BACKGROUND: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. 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.
METHODS:A 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.
RESULTS:During 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.
CONCLUSION:These 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.
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【Maternal BMI mediates the impact of crop-related agricultural work during pregnancy on infant length in rural Pakistan: a mediation analysis of cross-sectional data.].
【产妇体重指数（BMI）介导了巴基斯坦农村地区怀孕期间与农作物有关的农业工作对婴儿身长的影响：对横截面数据的中介分析。】
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DOI：10.1186/s12884-019-2638-3文章类型：杂志文章
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背景：婴儿期发育迟缓是中低收入国家的公共卫生问题。有证据表明，在低收入和中等收入国家，怀孕期间从事繁重的农业工作与孕产妇体重指数（BMI）和婴儿出生体重成反比。但是尚未研究将农业工作与婴儿早期的Z评分相关的途径。这项研究的目的是调查巴基斯坦农村地区的婴儿在怀孕期间从事农业工作，产后母亲BMI和LAZ之间的关系。并探讨了母亲的BMI是否介导了农业工作与婴儿LAZ之间的关系。
方法：2015年12月至2016年1月在巴基斯坦信德省农村进行了横断面调查。通过在产后2-12周内进行系统随机整群抽样（n = 1161）来招募母婴二联体。收集人体测量值（母亲和婴儿的身高/长度和体重）和问卷数据。基于多元线性回归和基于结构方程的中介分析用于检验孕期农业工作与孕产妇BMI和婴儿LAZ的关系。
结果：在怀孕期间，妇女报告从事与牲畜有关的工作（57.0％），与作物有关的工作（42.7％）和棉花收获（28.4％）。三种形式的农业工作均与孕产妇的BMI呈负相关（β==-0.67 [-1.06;-0.28]，β=-0.97 [-1.51;-0.48];β=-0.87 [-1.33;-0.45]，分别）。在控制了混杂因素之后，母亲单独从事棉花收获与婴儿LAZ呈负相关。棉花收获对婴儿LAZ的总负面影响为-0.35 [-0.53； -0.16]。母体BMI对婴儿LAZ的间接作用为-0.06 [-0.08; -0.03]，表明调整后的棉花收获与婴儿LAZ之间的关系中有16％（-0.06 /-0.35）是通过母体BMI介导的。
结论：这些结果强调需要减少怀孕期间劳动密集型农业工作量的需求，尤其是在棉花收获期间，以减少母体能量平衡不良和婴儿早期生长不良的风险。
方法：2015年12月至2016年1月在巴基斯坦信德省农村进行了横断面调查。通过在产后2-12周内进行系统随机整群抽样（n = 1161）来招募母婴二联体。收集人体测量值（母亲和婴儿的身高/长度和体重）和问卷数据。基于多元线性回归和基于结构方程的中介分析用于检验孕期农业工作与孕产妇BMI和婴儿LAZ的关系。
结果：在怀孕期间，妇女报告从事与牲畜有关的工作（57.0％），与作物有关的工作（42.7％）和棉花收获（28.4％）。三种形式的农业工作均与孕产妇的BMI呈负相关（β==-0.67 [-1.06;-0.28]，β=-0.97 [-1.51;-0.48];β=-0.87 [-1.33;-0.45]，分别）。在控制了混杂因素之后，母亲单独从事棉花收获与婴儿LAZ呈负相关。棉花收获对婴儿LAZ的总负面影响为-0.35 [-0.53； -0.16]。母体BMI对婴儿LAZ的间接作用为-0.06 [-0.08; -0.03]，表明调整后的棉花收获与婴儿LAZ之间的关系中有16％（-0.06 /-0.35）是通过母体BMI介导的。
结论：这些结果强调需要减少怀孕期间劳动密集型农业工作量的需求，尤其是在棉花收获期间，以减少母体能量平衡不良和婴儿早期生长不良的风险。
