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

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 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).