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FN1Authors' addresses: Laura E. Smith, Division of Nutritional Sciences, Cornell University, Ithaca, NY, and Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe, E-mail: email@example.com. Andrew J. Prendergast, Centre for Pediatrics, Queen Mary University of London, London, United Kingdom, and Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe, E-mail: firstname.lastname@example.org. Paul C. Turner, Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland at College Park, College Park, MD, E-mail: email@example.com. Jean H. Humphrey, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe, E-mail: firstname.lastname@example.org. Rebecca J. Stoltzfus, Division of Nutritional Sciences, Cornell University, Ithaca, NY, E-mail: email@example.com.
- The American Society of Tropical Medicine and Hygiene
- Source: The American Journal of Tropical Medicine and Hygiene, Volume 96, Issue 4, Apr 2017, p. 770 - 776
oa Aflatoxin Exposure During Pregnancy, Maternal Anemia, and Adverse Birth Outcomes
Pregnant women and their developing fetuses are vulnerable to multiple environmental insults, including exposure to aflatoxin, a mycotoxin that may contaminate as much as 25% of the world food supply. We reviewed and integrated findings from studies of aflatoxin exposure during pregnancy and evaluated potential links to adverse pregnancy outcomes. We identified 27 studies (10 human cross-sectional studies and 17 animal studies) assessing the relationship between aflatoxin exposure and adverse birth outcomes or anemia. Findings suggest that aflatoxin exposure during pregnancy may impair fetal growth. Only one human study investigated aflatoxin exposure and prematurity, and no studies investigated its relationship with pregnancy loss, but animal studies suggest aflatoxin exposure may increase risk for prematurity and pregnancy loss. The fetus could be affected by maternal aflatoxin exposure through direct toxicity as well as indirect toxicity, via maternal systemic inflammation, impaired placental growth, or elevation of placental cytokines. The cytotoxic and systemic effects of aflatoxin could plausibly mediate maternal anemia, intrauterine growth restriction, fetal loss, and preterm birth. Given the widespread exposure to this toxin in developing countries, longitudinal studies in pregnant women are needed to provide stronger evidence for the role of aflatoxin in adverse pregnancy outcomes, and to explore biological mechanisms. Potential pathways for intervention to reduce aflatoxin exposure are urgently needed, and this might reduce the global burden of stillbirth, preterm birth, and low birthweight.
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