Mireku Michael O, Boivin Michael J, Zoumenou Roméo, Garrison Amanda, Cot Michel, Alao Jules, Fievet Nadine, Massougbodji Achille, Bodeau-Livinec Florence
College of Health and Science, University of Lincoln, Lincoln, United Kingdom.
Department of Psychiatry, Michigan State University, East Lansing, Michigan.
Am J Trop Med Hyg. 2024 Dec 17;112(3):692-698. doi: 10.4269/ajtmh.24-0643. Print 2025 Mar 5.
Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = -6.8, 95% CI: -11.7 to -1.8; and β = -6.3, 95% CI: -10.4 to -2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.
孕期贫血定义为血红蛋白水平（Hb）低于110g/L，在撒哈拉以南非洲地区会导致婴儿死亡率和发病率上升。孕期母体的Hb会发生生理和病理变化。然而，这些变化对儿童长期神经认知功能的影响尚不清楚。因此，本研究调查了孕期特定产前检查时的Hb水平、孕期Hb轨迹与儿童长期神经认知功能之间的关联。我们分析了一项前瞻性队列研究的数据，该研究纳入了在妊娠29周前入组抗疟药物临床试验的孕妇所生的6岁单胎儿童。在孕期至少两次及分娩时采集静脉血分析血红蛋白水平。我们采用基于群体的轨迹模型来识别不同的产前Hb轨迹。共有478名儿童（占符合条件儿童的75.1%）在6岁时接受了认知和运动功能评估。识别出三种不同的Hb轨迹：持续性贫血（整个孕中期和孕晚期Hb<110g/L）、从贫血到非贫血（孕中期Hb<110g/L，孕晚期Hb逐渐升高至Hb≥110g/L）以及持续性非贫血（整个孕中期和孕晚期Hb≥110g/L）。持续性贫血组和从贫血到非贫血组女性的孩子神经认知得分显著低于持续性非贫血组女性的孩子（β = -6.8，95%CI：-11.7至-1.8；以及β = -6.3，95%CI：-10.4至-2.2）。该研究表明，孕期从孕中期到孕晚期维持Hb水平在110g/L及以上可能与儿童最佳长期神经认知功能相关。
