Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development

Area of Science:

• Obstetrics and Gynecology
• Pediatric Neurology
• Hematology

Background:

• Anemia in pregnancy, defined as hemoglobin (Hb) <110 g/L, is a significant public health issue in sub-Saharan Africa, contributing to maternal and infant morbidity and mortality.
• Physiological and pathological changes in maternal Hb occur during pregnancy, but their long-term impact on child neurocognitive development remains understudied.

Purpose of the Study:

• To investigate the association between maternal hemoglobin levels and trajectories during pregnancy and neurocognitive function in children at age six.
• To identify distinct patterns of maternal hemoglobin changes throughout gestation and their correlation with long-term child developmental outcomes.

Main Methods:

• Prospective cohort study involving 6-year-old children whose mothers participated in an antimalarial drug trial.
• Maternal hemoglobin levels were measured at least twice during pregnancy and at delivery.
• Group-based trajectory modeling was used to define prenatal Hb trajectories, followed by neurocognitive and motor function assessments in children.

Main Results:

• Three distinct maternal Hb trajectories were identified: persistently anemic, anemic to nonanemic, and persistently nonanemic.
• Children born to mothers with persistently anemic or anemic-to-nonanemic Hb trajectories exhibited significantly lower neurocognitive scores compared to those from persistently nonanemic pregnancies.
• Specifically, adjusted analyses showed significant negative associations between anemic trajectories and child neurocognitive scores (β = -6.8 and β = -6.3).

Conclusions:

• Maintaining maternal hemoglobin levels at or above 110 g/L from the second to third trimester of pregnancy is associated with optimal long-term neurocognitive function in children.
• Prenatal anemia, even if transient, may have lasting detrimental effects on child neurodevelopment.
• These findings underscore the critical importance of monitoring and managing maternal anemia throughout pregnancy to support optimal child cognitive outcomes.