Long-Term Association Between Maternal Preconception Hemoglobin Concentration, Anemia, and Child Health and Development in Vietnam

• Authors: Melissa F Young, Emory University; Phuong Nguyen, Thai Nguyen University; Lan Mai Tran, Emory University; Long Quynh Khuong, Hanoi School of Public Health; Reynaldo Martorell, Emory University; Usha Ramakrishnan, Emory University
• Journal Title: JOURNAL OF NUTRITION
• Volume: Volume 153, Number 5
• Publisher: ELSEVIER SCIENCE INC | 2023-05-01, Pages 1597-1606
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.tjnut.2023.03.015
• Subjects: Health Sciences, Nutrition; Health Sciences, Pharmacy; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Nutrition & Dietetics; hemoglobin; preconception; anemia; child development; birth outcomes; RANDOMIZED CONTROLLED-TRIAL; IRON-DEFICIENCY ANEMIA; MICRONUTRIENT SUPPLEMENTATION; GESTATIONAL-AGE; DEVELOPING-COUNTRIES; MOTOR DEVELOPMENT; RISK-FACTORS; FOLIC-ACID; PREGNANCY; BIRTH

Abstract

Background: The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear. Objectives: We examined associations between maternal preconception Hb concentrations and anemia with 1) birth outcomes (weight, length, preterm, gestational age, small for gestational age); 2) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; and 3) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6–7 y (Wechsler Intelligence Scale for Children). Methods: We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited, and offspring were prospectively followed from birth (n = 1599) through 6–7 y (n = 1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 12g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child, and household levels. Results: At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01, 0.12), 6 mo (0.08; 95% CI: 0.03, 0.13), 12 mo (0.10; 95% CI: 0.04, 0.15), and 24 mo (0.07; 95% CI: 0.02, 0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6 mo (0.89; 95% CI: 0.81, 0.98), 12 mo (0.81; 95% CI: 0.74, 0.89), and 24 mo (0.87; 95% CI: 0.79, 0.95). Maternal preconception anemia was negatively associated with cognition (−1.64; 95% CI: −3.09, −0.19) and language development (−1.61; 95% CI: −3.20, −0.03) at 24 mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6–7 y. Conclusions: Maternal preconception Hb was associated with child Hb across the first 1000 d of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive outcomes at 6–7 y in this cohort from Vietnam. Clinical Trial Registration: PRECONCEPT study (NCT: 01665378).