Maternal education and its in fl uence on child growth and nutritional status during the fi rst two years of life: a systematic review and meta-analysis

Abstract

Background The fi rst 1000 days of life are critical for a child ' s health and development. Impaired growth during this period is linked to increased child morbidity, mortality, and long-term consequences. Undernutrition is the main cause, and addressing it within the fi rst 1000 days of life is vital. Maternal education is consistently identi fi ed as a signi fi cant predictor of child undernutrition, but its speci fi c impact remains to be determined. This study presents a systematic review and meta -analysis investigating the in fl uence of high versus low maternal education levels on child growth from birth to age two, using population -based cohort studies. Methods Databases including PubMed, Scopus, EMBASE, Web of Science, ERIC, and Google Scholar were searched from January 1990 to January 2024 using appropriate search terms. We included population -based cohort studies of healthy children aged two years and under and their mothers, categorizing maternal education levels. Child growth and nutritional outcomes were assessed using various indicators. Two reviewers independently conducted data extraction and assessed study quality. The Newcastle Ottawa scale was utilized for quality assessment. Randomeffects models were used for meta -analysis, and heterogeneity was assessed using the Cochrane Q and I 2 statistic. Subgroup and sensitivity analyses were performed, and publication bias was evaluated. Findings The literature search retrieved 16,893 titles, and after full -text screening of 673 reports, 35 studies were included, covering eight outcomes: weight for age z -score (WAZ), height for age z -score (HAZ), BMI for age zscores (BMIZ), overweight, underweight, stunting, wasting, and rapid weight gain. In middle -income countries, higher maternal education is signi fi cantly associated with elevated WAZ (MD 0.398, 95 CI 0.301 - 0.496) and HAZ (MD 0.388, 95 CI 0.102 - 0.673) in children. Similarly, in studies with low -educated population, higher maternal education is signi fi cantly linked to increased WAZ (MD 0.186, 95 CI 0.078 - 0.294) and HAZ (0.200, 95 CI 0.036 - 0.365). However, in high -income and highly educated population, this association is either absent or reversed. In high -income countries, higher maternal education is associated with a non -signi fi cant lower BMIZ (MD - 0.028, 95 CI - 0.061 to 0.006). Notably, this inverse association is statistically signi fi cant in low -educated populations (MD - 0.045, 95 CI - 0.079 to - 0.011) but not in highly educated populations (MD 0.003, 95 CI - 0.093 to 0.098). Interpretation Maternal education ' s association with child growth varies based on country income and education levels. Further research is needed to understand this relationship better. Funding This study was a student thesis supported fi nancially by Tehran University of Medical Sciences (TUMS). Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).