PRECISE-DYAD: a prospective cohort study linking maternal and infant health trajectories in sub-Saharan Africa

The PREgnancy Care Integrating Translational Science, Everywhere (PRECISE)-DYAD Study is a prospective observational cohort designed to investigate health outcomes among mother-child pairs (dyads) over the first 3 years of life in two contexts from sub-Saharan Africa. The primary objective of the study was to explore the effects of selected placenta-related complications, such as pregnancy hypertension, fetal growth restriction and preterm birth, on (1) Child health and development, and (2) Women's health and well-being, including outcomes after stillbirth.

The PRECISE-DYAD Study enrolled women (and their children) originally recruited into the PRECISE pregnancy cohort study in The Gambia and Kenya between July 2021 and April 2024. Participants were seen at 6 weeks to 6 months, 12 months, 24 months and 36 months postpartum. Clinical and health data, including anthropometry and diet, were collected for both mothers and children. Mother assessment included a cardiology assessment and collection of data about symptoms of COVID-19 infection. In a subset of participants, mothers were asked about their mental health, their healthcare costs during and after pregnancy, and experiences of care during labour and childbirth/delivery. Additionally, a personal environmental exposure assessment was performed for a subset of the cohort by collecting air and water quality data alongside geographical, demographic and behavioural factors. Child development was assessed using neurodevelopmental assessments, home environment evaluation and quality of life measures. Biological samples were collected from mothers and children, processed promptly and biobanked locally. Sample data were entered into an OpenSpecimen database and linked to each individual, as well as to their corresponding social determinants and clinical data.

A total of 2980 women and 2909 children completed at least one PRECISE-DYAD Study visit. The biorepository contains 108 897 biological samples from mothers and children. Baseline descriptive analysis of the cohort is reported here.

Analysis of data and samples will include biomarker studies, social determinants of health and epidemiological investigations. These analyses will explore how placenta-related complications and environmental exposures, such as nutrition and air quality, interact to shape maternal health, mental well-being, subsequent pregnancies and mother-child interaction, as well as child growth and neurodevelopment through early childhood. Additional work will examine the biological pathways linking these exposures to outcomes and the impacts of caring for children with moderate-to-severe disabilities on maternal well-being. Findings will be disseminated through scientific publications, conference presentations, engagement with local stakeholders and continued community outreach.