Relative importance of birth size and postnatal growth for women's educational achievement.

BACKGROUND: Child undernutrition, commonly measured by growth failure, is associated with functional disadvantages later in life. AIMS: To assess relationships between child growth and women's educational achievement (EA). STUDY DESIGN AND SUBJECTS: Women from four ladino Guatemalan villages were measured as children (1969-1977) and again at ages 20-29 years (1996-1999). The anthropometric measurements analyzed were weight, length, and head circumference (HC) at birth and 2 years and height at adulthood. Sample sizes were 120 at birth, 133 at 2 years, and 145 at adulthood; 108 cases had data at all three points. OUTCOME MEASURES: Women's EA was computed based on five educational tests and was categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering. Multiple Stage Least Squares analyses were used to assess the relative importance of birth size and of early (birth to age 2 years) and late postnatal growth (2 years to adulthood). RESULTS: Size at 2 years (HC and length) but no indicator at birth was positively associated with women's EA. Schooling was a strong, positive predictor of women's EA (odds ratio (OR)=13.7, 95% confidence interval (CI) [6.1, 30.6]). Early postnatal growth but not birth size or late postnatal growth was associated with women's EA (OR with 1 standard deviation (S.D.) increment in length=1.5, 95% CI [1.05, 2.2]). CONCLUSIONS: Growth in length and HC from birth to 2 years of age, but not birth size or growth after 2 years, is an important predictor of women's EA.

Duke Scholars

Author Huiman Xie Barnhart Biostatistics & Bioinformatics, Division of Biostatistics