Maternal hemoglobin concentrations across pregnancy and child health and development from birth through 6-7 years

• Type of Material: Article
• Authors: Melissa Young, Emory University; Phuong Nguyen, International Food Policy Research Institute (IFPRI); Lan Mai Tran, Emory University; Long Quynh Khuong, Hanoi School of Public Health; Sonia Tandon, Emory University; Reynaldo Martorell, Emory University; Usha Ramakrishnan, Emory University
• Language: English
• Date: 2023-02-16
• Publisher: FRONTIERS MEDIA SA
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Young, Nguyen, Tran, Khuong, Tandon, Martorell and Ramakrishnan.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.3389/fnut.2023.1114101
• Title of Journal or Parent Work: FRONTIERS IN NUTRITION
• Volume: 10
• Start Page: 1114101
• End Page: 1114101
• Grant/Funding Information: This study was supported by the NIH (1R03HD102513-01), Nestle Foundation, Micronutrient Initiative, Mathile Institute for Advancement of Human Nutrition.
• Keywords: PRECONCEPTION MICRONUTRIENT SUPPLEMENTATION; MECHANISMS; child development; FOLIC-ACID; anemia; Science & Technology; ANEMIA; GESTATIONAL-AGE; WOMEN; LOW-INCOME; IRON; RANDOMIZED CONTROLLED-TRIAL; UNDERNUTRITION; Life Sciences & Biomedicine; nutrition; pregnant women; Nutrition & Dietetics; hemoglobin
• Research Categories: Health Sciences, Nutrition; Health Sciences, Public Health

Abstract

Background: The role of changes in maternal hemoglobin (Hb) across pregnancy on child health and development (CHD) remains unclear. Objective: We examined the association between maternal Hb trajectories and CHD outcomes: (a) birth outcomes (birth weight, length, gestational age, preterm, and small for gestational age); (b) child Hb at 3, 6, 12, and 24 months; and (c) motor and mental development at 12 and 24 months and cognitive functioning at age 6–7 years. Methods: We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam (N = 1,175 women enrolled during preconception with offspring follow-up through 6–7 years). Maternal Hb trajectories were developed using latent class analysis with Hb data at preconception, early (≤20 weeks), mid (21–29 weeks), and late (≥30 weeks) pregnancy. Multivariable linear and logistic regression models were used to assess the association between maternal Hb trajectories on CHD outcomes, adjusting for confounding variables at the maternal, child and household levels. Results: Four distinct maternal Hb trajectories were identified. Track 1 (low initial Hb-decline) was associated with lower child Hb at 3 months (β [95% CI] −0.52 [−0.87, −0.16]), 6 months (−0.36 [−0.68, −0.05]), 12 months (−0.46 [−0.79, −0.13]), and 24 months (−0.44 [−0.72, −0.15]) and motor development at 12 months (−3.58 [−6.76, −0.40]) compared to track 4 (high initial Hb-decline). After adjustment for multiple testing, relationships remained robust with the exception of associations with child Hb at 6 months and motor development at 12 months. Track 2 (low initial Hb-improve) was the only Hb trajectory to increase across pregnancy; however, it was insufficiently powered. Track 3 (mid Hb-decline) was associated with lower child Hb at 12 months (−0.27 [−0.44, −0.10]) and 24 months (−0.20 [−0.34, −0.05]) compared to track 4 (high initial Hb-decline). Maternal Hb trajectories were not associated with birth outcomes or child development at 24 months or 6–7 years. Conclusion: Maternal Hb trajectories during pregnancy are associated with child Hb concentrations across the first 1,000 days, but not with birth outcomes or later cognitive functioning. More work is needed to better understand and interpret changes in Hb levels during pregnancy especially in resource poor settings.