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Effects of Maternal and Early-Life Anaemia on Child Brain Development: A South African Birth Cohort Study

23 Pages Posted: 9 Sep 2021

See all articles by Catherine J. Wedderburn

Catherine J. Wedderburn

University of Cape Town (UCT)

Jessica Ringshaw

University of Cape Town (UCT)

Kirsten Donald

University of Cape Town (UCT) - Department of Pediatrics and Child Health

Shantanu Joshi

University of California, Los Angeles (UCLA)

Sivenesi Subramoney

University of Cape Town (UCT)

Jean-Paul Fouche

University of Cape Town (UCT) - Department of Psychiatry

Jacob A. M. Stadler

University of Cape Town (UCT)

Whitney Barnett

University of Cape Town (UCT) - Department of Pediatrics and Child Health; South African Medical Research Council

Andrea M. Rehman

London School of Hygiene & Tropical Medicine

Nadia Hoffman

University of Cape Town (UCT)

Annerine Roos

University of Cape Town (UCT)

Katherine Narr

University of California - Departments of Neurology, Psychiatry and Biobehavioral Sciences

Heather Zar

University of Cape Town (UCT) - Department of Pediatrics and Child Health

Dan J. Stein

University of Cape Town (UCT) - Neuroscience Institute

More...

Abstract

Background:  Anaemia affects millions of women and children worldwide, particularly in low- and middle-income countries. Although anaemia in pregnancy is a well-described risk factor for poor child neurodevelopmental outcomes, little is known about the impact on the structural development of the human brain. We explored the relationship between maternal anaemia, child anaemia, and brain structure at 2-3 years of age. 

Methods:  Pregnant women were enrolled into the Drakenstein Child Health Study, a South African population-based birth cohort. Mother-child pairs were followed prospectively and a subgroup of children had magnetic resonance imaging at 2-3 years of age. Mothers had haemoglobin measurements during pregnancy, and a group of children during early life. Linear regression models were used to analyse the effects of maternal and child anaemia on child brain volumes. 

Findings:  Prevalence of maternal anaemia in pregnancy (haemoglobin<11g/dl) was 31.3% (median gestation 13 weeks) and child anaemia 52.5% (median age 8.0 months) in this subgroup. Among 147 children (46 maternal anaemia) with high resolution scans, maternal anaemia was significantly associated with decreased volumes of the child caudate bilaterally (5.3% reduction), putamen (left hemisphere; 4.3% reduction), and corpus callosum (7.8% reduction). Maternal haemoglobin level predicted brain volumes in these regions (p<0.05). No relationships were seen between child anaemia and brain volumes (n=80; p>0.05). Associations between antenatal anaemia with child putamen and corpus callosum volumes increased in magnitude when adjusting for child anaemia. 

Interpretation:   Maternal anaemia may influence brain development during a critical window with persistent impact. 

Funding:  Gates Foundation, SAMRC, NIH, Wellcome Trust

Declaration of Interests: No conflicts of interest.

Ethics Approval Statement: The DCHS was approved by the Faculty of Health Sciences, Human Research Ethics Committee (HREC), UCT (401/2009), Stellenbosch University (N12/02/0002), and the Western Cape Provincial Health Research Committee (2011RP45). The neuroimaging sub-study was further approved by the UCT HREC (525/2012).

Keywords: Anaemia, child, brain structure, haemoglobin, magnetic resonance imaging

Suggested Citation

Wedderburn, Catherine J. and Ringshaw, Jessica and Donald, Kirsten and Joshi, Shantanu and Subramoney, Sivenesi and Fouche, Jean-Paul and Stadler, Jacob A. M. and Barnett, Whitney and Rehman, Andrea M. and Hoffman, Nadia and Roos, Annerine and Narr, Katherine and Zar, Heather and Stein, Dan J., Effects of Maternal and Early-Life Anaemia on Child Brain Development: A South African Birth Cohort Study. Available at SSRN: https://ssrn.com/abstract=3920258 or http://dx.doi.org/10.2139/ssrn.3920258

Catherine J. Wedderburn

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Jessica Ringshaw

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Kirsten Donald (Contact Author)

University of Cape Town (UCT) - Department of Pediatrics and Child Health ( email )

5 th floor ICH Building
Cape Town
South Africa

Shantanu Joshi

University of California, Los Angeles (UCLA)

405 Hilgard Avenue
Box 951361
Los Angeles, CA 90095
United States

Sivenesi Subramoney

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Jean-Paul Fouche

University of Cape Town (UCT) - Department of Psychiatry

United States

Jacob A. M. Stadler

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Whitney Barnett

University of Cape Town (UCT) - Department of Pediatrics and Child Health

5 th floor ICH Building
Cape Town
South Africa

South African Medical Research Council

296 Umbilo Rd.
Durban 4000
South Africa

Andrea M. Rehman

London School of Hygiene & Tropical Medicine

Nadia Hoffman

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Annerine Roos

University of Cape Town (UCT) ( email )

Private Bag X3
Rondebosch, Western Cape 7701
South Africa

Katherine Narr

University of California - Departments of Neurology, Psychiatry and Biobehavioral Sciences

540 Alumni Ln
Davis, CA 95616
United States

Heather Zar

University of Cape Town (UCT) - Department of Pediatrics and Child Health ( email )

Klipfontein Road
Rondebosch, 7700
South Africa
+27 21 658 5319/5324 (Phone)

Dan J. Stein

University of Cape Town (UCT) - Neuroscience Institute ( email )

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