Aflatoxin exposure during pregnancy or infancy and its effect on infant health: a narrative review

Pregnant women are exposed to various contaminants through foods, with environmental toxicants and aflatoxin (AF) being among the major food contaminants. Therefore, this review was conducted for a better perspective on the AF exposure during pregnancy or infancy, highlighting how exposure through the mother (via placenta and breast milk) and directly through infant foods ultimately affects infant health. The literature suggests that AF exposure during pregnancy may lead to maternal anaemia, premature delivery, pregnancy loss or decreased number of live births. AF crosses through the placenta and also passes through breast milk. AF exposure during pregnancy may also lead to deleterious effects on the fetus or infants such as reduced fetal growth, low birth weight, impairment of linear or long bone growth and developmental delay such as small head circumference and reduced brain size, stillbirth or fetal death. It may also have an adverse effect on some organs and organ systems, causing aberrations such as neonatal jaundice and disrupting hormone synthesis. In the Indian context, there are limited clinical studies to assess the health effects of AF exposure during pregnancy. For the first time, we have made an attempt to estimate the AF exposure by calculating the AF estimated daily intake using the empirical formulae based on several reported studies. However, more research needs to be undertaken to understand the AF exposure outcomes during pregnancy. The data presented in this review warrant more clinical studies in India on maternal AF exposure to elucidate the birth outcomes and associated infant health outcomes.