Maternal Anemia and Pediatric Neurodevelopment in Children from Mothers Exposed to Mixed Heavy Metals in Suriname

Maternal anemia and prenatal exposure to neurotoxic metals are widespread in low- and middle-income countries and may affect early childhood development. In Suriname, where mercury contamination from artisanal gold mining and social disparities coexist, we examined associations between maternal anemia, prenatal exposure to mercury (Hg), lead (Pb), manganese (Mn), selenium (Se), and cadmium (Cd), and early neurodevelopment. The study included 755 pregnant women and 644 children (10-26 months) from the Caribbean Consortium for Research in Environmental and Occupational Health (CCREOH) cohort. Maternal anemia was defined using WHO criteria for Hb, metals were measured in maternal blood, and child development was assessed using the Bayley Scales of Infant and Toddler Development, third edition (BSID-III-NL). Analyses used non-parametric tests, correlations, and multivariable regression. Anemia, though common (34%), was not independently associated with cognitive, language, motor, or social-emotional outcomes. However, iron status was not directly measured; therefore, the absence of an observed association should not be interpreted as evidence that maternal iron deficiency is unrelated to early neurodevelopment. Pb showed the most consistent associations, with higher prenatal levels predicting poorer cognitive, motor, and language scores. Hg demonstrated weaker but significant negative associations with several domains, while Mn and Cd showed limited direct effects. Interaction analyses suggested a potential modifying role of Se in certain metal-neurodevelopment associations; however, these findings require confirmation in future studies. Overall, these results suggest that prenatal exposure to neurotoxic metals and sociodemographic disparities may be important contributors to variation in early neurodevelopment in this population, but causal inferences cannot be made from this cross-sectional analysis.