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We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted secondary analyses of data from a cluster\u2010randomized trial. Women aged 14\u201335\u2009years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, <jats:italic>n<\/jats:italic>\u00a0=\u200914\u2009261), and obstructed labor (OL, <jats:italic>n<\/jats:italic>\u00a0=\u20095185).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Risks were greatest among first\u2010time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At the individual level, the risk childbirth complications is shaped by trade\u2010offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio\u2010economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ajhb.23566","type":"journal-article","created":{"date-parts":[[2021,1,16]],"date-time":"2021-01-16T02:14:45Z","timestamp":1610763285000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0411-8025","authenticated-orcid":false,"given":"Jonathan C. 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