{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:44:29Z","timestamp":1784630669548,"version":"3.55.0"},"reference-count":47,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T00:00:00Z","timestamp":1643155200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005297","name":"Medical University of Bia\u0142ystok","doi-asserted-by":"publisher","award":["N\/ST\/ZB\/18\/002\/3303"],"award-info":[{"award-number":["N\/ST\/ZB\/18\/002\/3303"]}],"id":[{"id":"10.13039\/501100005297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Despite numerous studies of women having children later in life, evidence of the relationship between maternal factors and newborn outcomes in Central and Eastern European countries is limited. This study aimed to examine the association between maternal age, biological determinants, including parity and sex of the newborn, demographic and social background, and birth weight in 3.8 million singleton live births in Poland. Methods: The effect of maternal age on birth weight (in grams and Z-scores) adjusted for confounders was assessed using Generalized Linear Models. Results: The mean (\u00b1SD) birth weights of neonates born to primiparous women and multiparous women were 3356.3 \u00b1 524.9 g and 3422.7 \u00b1 538.6 g, respectively, which corresponded to a Z-score of \u22120.07 \u00b1 0.96 and 0.14 \u00b1 1.00, respectively (p \u2264 0.001). After controlling for biological, demographic, and social factors, a significant decrease in birth weight was found for primiparous women of the age group \u226530 years and multiparous women aged \u226535 years compared to the age group of 25\u201329 years. The lowest neonatal birth weight was observed in the case of women aged \u226545 years. Confounders did not affect birth weight Z-scores among primiparous women, whereas among multiparous women, together with educational factors, they reversed Z-scores from positive to negative values. The lower birth weight of neonates was overall associated with lower maternal education. Conclusions: Regardless of parity, advanced maternal age is strongly associated with a decreased neonatal birth weight, implying complications in early pregnancy and the antenatal period as well as obstetric complications. Counseling to support women\u2019s family planning decisions and improving women\u2019s education during their reproductive age may help to alleviate unfavorable newborn outcomes.<\/jats:p>","DOI":"10.3390\/ijerph19031384","type":"journal-article","created":{"date-parts":[[2022,1,26]],"date-time":"2022-01-26T11:02:53Z","timestamp":1643194973000},"page":"1384","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Inequalities in Birth Weight in Relation to Maternal Factors: A Population-Based Study of 3,813,757 Live Births"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-1062","authenticated-orcid":false,"given":"Agnieszka","family":"Genowska","sequence":"first","affiliation":[{"name":"Department of Public Health, Medical University of Bialystok, 15-295 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8735-2783","authenticated-orcid":false,"given":"Rados\u0142aw","family":"Motkowski","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children\u2019s Hospital, 15-274 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaiva","family":"Strukcinskaite","sequence":"additional","affiliation":[{"name":"Faculty of Health Care, Vilnius University of Applied Sciences, LT-08303 Vilnius, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6150-0971","authenticated-orcid":false,"given":"Pawe\u0142","family":"Abramowicz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children\u2019s Hospital, 15-274 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-332X","authenticated-orcid":false,"given":"Jerzy","family":"Konstantynowicz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children\u2019s Hospital, 15-274 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e849","DOI":"10.1016\/S2214-109X(18)30565-5","article-title":"National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: A systematic analysis","volume":"7","author":"Blencowe","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1016\/S2214-109X(15)00038-8","article-title":"Association between maternal age at childbirth and child and adult outcomes in the offspring: A prospective study in five low-income and middle-income countries (COHORTS collaboration)","volume":"3","author":"Fall","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e018745","DOI":"10.1136\/bmjopen-2017-018745","article-title":"Are risk factors for preterm and early-term live singleton birth the same? A population-based study in France","volume":"8","author":"Delnord","year":"2018","journal-title":"BMJ Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9677","DOI":"10.1038\/s41598-017-09814-w","article-title":"Placental dysfunction underlies increased risk of fetal growth restriction and stillbirth in advanced maternal age women","volume":"7","author":"Lean","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"849","DOI":"10.3390\/ijerph110100849","article-title":"Anthropometric and health-related behavioral factors in the explanation of social inequalities in low birth weight in children with prenatal alcohol exposure","volume":"11","author":"Pfinder","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1471-0528.2010.02823.x","article-title":"Explaining differences in birth outcomes in relation to maternal age: The Generation R Study","volume":"118","author":"Bakker","year":"2011","journal-title":"BJOG"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1002\/uog.11125","article-title":"Impact of maternal characteristics on fetal growth in the third trimester: A population-based study","volume":"40","author":"Lindell","year":"2012","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e005840","DOI":"10.1136\/bmjopen-2014-005840","article-title":"Impact of maternal age on obstetric and neonatal outcome with emphasis on primiparous adolescents and older women: A Swedish Medical Birth Register Study","volume":"4","author":"Blomberg","year":"2014","journal-title":"BMJ Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/j.1365-3016.1998.00075.x","article-title":"Social variation in size at birth and preterm delivery in the Czech Republic and Sweden, 1989\u20131991","volume":"12","author":"Leon","year":"1998","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/ije\/29.1.118","article-title":"Social determinants of birthweight and length of gestation in Estonia during the transition to democracy","volume":"29","author":"Rahu","year":"2000","journal-title":"Int. J. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.26444\/aaem\/75544","article-title":"Study on changing patterns of reproductive behavior due to maternal features and place residents in Poland during 1995\u20132014","volume":"25","author":"Genowska","year":"2018","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_12","first-page":"35","article-title":"Twenty Years after the economic restructuring of Eastern Europe: An economic review","volume":"7","author":"Giannaros","year":"2008","journal-title":"Int. Bus. Econ. Res. J."},{"key":"ref_13","unstructured":"Central Statistical Office (2020). Demographic Yearbook 2020, CSO."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1002\/ajpa.22512","article-title":"A synthetic biosocial model of fertility transition: Testing the relative contribution of embodied capital theory, changing cultural norms, and women\u2019s labor force participation","volume":"154","author":"Snopkowski","year":"2014","journal-title":"Am. J. Phys. Anthropol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1097\/EDE.0000000000000818","article-title":"Absolute risks of obstetric outcomes risks by maternal age at first birth: A population-based cohort","volume":"29","author":"Schummers","year":"2018","journal-title":"Epidemiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s10995-010-0654-z","article-title":"Maternal marital status and birth outcomes: A systematic review and meta-analyses","volume":"15","author":"Shah","year":"2011","journal-title":"Matern. Child Health J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"751","DOI":"10.2147\/IJWH.S283216","article-title":"Management of pregnancy in women of advanced maternal age: Improving outcomes for mother and baby","volume":"13","author":"Glick","year":"2021","journal-title":"Int. J. Womens Health"},{"key":"ref_18","first-page":"856","article-title":"Social and health factors of respiratory distress syndrome in preterm infants","volume":"78","author":"Borkowski","year":"2007","journal-title":"Ginekol. Pol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.3109\/03014460.2013.824026","article-title":"Intergenerational changes in birth parameters in Krak\u00f3w (Poland) in the context of socio-economic transformation from 1985\u20132010","volume":"41","author":"Kryst","year":"2014","journal-title":"Ann. Hum. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"369","DOI":"10.26444\/aaem\/95215","article-title":"Is socio\u2014Economic status associated with adverse birth outcomes in Poland?","volume":"26","author":"Genowska","year":"2019","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Preedy, V.R. (2012). Handbook of Anthropometry. Physical Measures of Human Form in Health and Disease, Springer.","DOI":"10.1007\/978-1-4419-1788-1"},{"key":"ref_22","unstructured":"Aho, K.A. (2013). Foundational and Applied Statistics for Biologists Using R, CRC Press, Chapman and Hall. [1st ed.]."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1111\/ppe.12208","article-title":"Socioeconomic disparities in adverse birth outcomes in urban and rural contexts: A French Mother\u2013Child Cohort","volume":"29","author":"Bertin","year":"2015","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1093\/ije\/dyq069","article-title":"Mother\u2019s educational level and fetal growth: The genesis of health inequalities","volume":"39","author":"Silva","year":"2010","journal-title":"Int. J. Epidemiol."},{"key":"ref_25","unstructured":"United Nations Educational, Scientific and Cultural Organization (2012). International Standard Classification of Education (ISCED 2011), UNESCO."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Heino, A., Gissler, M., Hindori-Mohangoo, A.D., Blondel, B., Klungs\u00f8yr, K., Verdenik, I., Mierzejewska, E., Velebil, P., S\u00f3l \u00d3lafsd\u00f3ttir, H., and Macfarlane, A. (2016). Variations in multiple birth rates and impact on perinatal outcomes in Europe. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149252"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e003225","DOI":"10.1136\/bmjopen-2013-003225","article-title":"Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011","volume":"3","author":"Gissler","year":"2013","journal-title":"BMJ Open"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s13690-020-00484-1","article-title":"Inequality in fertility rate among adolescents: Evidence from Timor-Leste demographic and health surveys 2009\u20132016","volume":"78","author":"Yaya","year":"2020","journal-title":"Arch. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1002\/huon.200900001","article-title":"Determinants of birth weight in boys and girls","volume":"3","author":"Voldner","year":"2009","journal-title":"Hum. Ontogenet."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Inkster, A.M., Fern\u00e1ndez-Boyano, I., and Robinson, W.P. (2021). Sex Differences Are Here to Stay: Relevance to Prenatal Care. J. Clin. Med., 10.","DOI":"10.3390\/jcm10133000"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1055\/s-0039-1700859","article-title":"Perinatal outcomes of women aged 50 years and above","volume":"37","author":"Pariente","year":"2020","journal-title":"Am. J. Perinatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12963-019-0195-7","article-title":"The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main health determinants in the extreme south of Brazil","volume":"17","author":"Vilanova","year":"2019","journal-title":"Popul. Health Metr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1042\/cs0950115","article-title":"In utero programming of chronic disease","volume":"95","author":"Barker","year":"1998","journal-title":"Clin. Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1111\/1753-0407.12800","article-title":"Prospective cohort studies of birth weight and risk of obesity, diabetes, and hypertension in adulthood among the Chinese population","volume":"11","author":"Xia","year":"2019","journal-title":"J. Diabetes"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"531543","DOI":"10.3389\/fimmu.2020.531543","article-title":"Maternal-Fetal Inflammation in the Placenta and the Developmental Origins of Health and Disease","volume":"11","author":"Goldstein","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"6739345","DOI":"10.1155\/2017\/6739345","article-title":"Physiological Uterine involution in primiparous and multiparous women: Ultrasound Study","volume":"2017","author":"Paliulyte","year":"2017","journal-title":"Obstet. Gynecol. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1111\/j.1447-0756.2011.01552.x","article-title":"Impact of maternal age on the incidence of obstetrical complications in Japan","volume":"37","author":"Matsuda","year":"2011","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1111\/ppe.12544","article-title":"Does smoking during pregnancy mediate educational disparities in preterm delivery? Findings from three large birth cohorts","volume":"33","author":"Poulsen","year":"2019","journal-title":"Paediatr. Perinat. Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13690-020-00402-5","article-title":"The influence of education on health: An empirical assessment of OECD countries for the period 1995\u20132015","volume":"78","author":"Raghupathi","year":"2020","journal-title":"Arch. Public Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1038\/sj.ijo.0803317","article-title":"The gender insulin hypothesis: Why girls are born lighter than boys, and the implications for insulin resistance","volume":"30","author":"Wilkin","year":"2006","journal-title":"Int. J. Obes."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1016\/j.placenta.2009.11.010","article-title":"Review: Sex and the human placenta: Mediating differential strategies of fetal growth and survival","volume":"31","author":"Clifton","year":"2010","journal-title":"Placenta"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"F486","DOI":"10.1136\/archdischild-2018-315295","article-title":"Social gradient of birthweight in England assessed using the INTERGROWTH-21st gestational age specific standard","volume":"104","author":"Hirst","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12963-018-0180-6","article-title":"How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data","volume":"16","author":"Phillips","year":"2018","journal-title":"Popul. Health Metr."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Isaacs, K.R., Atreyapurapu, S., Alyusuf, A.H., Ledgerwood, D.M., Finnegan, L.P., Chang, K.H.K., Ma, T.X., and Washio, Y. (2021). Neonatal outcomes after combined opioid and nicotine exposure in utero: A scoping review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph181910215"},{"key":"ref_45","first-page":"117","article-title":"Tobacco-related Foetal Origin of Adult Diseases Hypothesis-population studies in Poland","volume":"19","author":"Paprzycki","year":"2012","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jpag.2015.08.006","article-title":"Adverse maternal and neonatal outcomes in adolescent pregnancy","volume":"29","author":"Kawakita","year":"2016","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_47","unstructured":"\u017bukiewicz-Sobczak, W., Paprzycki, P., and Zwoli\u0144ski, J. (2013). Health Behaviors among Pregnant Women, Institute of Rural Medicine. (In Polish)."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1384\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:08:15Z","timestamp":1760134095000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/3\/1384"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,26]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,2]]}},"alternative-id":["ijerph19031384"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19031384","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,26]]}}}