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Author Notes:

Melissa F. Young, melissa.young@emory.edu

MY, PN, RM, and UR designed the research. PN, LT, and LK conducted the field research. MY, LT, LK, ST, and PN analyzed the data. MY, PN, and UR wrote the manuscript. MY had primary responsibility for the final content of the manuscript. All authors reviewed and provided critical feedback.

We would like to kindly acknowledge and thank the efforts of the field staff and the women who participated in the study. We also thank Dr. Yaw Addo for his important contributions to this work.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Research Funding:

This study was supported by the NIH (1R03HD102513-01), Nestle Foundation, Micronutrient Initiative, Mathile Institute for Advancement of Human Nutrition.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Nutrition & Dietetics
  • hemoglobin
  • pregnant women
  • child development
  • anemia
  • nutrition
  • IRON

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


Journal Title:



Volume 10


, Pages 1114101-1114101

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2023 Young, Nguyen, Tran, Khuong, Tandon, Martorell and Ramakrishnan.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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