal feces. Other associations, including with season, hygiene characteristics, and maternal demographics, varied by age and site. CONCLUSIONS: These findings show that environmental conditions influenced postnatal linear growth more strongly, compared to prenatal growth, which was associated with maternal anthropometry and nutrition. Community context strongly influenced growth only after age six months and modified associations with environmental conditions, suggesting that interventions targeting child growth faltering after six months may be important for certain populations.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Observational analysis of prenatal and postnatal environmental influences on child growth across different geographic and socioeconomic contexts
- Population
- 401 children and their mothers enrolled from four sites in northwest coastal Ecuador (urban, intermediate town, rural-road, rural-river) between 2021-2022
Key finding
At 24 months, stunting prevalence was 51% in rural river sites, 14% in intermediate towns, 8% in urban areas, and 5% in rural road sites
Hemlock et al. · PubMed (US National Library of Medicine) · 13 Nov 2025