Young maternal age and the risk of neonatal mortality in rural Nepal

Arch Pediatr Adolesc Med. 2008 Sep;162(9):828-35. doi: 10.1001/archpedi.162.9.828.


Objectives: To investigate the relationship between adolescent pregnancy and neonatal mortality in a nutritionally deprived population in rural Nepal, and to determine mechanisms through which low maternal age may affect neonatal mortality.

Design: Nested cohort study using data from a population-based, cluster-randomized, placebo-controlled trial of newborn skin and umbilical cord cleansing with chlorhexidine.

Setting: Sarlahi District of Nepal.

Participants: Live-born singleton infants of mothers younger than 25 years who were either parity 0 or 1 (n = 10,745).

Main exposure: Maternal age at birth of offspring.

Outcome measure: Crude and adjusted odds ratios of neonatal mortality by maternal age category.

Results: Infants born to mothers aged 12 to 15 years were at a higher risk of neonatal mortality than those born to women aged 20 to 24 years (odds ratio, 2.24; 95% confidence interval, 1.40-3.59). After adjustment for confounders, there was a 53% excess risk of neonatal mortality among infants born to mothers in the youngest vs oldest age category (1.53; 0.90-2.60). This association was attenuated on further adjustment for low birth weight, preterm birth, or small-for-gestational-age births.

Conclusions: The higher risk of neonatal mortality among younger mothers in this setting is partially explained by differences in socioeconomic factors in younger vs older mothers; risk is mediated primarily through preterm delivery, low birth weight, newborns being small for gestational age, and/or some interaction of these variables.

Trial registration: Identifier: NCT00109616.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Infective Agents, Local / therapeutic use
  • Chlorhexidine / therapeutic use
  • Female
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Logistic Models
  • Maternal Age*
  • Nepal / epidemiology
  • Postnatal Care
  • Pregnancy
  • Pregnancy in Adolescence
  • Randomized Controlled Trials as Topic
  • Risk Factors


  • Anti-Infective Agents, Local
  • Chlorhexidine

Associated data