Effects of maternal and early-life anaemia on child brain development: a South African birth cohort study

Objectives: Anaemia affects millions of women and children worldwide, particularly in low- and middle-income countries. Although maternal anaemia in pregnancy has consistently been associated with poor neurodevelopmental outcomes, little is known about its impact on the structure of the developing child 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 old. Mothers had haemoglobin measurements during pregnancy, and a sub-group of children during early life. Linear regression models were used to analyse the associations between maternal anaemia, child anaemia, and child brain volumes.

Results: In the neuroimaging sub-group, the prevalence of maternal anaemia in pregnancy (haemoglobin <11g/dL) was 31.3% (46/147; median gestation of measurement 13 weeks). Among 147 children with high-resolution brain scans, maternal anaemia was significantly associated with smaller volumes of the child caudate bilaterally (-5.3%), putamen (L-hemisphere; -4.3%), and corpus callosum (-7.8%). Maternal haemoglobin level predicted brain volumes in these regions (p<0.05). Child anaemia prevalence was 52.5% (42/80; median age of measurement 8.0 months). There were no significant relationships between child anaemia and brain volumes (n=80; p>0.05). Associations between antenatal anaemia with child putamen and corpus callosum volumes strengthened when adjusting for child anaemia.

Conclusions: Maternal anaemia in pregnancy is a global health priority which may have long-term, persistent consequences for the developing child brain.
Keywords: Anaemia, haemoglobin, neurodevelopment, neuroimaging, brain