Article Category:
Research Article

Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development

Michael O. Mireku College of Health and Science, University of Lincoln, Lincoln, United Kingdom;

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Michael J. Boivin Department of Psychiatry, Michigan State University, East Lansing, Michigan;

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Roméo Zoumenou UMR 261-MERIT, Institut de Recherche pour le Développement (IRD), Université Paris Cité, Paris, France;
Institute of Psychology, Laboratoire de Psychopathologie et Processus de Santé, Boulogne, France;

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Amanda Garrison Université Rennes, EHESP, Inserm, IRSET (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085, Rennes, France;

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Michel Cot UMR 261-MERIT, Institut de Recherche pour le Développement (IRD), Université Paris Cité, Paris, France;

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Jules Alao Service de Pédiatrie, CHU de la Mère et de l’Enfant-Lagune de Cotonou, Cotonou, Benin;

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Nadine Fievet UMR 261-MERIT, Institut de Recherche pour le Développement (IRD), Université Paris Cité, Paris, France;
Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin

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Achille Massougbodji Institut de Recherche Clinique du Bénin (IRCB), Abomey-Calavi, Benin

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Florence Bodeau-Livinec UMR 261-MERIT, Institut de Recherche pour le Développement (IRD), Université Paris Cité, Paris, France;
Université Rennes, EHESP, Inserm, IRSET (Institut de Recherche en Santé, Environnement et Travail)–UMR_S 1085, Rennes, France;

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DOI:
https://doi.org/10.4269/ajtmh.24-0643
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Ahead of Print
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Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = −6.8, 95% CI: −11.7 to −1.8; and β = −6.3, 95% CI: −10.4 to −2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.

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Author Notes

Financial support: This work was supported by the Fondation de France (grant number 2015 00060746). The MiPPAD study, funded by the the European and Developing Countries Clinical Trials Partnership (grant number EDCTP-IP.07.31080.002, supported the follow up of pregnant women during the clinical trial. The follow-up of children at age 1 year was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number NIH/NICHD-R21-HD060524). The funder had no role in study design, conduct, or reporting of the results. The views expressed are those of the authors and not necessarily those of the funders.

Disclosures: All relevant data related to this study are within the manuscript and supporting supplemental documents. MiPPAD data cannot be shared publicly because of ethical restrictions. Access to MiPPAD study data may be available upon request through The MiPPAD Executive Committee (Raquel Gonzalez at +34-932-275-400 or raquel.gonzalez@cresib.cat).

We sought ethical approvals from the institutional ethical review boards of the Faculté des Sciences de la Santé and the Applied Biomedical Sciences Institute (CER-ISBA) in Benin, New York University in New York, New York, and the Research Institute for Development’s (IRD) Consultative Ethics Committee in France. We obtained informed consent from all mothers in accordance with the World Medical Association Declaration of Helsinki.

Authors’ contributions: M. O. Mireku, M. J. Boivin, M. Cot, and F. Bodeau-Livinec conceptualized the study. M. O. Mireku completed the literature review, performed the statistical analysis, and wrote the first draft of the manuscript. M. O. Mireku, R. Zoumenou, and A. Garrison performed data cleaning. All authors had full access to all the study findings, contributed to interpretation of the results and revision of the manuscript, and were responsible for the decision to submit the report for publication.

Current contact information: Michael O. Mireku, University of Lincoln, School of Psychology, Sarah Swift Building, Lincoln, United Kingdom, E-mail: Mmireku@lincoln.ac.uk. Michael J. Boivin, Department of Psychiatry, Michigan State University, East Lansing, Michigan, E-mails: boivin@msu.edu. Romeo Zoumenou, Laboratoire de Psychopathologie et Processus de Santé, Institute of Psychology, Boulogne, France, E-mail: zoumenour@yahoo.fr. Amanda Garrison, Université Rennes, EHESP, Rennes, France. E-mail: amanda.garrison@ehesp.fr. Michel Cot and Nadine Fievet, UMR 261 - MERIT, Institut de Recherche pour le Developpement (IRD), Universite Paris Cite, Paris, France, E-mails: michel.cot@ird.fr. and nadine.fievet@ird.fr. Jules Alao, Service de Pediatrie, CHU de la Mere et de l’Enfant-Lagune de Cotonou, Cotonou, Benin. E-mail: amomj@yahoo.fr. Achille Massougbodji, Institut de Recherche Clinique du Bénin, Abomey-Calavi, Benin, E-mail: massougbodjiachille@yahoo.fr.

Address correspondence to Florence Bodeau-Livinec, UMR 261 - MERIT, Institut de Recherche pour le Développement (IRD), Université Paris Cité, 4 Avenue de l’Observatoire, 75006 Paris, France. E-mail: florence.bodeau-livinec@ehesp.fr
Copyright:
© American Society of Tropical Medicine and Hygiene 2024
Received:
25 Sep 2024
|
Accepted:
25 Oct 2024
|
Published Online:
17 Dec 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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