Abstract
BackgroundStunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. This study aimed to investigate the relationship between agricultural work during pregnancy, post-natal maternal BMI and LAZ among young infants in rural Pakistan; and explored whether maternal BMI mediated the relationship between agricultural work and infant LAZ.MethodsA cross-sectional survey was conducted from December 2015 to January 2016 in rural Sindh, Pakistan. Mother-infant dyads were recruited via systematic random cluster sampling at 2–12 weeks’ post-partum (n = 1161). Anthropometric measurements (maternal and infant height/length and weight) and questionnaire data were collected. Multivariable linear regression and structural-equation based mediation analyses were used to examine associations of agricultural work during pregnancy with maternal BMI and infant LAZ.ResultsDuring pregnancy, women reported engaging in livestock-related work (57.0%), crop-related work (42.7%), and cotton harvesting (28.4%). All three forms of agricultural work were negatively associated with maternal BMI (β = − 0.67 [− 1.06; − 0.28], β = − 0.97 [− 1.51; − 0.48]; and β = − 0.87 [− 1.33; − 0.45], respectively). Maternal engagement in cotton harvesting alone was negatively associated with infant LAZ after controlling for confounding factors. The total negative effect of cotton harvesting on infant LAZ was − 0.35 [− 0.53; − 0.16]. The indirect effect of maternal BMI on infant LAZ was − 0.06 [− 0.08; − 0.03], revealing that 16% (− 0.06/− 0.35) of the relationship between cotton harvesting and infant LAZ, after adjustment, was mediated via maternal BMI.ConclusionThese results underscore a need to reduce labour-intensive agricultural workload demands during pregnancy, especially in cotton harvesting, to reduce risks of negative maternal energy balance and poor growth outcomes in early infancy.
Highlights
Stunted growth in early infancy is a public health problem in low-and-middle income countries
Anthropometric measurements were provided by 98.7% (n = 1146) and 98.4% (n = 1143) of women and infants, respectively, and length-for-age Z-scores (LAZ) data from nine infants were excluded as outliers (Additional file 4)
Failure to address these high rates of stunting in early life will have both short and long-term negative consequences on health, cognitive development and adult stature, which in turn increases the risks for poor pregnancy outcomes and adult work capacity later in life [28]
Summary
Stunted growth in early infancy is a public health problem in low-and-middle income countries. Evidence suggests heavy agricultural work during pregnancy is inversely associated with maternal body mass index (BMI) and infant birth weight in low- and middle-income countries; but pathways linking agricultural work to length-for-age Z-scores (LAZ) in early infancy have not been examined. Maternal nutrition prior to and during pregnancy, environmental exposures and lifestyle behaviours increase the risk of intrauterine growth restriction and preterm birth, leading to childhood undernutrition [2, 3]. Employment in agriculture is relevant in Pakistan because agriculture is the most common occupation among employed women [4]; and their roles often involve long hours of labour-intensive agricultural work [5]. The physically demanding work, long hours and potential exposure to chemical hazards can have negative effects on the health of pregnant women and the development of their foetuses [2, 7, 8]
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