Associations between maternal and child anemia and development outcomes: evidence from a large cross-sectional...

This cross-sectional study investigated the association between maternal and child anemia and development in 2,473 children up to 72 months old in Ceará, Brazil. Hemoglobin was measured using HemoCue Hb 201, and child development was assessed via the Ages and Stages Questionnaires-Brazil (ASQ-BR). In multivariate analyses, neither maternal anemia nor child anemia (overall) was associated with continuous domain z-scores or developmental delays (all p > 0.05). However, when stratified by severity, mild child anemia was associated with a higher prevalence of fine motor delay (Prevalence Ratio = 1.65, 95% CI: 1.18-2.31), while moderate-to-severe child anemia was associated with a higher prevalence of gross motor delay (PR = 1.71, 95% CI: 1.06-2.75). Exploratory analyses revealed effect modification by age; in children aged 49-72 months, mild child anemia was associated with lower gross motor (Standardized Mean Difference = -0.52), fine motor (SMD = -0.91), and problem-solving scores (SMD = -0.33), while moderate-to-severe child anemia was associated with lower gross motor scores (SMD = -0.83). Our findings suggest that the severity and timing of child anemia are associated with specific developmental outcomes, reinforcing the need for targeted interventions.