Breast-feeding, birth interval and child mortality in Bangladesh

The 1975-76 Bangladesh Fertility Survey data show little evidence that breast-feeding is the intermediate factor through which birth intervals influence child survival in Bangladesh. Preceding birth interval, subsequent pregnancy and breast-feeding duration each have an independent influence on early mortality risk. Within a specific interval the risk of dying decreases with increase in duration of breast-feeding, and also with an increase in the time between the index birth and the next pregnancy. The death of the immediately preceding child in infancy has a significant negative effect on the survival chance of the index child at ages 1-5 months. However, death of the preceding child appears to have a significantly positive effect on the survival chance of the index child between ages 9 months and 5 years; this may be related to competition between siblings.     

Sibling mortality correlation in Kenya

This paper examines whether infant and child mortality risks among successive siblings are closely correlated, and if so, whether the survival status of the preceding child is an important factor affecting infant and child mortality in Kenya. The data were drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression was used as the major method of data analysis. The results show that both infant and child mortality rates are significantly higher among subsequent children whose preceding siblings had died in infancy than for those whose preceding sibling had survived through infancy. The effect of the survival status of the preceding child on infant mortality was statistically strong, even after a large number of control variables were taken into account. However, its effect on child mortality appears to be spurious since it was rendered statistically insignificant when just a few control variables were introduced into the analysis. The results provide empirical evidence that infant and child mortality risks among successive siblings are closely correlated in Kenyan families, and that the effect of the survival status of the preceding child is important in determining infant mortality but not child mortality.     

Effect of birth spacing on infant and child mortality in rural Nepal

This examination of the effect of birth spacing on infant and child mortality in rural Nepal is based on data from the Nepal Fertility Survey 1976 carried out by the Nepal Family Planning and Maternal Child Health Project in collaboration with the World Fertility Survey. The study confirms that the higher risk of infant death to 1st born children is mainly due to the higher proportion of younger women having 1st births, rather than due to their being 1st order births per se. The effect of maternal age on infant and child mortality is largely associated with birth interval. Previous birth interval, therefore, stands out as the most important factor affecting infant mortality; the next most important factor is the survival of the preceding child. A child born after an interval of less than 18 months since the previous live birth has a 31% higher risk of dying during infancy than 1 born after an interval of 1 1/2 to 2 years. The risk of the index child's dying is only 50% of that when its preceding sibling is dead. Neither education of mother nor education of father has a significant effect on infant mortality in rural Nepal.     

Multivariate analysis of infant and child mortality in Java and Bali

The data used in this analysis come from the 1976 Indonesian Fertility Survey, part of the World Fertility Survey. The data are examined 3 times, fitting them to models which include different combinations of independent variables. The dependent variables are: 1) the proportion of children born between 5 and 15 years before the survey who died before their 1st birthday, for infant mortality; and 2) among those alive on their 1st birthday, the proportions who died before reaching their 5th birthday, for child mortality. The figures indicate that the chance of dying for children who were 1st born, born shortly after a previous child, whose previous sibling had died, who lived in rural areas, or had parents who were young and with little education, was greater than for children without these characteristics. In all 3 models used, the greatest net effects are attributed to the survival of a preceding sibling or the length of the preceding interval. Birth order does not have a significant gross effect on infant mortality, but the net effects are significant because of the control on maternal age. Education of both parents has significant effects, but these are overshadowed in magnitude by the demographic variables. Maternal education has a greater influence in determining differences in child mortality than was found for infant mortality. Father's education also has a significant independent effect, but mainly for 1st births. It is uncertain whether these variables are measuring the effect of schooling as such, or other characteristics such as economic status or various social roles adopted by people with different levels of education. The variables distinguishing urban from rural status shows significant gross effects which are greatly reduced when controls for other variables are introduced in the model which includes all births. That is to say, the difference in the survival chances of a child in the city is more a function of the education of its parents, and the associated demographic variables than city residence as such. Access to medical services is quite probably the main element in these differences. The findings are weakened to some extent by the lack of satisfactory data on household economic status which might have provided a better base for indirectly discerning the effects of nutrition and sanitation on mortality at young ages.     

Sibling resemblance in natal dispersal distance and direction in the Ortolan Bunting Emberiza hortulana

Natal dispersal distance and direction determine the likelihood that siblings will settle close together and hence the risk of inbreeding. Several studies have shown a sibling resemblance in dispersal distance, but few studies have analysed sibling resemblance in dispersal direction or the distance between siblings after dispersal at the landscape level. I studied the entire Norwegian population of Ortolan Buntings Emberiza hortulana, which is patchily distributed in an area covering c. 500 km². Males and females did not differ in dispersal distance (overall median 3.7 km), but directions were different. Natal dispersal distances and directions were positively related within sibling pairs, but comparisons with control individuals suggested that any effects were due to spatial effects of configuration of habitat patches in the study area. Brother–sister pairs (n = 16) were at least as similar as brother–brother pairs (n = 18). Distance between siblings after natal dispersal increased with dispersal distance, but even so, five of 35 sibling pairs settled < 1 km apart, despite dispersal distances of 8.3–9.9 km for two of these pairs. Including movements later in life, eight sibling pairs were < 1 km apart at some time (four pairs of brothers and four brother–sister pairs), and in one case a brother mated with its sister. Another case of mating between close relatives (father and daughter) involved short female natal dispersal. These data indicate that female‐biased natal dispersal and long‐distance dispersal may reduce, but do not exclude, the possibility of inbreeding.     

Sex of preceding sibling and anthropometrics of subsequent offspring at birth and in young adulthood: A population‐based study in Sweden

In many mammal species with sexual dimorphism producing sons is energetically more demanding to the mother than producing daughters. Although some studies in humans have suggested that offspring born after a brother have a smaller birth weight and adult height when compared with those born after a sister, little is known about this intergenerational cost of producing sons. We aimed to study whether the sex of preceding sibling is associated with anthropometrics of the subsequent child at birth and in young adulthood. This population‐based study was carried out on two data sets derived from the Swedish registers. Information on birth weight and length was obtained for 752,723 children of both sexes. Adult weight, height and muscle strength were available for 506,326 men. Multiple linear regression analyses showed that boys and girls born after a brother were, respectively, 18 and 9 g lighter and 0.08 and 0.03 cm (P < 0.001) shorter at birth than those born after a sister. Adjustment for gestational age decreased the magnitude of the associations [10 g and 0.04 cm (P < 0.001) in men and nonsignificant estimates in women], suggesting that part of the lower mean birth weight and length of individuals born after a brother was due to a shorter gestation. In young adulthood, men with a preceding brother showed 0.16 kg more in weight, 0.3% higher body mass index (P < 0.001) and a trend towards reduced height and muscle strength. Our results suggest that even though the sex of the previous child is associated with the anthropometrics of the subsequent child, the effect sizes are very small questioning whether this mechanism has adaptive value in contemporary humans. Am J Phys Anthropol 154:471–478, 2014. © 2014 Wiley Periodicals, Inc.     

Bereavement after sibling death: a population‐based longitudinal case‐control study

The objective of this study was to examine mental disorders and treatment use among bereaved siblings in the general population. Siblings (N=7243) of all deceased children in the population of Manitoba, Canada who died between 1984 and 2009 were matched 1:3 to control siblings (N=21,729) who did not have a sibling die in the study period. Generalized estimating equations were used to compare the two sibling groups in the two years before and after the index child's death on physician‐diagnosed mental disorders and treatment utilization, with adjustment for confounding factors including pre‐existing mental illness. Analyses were stratified by age of the bereaved (<13 vs. 13+). Results revealed that, in the two years after the death of the child, bereaved siblings had significantly higher rates of mental disorders than control siblings, even after adjusting for pre‐existing mental illness. When comparing the effect of a child's death on younger versus older siblings, the rise in depression rates from pre‐death to post‐death was significantly higher for siblings aged under 13 (p<0.0001), increasing more than 7‐fold (adjusted relative rate, ARR=7.25, 95% CI: 3.65‐14.43). Bereaved siblings aged 13+ had substantial morbidity in the two years after the death: 25% were diagnosed with a mental disorder (vs. 17% of controls), and they had higher rates of almost all mental disorder outcomes compared to controls, including twice the rate of suicide attempts (ARR=2.01, 95% CI: 1.29‐3.12). Siblings in the bereaved cohort had higher rates of alcohol and drug use disorders already before the death of their sibling. In conclusion, the death of a child is associated with considerable mental disorder burden among surviving siblings. Pre‐existing health problems and social disadvantage do not fully account for the increase in mental disorder rates.     

Birth order,conscientiousness, and openness to experience: Tests of the family-niche model of personality using a within-family methodology

We investigated differences between firstborn and secondborn siblings on major dimensions of personality, in the context of the proposal of Sulloway [Sulloway, F. J. (1996). Born to rebel: Birth order, family dynamics and creative lies. New York: Pantheon] that personality is influenced by the specialized niches siblings adopt in the quest for access to parental resources. Using a within-family methodology, we tested two predictions from Sulloway's model: that firstborns are more achieving and conscientious than secondborns and that secondborns are more rebellious and open to new experiences than firstborns. To test an alternative prenatal hypomasculinization theory proposed by Beer and Horn [Beer, J. M., & Horn, J. M. (2000). The influence of rearing order on personality development within two adoption cohorts. Journal of Personality, 68, 769–819], we also examined the size of birth-order effects in sister–sister versus brother–brother pairs. The hypothesized effects of birth order on personality were found in both Study 1 (n=161 sibling pairs) and Study 2 (n=174 sibling pairs) and provided support for Sulloway's family-niche model. No support was found for Beer and Horn's hypomasculinization model.     

Kin and birth order effects on male child mortality: three East Asian populations, 1716–1945

Human child survival depends on adult investment, typically from parents. However, in spite of recent research advances on kin influence and birth order effects on human infant and child mortality, studies that directly examine the interaction of kin context and birth order on sibling differences in child mortality are still rare. Our study supplements this literature with new findings from large-scale individual-level panel data for three East Asian historical populations from northeast China (1789–1909), northeast Japan (1716–1870), and north Taiwan (1906–1945), where preference for sons and first-borns is common. We examine and compare male child mortality risks by presence/absence of co-resident parents, grandparents, and other kin, as well as their interaction effects with birth order. We apply discrete-time event-history analysis on over 172,000 observations of 69,125 boys aged 1–9 years old. We find that in all three populations, while the presence of parents is important for child survival, it is more beneficial to first/early-borns than to later-borns. Effects of other co-resident kin are however null or inconsistent between populations. Our findings underscore the importance of birth order in understanding how differential parental investment may produce child survival differentials between siblings.     

Intralocus sexual conflict over human height

Intralocus sexual conflict (IASC) occurs when a trait under selection in one sex constrains the other sex from achieving its sex-specific fitness optimum. Selection pressures on body size often differ between the sexes across many species, including humans: among men individuals of average height enjoy the highest reproductive success, while shorter women have the highest reproductive success. Given its high heritability, IASC over human height is likely. Using data from sibling pairs from the Wisconsin Longitudinal Study, we present evidence for IASC over height: in shorter sibling pairs (relatively) more reproductive success (number of children) was obtained through the sister than through the brother of the sibling pair. By contrast, in average height sibling pairs most reproductive success was obtained through the brother relative to the sister. In conclusion, we show that IASC over a heritable, sexually dimorphic physical trait (human height) affects Darwinian fitness in a contemporary human population.     

Infant and early childhood mortality in the Sine-Saloum region of Senegal

Infant and early childhood mortality in Senegal's Sine-Saloum region was investigated through use o f data from a 1982-83 family health survey. The survey involved interviews with 1894 married women 15-44 years of age living in extended family residential units in rural areas. Given evidence of substantial underreporting of early deaths, at least among children born before 1980, an adjustment factor was applied to the survey data. Infant mortality was estimated to be about 113/1000 live births and mortality before age 5 years was 263/1000. Strong mortality differentials, particularly after infancy, were noted according to the 2 socioeconomic variables included in the analysis: type of house and father's occupation. The probability of dying at ages 1-4 years was 50% higher among children living in traditional homes than among those in modern homes as well as among children whose fathers' were engaged in primary sector occupations (farming, livestock, fishing). Infant mortality showed no sex differential, while mortality at ages 1-4 years was 18% higher among females. Diarrheal and respiratory diseases were the 2 leading causes of death, killing at least 15% of all children by 5 years of age. Tetanus was an important cause of death during infancy, while measles and malaria were significant causes only after the 1st birthday. For all causes of death, the effect of socioeconomic status is higher in early childhood than in infancy, presumably because of the protective effect of breastfeeding. 82% of children who died had fever during their terminal illness, 51% had diarrhea, 39% had a cough, and 14% a rash. At least some mortality in this area might be prevented through treatment of these symptoms. However, calculating the degree to which particular interventions such as oral rehydration for diarrhea would reduce mortality is a complex task, requiring knowledge of replacement mortality, effectiveness of interventions, and the numbers of mothers who would utilize them.     

Association of household demographic variables with child mortality in Côte d'Ivoire

The associations between household demographic variables and mortality of children aged less than five years were investigated using data from the 1998 Demographic and Health Survey (DHS) of the Republic of C?te d'Ivoire, Western Africa. Of the total of 1992 children born to women included in the study population during the 5-year period preceding the survey, 260 (13%) had died and 1732 (87%) were alive at the time of the survey. Logistic regression analyses used to compare biosocial variables between the deceased and living children showed that the sex of the child, birth interval and mother's occupation were associated with child's survival status. After adjusting for their effects, household demographic variables (i.e. number of household members, number of household members under 5 years [HM-5Y], number of household members 5 years or older [HM+5Y], the proportion of HM-5Y among all household members, and the ratio of HM-5Y to HM+5Y) were shown to be associated with the child's survival status. This study provided insight into the effects of intra-household competition among children and availability of care-givers as potential determinants of child survival. The results indicate that improvement of the childcare environment and reproductive intervention are necessary to reduce child mortality in West African countries.     

Effect of number, order, and spacing of siblings on child and adult outcomes: an overview of current research

The impact of the number, order, and spacing of siblings on child and adult outcomes has been the topic of research by scholars in 4 separate fields (human biology, psychology, sociology, and economics), and the barriers to communication between academic disciplines are strong. Also most researchers have had to work with data sets gathered for other purposes. This has resulted in a relative inadequacy of research. Social scientists have 3 theories concerning the relationship between the number, order, and spacing of siblings and child and adult outcomes: that an increase in the number of siblings or a decrease in the spacing between them dilutes the time and material resources that parents can give to each child and that these resource dilutions hinder the outcome for each child; that account must be taken not only of parental resources but also of the resources given to each child by his/her siblings; and that there is no causal relationship between number, order and spacing of siblings and child outcomes and that any apparent relationships are spurious. In light of these theories, the question arises as to how should the sibling variables be measured. The most important aspect of sibling number is that it is a variable over time. Yet, the proper measurement of sibling number has an additional complication. According to all existing theories, the ages of the other siblings are relevant for the outcome for the given child. All of the relevant information is now available only when it is possible to construct a matrix in which the rows present the age of the given child and the columns the age grouping of the siblings for whom a count of sibling number will be made. Many such matrices could be developed, some much more elaborate than others. For illustrative purposes, Table 1 presents the matrix of the number of siblings for a child who is the first-born among 5 children, all of whom are spaced exactly 3 years apart and all of whom are financially dependent only up to exact age 21. Table 2 presents the matrix for the last-born child among 5 children with characteristics identical to those in Table 1. It can be inferred from these tables that the oldest child in the family, as compared to the youngest child, probably will suffer from a diminution of parental resources, most likely financial resources, in adolescence. The youngest will suffer from a reduction of parental resources, probably time resources, in infancy and early childhood. Research concerned with the consequences of the number and spacing of children should be based on data sets for which some version of this matrix can be constructed.     

Causes of Early Childhood Deaths in Urban Dhaka,Bangladesh

Data on causes of early childhood death from low-income urban areas are limited. The nationally representative Bangladesh Demographic and Health Survey 2007 estimates 65 children died per 1,000 live births. We investigated rates and causes of under-five deaths in an urban community near two large pediatric hospitals in Dhaka, Bangladesh and evaluated the impact of different recall periods. We conducted a survey in 2006 for 6971 households and a follow up survey in 2007 among eligible remaining households or replacement households. The initial survey collected information for all children under five years old who died in the previous year; the follow up survey on child deaths in the preceding five years. We compared mortality rates based on 1-year recall to the 4 years preceding the most recent 1 year. The initial survey identified 58 deaths among children <5 years in the preceding year. The follow up survey identified a mean 53 deaths per year in the preceding five years (SD±7.3). Under-five mortality rate was 34 and neonatal mortality was 15 per thousand live births during 2006–2007. The leading cause of under-five death was respiratory infections (22%). The mortality rates among children under 4 years old for the two time periods (most recent 1-year recall and the 4 years preceding the most recent 1 year) were similar (36 versus 32). The child mortality in urban Dhaka was substantially lower than the national rate. Mortality rates were not affected by recall periods between 1 and 5 years.     

Mortality rates in subjects with fetal alcohol spectrum disorders and their siblings

BACKGROUND: Our objective was to estimate the mortality rate in subjects with fetal alcohol spectrum disorders (FASD) and their siblings whose FASD status was unknown. METHODS: We used the state FASD Registry to link subjects with FASD to a North Dakota birth certificate. We were able to link 304 of 486 cases (63%). We used the birth certificates to identify the mother and children born to the mother (siblings). We then searched for death certificates for both the FASD cases and their siblings. We then calculated the annual and age‐adjusted mortality rates for the siblings of the Registry cases and compared them with mortality rates from North Dakota. RESULTS: The FASD case mortality rate was 2.4%, with a 4.5% mortality rate for their sibings, accounting for 14% of all deaths when compared to the North Dakota residents matched by age and year of death. The sibling deaths accounted for 21.5% of all cause mortality matched by age and year of death. The age‐standardized mortality ratios were 4.9 for the FASD cases and 2.6 for their siblings whose FASD status was unknown. CONCLUSIONS: Mortality rates for FASD cases and their siblings were increased and represent a substantial proportion of all cause mortality in North Dakota. Prevention of FASD may be a useful strategy to decrease mortality. Birth Defects Research (Part A), 2008. © 2008 Wiley‐Liss, Inc.     

Sex differentials in infant and child mortality in Korea

This paper reports on a study of infant and child mortality in the Republic of Korea, a country known for a strong son preference, using the 1974 World Fertility Survey data. When the age-specific probabilities of dying for ages 0 to 5 are compared for male and female children, an unusual pattern of relatively high female mortality is observed. The higher female mortality is more pronounced during childhood than during infancy. Multivariate analysis of life tables, using a hazard model, shows that covariates influencing the mortality at young ages differ for male and female children and suggests that male and female children receive unequal care by their parents. The analysis also reveals different patterns of interaction between infant and child mortality and mother's fertility control behavior depending on the sex of the child.     

Heights and weights of Da-an boys: did sisters really make a difference?

This study further examined the negative association between boys' growth and the presence of sisters within a relatively affluent community in Taipei, Taiwan. Among 596 boys born in 1976-77, differences in height and log-transformed weight were judged using analysis of covariance (ANCOVA) with measurement age as a covariate, and parental education level (four levels), number of sisters (0, 1, 2 or 3+) and number of brothers (0, 1, 2+) as predictors. The relative importance of birth order and sibling sex was examined among the near majority of boys with one sibling (47%, 278/596). The sibling composition variable was defined using mutually exclusive categories representing individuals with one sibling: either one older or younger brother or sister. All boys contributed information before leaving middle school at a mean age of 14.9 +/- 0.4 years SD. The results were compared with similar analyses of data for 154 of these same boys for whom measurements were available from primary school entry at a mean age of 64 +/- 0.3 years SD onward. Results were also compared with data for a cohort of 153 boys who entered primary school later in 1986. Results confirm that boys from the Da-an area born in the mid-1970s who did not have sisters were significantly taller (2.2-2.5 cm, p < or = 0.008) and heavier (3.0-3.9 kg, p < or = 0.016) than those with one or two sisters. However, the 26 boys with three or more sisters, most of whom were last-born, were somewhat taller than those with one or two sisters. The same curvilinear relationships in height and weight appeared both among boys as they prepared to leave middle school and among the subset also measured just after entering primary school. When numbers of sisters were statistically controlled, the presence of two or more brothers was also significantly negatively associated with mean stature, but not weight, among middle school boys. Analyses among boys with one sibling revealed that birth order was associated with mean stature, but only if the sibling was female; an older sister was associated with a greater deficit in mean stature than a younger sister. Evidence of rising educational expectations, continued declines in family size with fewer gender-related differences in numbers of siblings, and a clear secular increase in body size in this community among children entering primary school from 1982 to 1986 suggest a possible explanatory model.     

Birth spacing,breastfeeding, and early child mortality in a traditional Indian society: A hazards model analysis

Abstract

There are few studies of the interrelationships among breastfeeding, child spacing, and child mortality in traditional societies that incorporate extensive controls for social and demographic characteristics of the mother and child. In this paper, we investigate the impact of breastfeeding and the length of the preceding birth interval on early child mortality (defined as a death in the first two years of life) using data from a traditional society of India. Multivariate hazards models are used to analyze the data. Most prior analyses related the impact of breastfeeding duration to the duration of child survivability by taking breastfeeding as a fixed covariate. The present study has a methodological focus in the sense that breastfeeding information from retrospective survey data is treated as a time‐dependent covariate both as a status variate as well as a duration—with empirical findings compared across the two specifications. The effects of postpartum amenorrhoea and various other demographic and socioeconomic characteristics of mother and child are also studied. The results suggest that breastfeeding duration has a strong impact in reducing the relative risk of early child mortality; but it does not explain the effect of the length of the preceding birth interval on early child mortality.     

Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study.

OBJECTIVE: To assess the risk of death associated with work based and non-work based measures of socioeconomic status before and after retirement age. DESIGN: Follow up study of mortality in relation to employment grade and car ownership over 25 years. SETTING: The first Whitehall study. SUBJECTS: 18,133 male civil servants aged 40-69 years who attended a screening examination between 1967 and 1970. MAIN OUTCOME MEASURE: Death. RESULTS: Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40-64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidence interval 2.4 to 4.1). After retirement the ability of grade to predict mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality less well than employment grade before retirement but its ability to predict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconomic groups showed employment grade and car ownership to have independent associations with mortality that were of equal magnitude after retirement. The absolute difference in death rates between the lowest and highest employment grades increased with age from 12.9 per 1000 person years at ages 40-64 to 38.3 per 1000 at ages 70-89. CONCLUSIONS: Socioeconomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based on an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an important part in generating social inequalities in health in men of working age.     

The Bacon Chow study: Genetic analysis of physical growth in assessment of energy–protein malnutrition

Estimates of the prevalence of energy–protein malnutrition almost universally employ physical growth measurements. In this study we focus on this disease and the role of body size of relatives as mediators of responses in individuals to one type of nutrition intervention: supplementation of pregnant and lactating women. In this study, initiated by Dr. Bacon Chow and others in 1967, during gestation of a first infant a mother was untreated, while during the lactation of the first infant and the gestation and lactation of a second infant she was treated with either a calorie supplement or a placebo. Supplement–placebo group differences were sought in sibling and mother–child correlations in growth from birth to 30 months, in order to assess the role of heredity as a mediator of supplement effects. There were 108 pairs of siblings whose mothers had received a high-calorie–high-protein supplement as described above and 105 pairs of siblings whose mothers had received a placebo. Among the latter, sibling correlations for most measurements are statistically significant at birth, and of the same magnitude seen in previous studies (～0.5), while among supplemented siblings, birth correlations are unusually low and often insignificant. The sibling correlations in Rohrer's index (wt/L³) differed the most between groups (p < 0.01). Group differences in the sibling correlation tended to disappear over the first 2.5 years of life. Correlations between mothers and their second children in subscapular skinfold tended to be higher in the supplemented than in the placebo group, birth to 30 months. In both supplement groups mother–second child correlations for body weight were higher than mother–first child correlations, suggesting the occurrence of secular changes in the environment unconnected with the treatment. The results suggest that: (1) genetic analysis of components of anthropometric variation may be a more sensitive method than the more conventional comparison of group means in detecting supplement effects; and (2) infant relative weight (Rohrer index), particularly the addition of subcutaneous fat, may be more affected by maternal supplementation than growth in weight or length alone.