Prenatal Hemoglobin Levels and Early Cognitive and Motor Functions of One-Year-Old Children.

Michael O Mireku, Leslie L Davidson, Ghislain K Koura, Smaïla Ouédraogo, Michael J Boivin, Xu Xiong, Manfred M K Accrombessi, Achille Massougbodji, Michel Cot, Florence Bodeau-Livinec

Journal: Pediatrics 2015;136(1):e76-83

PMID: 26055847

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Abstract

OBJECTIVE

To explore the relationship between prenatal hemoglobin (Hb) concentration and infant cognitive and motor functions.

METHODS

Our prospective cohort study included 1-year-old children born to women enrolled at their first antenatal care (ANC) visit in Allada, Benin, before 29 weeks of pregnancy, within a trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine. Hb concentrations of pregnant women were determined from venous blood samples collected at first and second ANC visits of at least 1-month interval and at delivery. Women were prescribed oral iron, folic acid, and anthelminthics after the first ANC visit. A total of 636 children (76.8% of eligible children) were assessed by trained research nurses for cognitive and motor functions by using the Mullen Scales of Early Learning.

RESULTS

Prevalence of anemia (Hb < 110 g/L) decreased from 67.0% at first ANC visit (mean gestational age [SD], 22.1 [4.0] weeks) to 38.4% at delivery. Mean (SD) Hb concentrations increased from 103.7 (12.3) at first ANC visit to 112.4 (14.1) at delivery. We observed a significant negative quadratic relationship between infant gross motor (GM) function and Hb concentration at first and second ANC visits. Thus, infant GM scores increased sharply with increasing maternal Hb concentration until 90 g/L where increasing GM was mild, and began to decline after 110 g/L.

CONCLUSIONS

There appears to be an Hb concentration range that may be optimal for GM function of 1-year-old children. This may reflect the importance of physiologic hemodilution, which occurs after the second trimester until 34 weeks of gestation.

Address: Ecole des Hautes Etudes en Santé Publique, Département Épidémiologie et Biostatistiques, Rennes, France; Université Pierre et Marie Curie (UPMC-Paris VI), Ecole doctorale Pierre Louis de santé publique, Paris, France; Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales, Paris, France; [email protected].; Mailman School of Public Health and the College of Physicians and Surgeons, Columbia University, New York, New York;; Union Internationale Contre la Tuberculose et les Maladies Respiratoires, Département Tuberculose et VIH, Paris, France;; Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales, Paris, France; Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso;; Departments of Psychiatry and Neurology/Ophthalmology, Michigan State University, East Lansing, Michigan;; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana;; Université Pierre et Marie Curie (UPMC-Paris VI), Ecole doctorale Pierre Louis de santé publique, Paris, France; Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales, Paris, France;; Université d'Abomey-Calavi, Faculté des Sciences de la Santé, Cotonou, Bénin;; Institut de Recherche pour le Développement (IRD), Mère et Enfant Face aux Infections Tropicales, Paris, France; PRES Sorbonne Paris Cité, Université Paris Descartes, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France;; Ecole des Hautes Etudes en Santé Publique, Département Épidémiologie et Biostatistiques, Rennes, France; Center for Epidemiology and Statistics Sorbonne Paris Cité, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), DHU Risks in Pregnancy, Paris Descartes University, Paris, France; and Division of Parasitology, Department of Microbiology, New York University Medical Center, New York, New York.

DOI: 10.1542/peds.2015-0491

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MeSH Terms: Anemia, Benin, Cognition, Female, Follow-Up Studies, Hemoglobins, Humans, Infant, Infant, Newborn, Male, Motor Activity, Pregnancy, Prenatal Care, Prevalence, Prospective Studies