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Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development
Michael O Mireku1, Michael J Boivin2, Roméo Zoumenou3,4
1College of Health and Science, University of Lincoln, Lincoln, United Kingdom.
Insights
Maintaining adequate hemoglobin levels during pregnancy is crucial for child development. Anemia in mothers is linked to lower neurocognitive scores in children at age six, highlighting the importance of prenatal care.
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.
Abstract:
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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