Mediating and Interacting Effects of Birth Outcomes on the Relationship between Prenatal Manganese Exposure and Cognitive Outcome among 2-3 years-old Bangladeshi Children

Background/Aim: We investigated the mediating and interacting influence of physical measurements at birth on the relationship between prenatal exposure to manganese and cognitive status among 2-3 years-old Bangladeshi children. Methods: Pregnant mothers were enrolled in a prospective birth cohort in rural Bangladesh between 2008-2011 and children followed longitudinally. Manganese was measured in umbilical cord blood metal by ICP-MS. Anthropometric measurements (weight, length, head circumference) were assessed at delivery. Cognitive status of the children was assessed by translated and culturally appropriate version of the Bayley Scales of Infant and Toddler Development Third Edition at age 20-40 months. We assessed the effect of cord blood manganese on neurodevelopment considering whether physical measures at birth mediated the association with cognitive score or whether these measures modified the association between cord blood manganese and cognitive score. Recently developed statistical approaches al...