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Published on: November 20, 2015
Perinatal inflammation, fetal growth restriction, and long-term neurodevelopmental impairment in Bangladesh
Anne Cc Lee1,2, Sara Cherkerzian3,4, Fahmida Tofail5
1Department of Pediatrics, Brigham and Women's Hospital, Boston, MA, 02115, USA. alee6@bwh.harvard.edu.
Insights
Perinatal inflammation in rural Bangladesh is linked to impaired child neurodevelopment, especially in small-for-gestational-age infants. These findings highlight the impact of inflammation on fetal development and the need for interventions.
Area of Science:
- Global child development research
- Neuroscience and immunology
- Low- and middle-income country health studies
Background:
- Limited data exist on perinatal inflammation's effects on neurodevelopment in low-resource settings.
- Growth-restricted infants are a vulnerable population with potential inflammation-related developmental risks.
Purpose of the Study:
- To investigate the association between perinatal inflammation and neurodevelopmental outcomes in infants in rural Bangladesh.
- To assess the impact of specific inflammatory biomarkers in umbilical cord blood on child development at 24 months.
- To examine if these associations differ between small-for-gestational-age (SGA) infants and their peers.
Main Methods:
- A population-based, prospective birth cohort study was conducted in Sylhet, Bangladesh, with 288 infants.
- Umbilical cord blood was analyzed for inflammatory markers: interleukin-1α, IL-1β, IL-6, IL-8, and C-reactive protein (CRP).
- Child neurodevelopment was assessed at 24 months using the Bayley-III Scales of Infant Development, controlling for confounders.
Main Results:
- Elevated CRP and IL-6 were associated with increased odds of fine motor delay, and CRP with lower receptive communication scores in all infants.
- Among SGA infants, elevated IL-1α correlated with cognitive delay, IL-8 with language delay, CRP with receptive communication deficits, and IL-1β with expressive communication and motor deficits.
- These associations indicate a significant link between perinatal inflammation and neurodevelopmental impairments, particularly in growth-restricted infants.
Conclusions:
- Perinatal inflammation is associated with impaired neurodevelopment in 24-month-old children in rural Bangladesh.
- The impact of inflammation on neurodevelopment is more pronounced in small-for-gestational-age (SGA) infants across multiple developmental domains.
- Findings support the neurobiological role of inflammation in adverse fetal development and underscore the need for prenatal interventions to prevent intrauterine growth restriction in LMICs.
Background:
There are limited data on the impact of perinatal inflammation on child neurodevelopment in low-middle income countries and among growth-restricted infants.
Methods:
Population-based, prospective birth cohort study of 288 infants from July 2016-March 2017 in Sylhet, Bangladesh. Umbilical cord blood was analyzed for interleukin(IL)-1α, IL-1β, IL-6, IL-8, and C-reactive protein(CRP). Child neurodevelopment was assessed at 24 months with Bayley-III Scales of Infant Development. We determined associations between cord blood inflammation and neurodevelopmental outcomes, controlling for potential confounders.
Results:
248/288 (86%) live born infants were followed until 24 months, among whom 8.9% were preterm and 45.0% small-for-gestational-age(SGA) at birth. Among all infants, elevated concentrations (>75%) of CRP and IL-6 at birth were associated with increased odds of fine motor delay at 24 months; elevated CRP was also associated with lower receptive communication z-scores. Among SGA infants, elevated IL-1α was associated with cognitive delay, IL-8 with language delay, CRP with lower receptive communication z-scores, and IL-1β with lower expressive communication and motor z-scores.
Conclusions:
In rural Bangladesh, perinatal inflammation was associated with impaired neurodevelopment at 24 months. The associations were strongest among SGA infants and noted across several biomarkers and domains, supporting the neurobiological role of inflammation in adverse fetal development, particularly in the setting of fetal growth restriction.
Impact:
Cord blood inflammation was associated with fine motor and language delays at 24 months of age in a community-based cohort in rural Bangladesh. 23.4 million infants are born small-for-gestational-age (SGA) globally each year. Among SGA infants, the associations between cord blood inflammation and adverse outcomes were strong and consistent across several biomarkers and neurodevelopmental domains (cognitive, motor, language), supporting the neurobiological impact of inflammation prominent in growth-restricted infants. Prenatal interventions to prevent intrauterine growth restriction are needed in low- and middle-income countries and may also result in long-term benefits on child development.
