Assessing the Effects of Maternal Anemia on Child Development in Benin

  • Florence Bodeau-Livinec
  • Michel Cot
  • Ghislain K. Koura
  • Michael J. Boivin
Part of the Specialty Topics in Pediatric Neuropsychology book series (STPN)


More than 50 % of women develop moderate anemia during pregnancy with about 5–10 % of women developing severe anemia in Sub-Saharan Africa. Severe anemia increases the risk of mortality and morbidity in mothers, but there is limited information on anemia during pregnancy and cognitive outcome in childhood despite the very high prevalence of anemia in Sub-Saharan Africa. The main goal of this research project is to study the relationship between anemia in pregnancy and cognitive function in childhood. This study takes advantage of a group of infants born following a randomized controlled trial of intermittent preventive treatment for malaria in women during pregnancy funded by the European Union. Mothers have been followed from the second trimester of pregnancy until delivery including at least three blood samples with infections (malaria) and micronutrient deficiencies analyses. Offspring are assessed with the Mullen Scales of Early Learning (MSEL) at 12 months of age. A blood draw is also performed assessing Hb concentration, infections (malaria), iron deficiency, and lead in blood. So far, preliminary results show significant associations between impaired development and both environmental and care giving quality risk factors.


  1. Ahmad, S. H., Amir, M., Ansari, Z., & Ahmed, K. N. (1983). Influence of maternal iron deficiency anemia on the fetal total body iron. Indian Pediatrics, 20, 643–646.PubMedGoogle Scholar
  2. Allen, L. H. (2000). Anemia and iron deficiency: Effects on pregnancy outcome. The American Journal of Clinical Nutrition, 71, 1280S–1284S.PubMedGoogle Scholar
  3. Allen, L. H. (2001). Biological mechanisms that might underlie iron’s effects on fetal growth and preterm birth. The Journal of Nutrition, 131, 581S–589S.PubMedGoogle Scholar
  4. Ballard, J. L., Khoury, J. C., Wedig, K., Wang, L., Eilerswalsman, B. L., & Lipp, R. (1991). New Ballard Score, expanded to include extremely premature-infants. The Journal of Pediatrics, 119, 417–423.PubMedCrossRefGoogle Scholar
  5. Berkowitz, G. S., & Papiernik, E. (1993). Epidemiology of preterm birth. Epidemiologic Reviews, 15, 414–443.PubMedGoogle Scholar
  6. Bodeau-Livinec, F., Briand, V., Berger, J., Xiong, X., Massougbodji, A., Day, K. P., et al. (2011). Maternal anemia in Benin: Prevalence, risk factors and association with low birth weight. The American Journal of Tropical Medicine and Hygiene, 85(3), 414–420.PubMedCrossRefGoogle Scholar
  7. Bodnar, L. M., Ness, R. B., Harger, G. F., & Roberts, J. M. (2005). Inflammation and triglycerides partially mediate the effect of prepregnancy body mass index on the risk of preeclampsia. American Journal of Epidemiology, 162, 1198–1206.PubMedCrossRefGoogle Scholar
  8. Brabin, B. J., Kalanda, B. F., Verhoeff, F. H., Chimsuku, L. H., & Broadhead, R. L. (2004). Risk factors for fetal anaemia in a malarious area of Malawi. Annals of Tropical Paediatrics, 24, 311–321.PubMedCrossRefGoogle Scholar
  9. Caldwell, B. M. B. R. (2001). HOME inventory administration manual. Little Rock, AR: Center for Research on Teaching & Learning.Google Scholar
  10. Calis, J. C. J., Phiri, K. S., Faragher, E. B., Brabin, B. J., Bates, I., Cuevas, L. E., et al. (2008). Severe anemia in Malawian children. The New England Journal of Medicine, 358, 888–899.PubMedCrossRefGoogle Scholar
  11. Christian, P., Murray-Kolb, L. E., Khatry, S. K., Katz, J., Schaefer, B. A., Cole, P. M., et al. (2010). Prenatal micronutrient supplementation and intellectual and motor function in early school-­aged children in Nepal. JAMA: The Journal of the American Medical Association, 304, 2716–2723.CrossRefGoogle Scholar
  12. Colomer, J., Colomer, C., Gutierrez, D., Jubert, A., Nolasco, A., Donat, J., et al. (1990). Anaemia during pregnancy as a risk factor for infant iron deficiency: Report from the Valencia Infant Anaemia Cohort (VIAC) study. Paediatric and Perinatal Epidemiology, 4, 196–204.PubMedCrossRefGoogle Scholar
  13. Engle, P. L., Fernald, L. C. H., Alderman, H., Behrman, J., O’Gara, C., Yousafzai, A., et al. (2011). Child development 2 strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet, 378, 1339–1353.PubMedCrossRefGoogle Scholar
  14. Geelhoed, D., Agadzi, F., Visser, L., Ablordeppey, E., Asare, K., O’Rourke, P., et al. (2006). Severe anemia in pregnancy in rural Ghana: A case-control study of causes and management. Acta Obstetricia Et Gynecologica Scandinavica, 85, 1165–1171.PubMedCrossRefGoogle Scholar
  15. Hernan, M. A., Hernandez-Diaz, S., Werler, M. M., & Mitchell, A. A. (2002). Causal knowledge as a prerequisite for confounding evaluation: An application to birth defects epidemiology. American Journal of Epidemiology, 155, 176–184.PubMedCrossRefGoogle Scholar
  16. Hernandez-Martinez, C., Canals, J., Aranda, N., Ribot, B., Escribano, J., & Arija, V. (2011). Effects of iron deficiency on neonatal behavior at different stages of pregnancy. Early Human Development, 87, 165–169.PubMedCrossRefGoogle Scholar
  17. Idjradinata, P., & Pollitt, E. (1993). Reversal of developmental delays in iron-deficient anemic infants treated with iron. Lancet, 341, 1–4.PubMedCrossRefGoogle Scholar
  18. Insel, B. J., Schaefer, C. A., McKeague, I. W., Susser, E. S., & Brown, A. S. (2008). Maternal iron deficiency and the risk of schizophrenia in offspring. Archives of General Psychiatry, 65, 1136–1144.PubMedCrossRefGoogle Scholar
  19. Kilbride, J., Baker, T. G., Parapia, L. A., Khoury, S. A., Shuqaidef, S. W., & Jerwood, D. (1999). Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: A case-­control study in Jordan. International Journal of Epidemiology, 28, 461–468.PubMedCrossRefGoogle Scholar
  20. Lao, T. T., Loong, E. P. L., Chin, R. K. H., Lam, C. W. K., & Lam, Y. M. (1991). Relationship between newborn and maternal iron status and hematological indexes. Biology of the Neonate, 60, 303–307.PubMedCrossRefGoogle Scholar
  21. Latoundji, S., Ablete, A. L., Zohoun, I. (1991). Morbidite et mortalite drepanocytaire au Benin. Médecine d'Afrique Noire 38 (8/9).Google Scholar
  22. Li, S. C. (2003). Biocultural orchestration of developmental plasticity across levels: The interplay of biology and culture in shaping the mind and behavior across the life span. Psychological Bulletin, 129, 171–194.PubMedCrossRefGoogle Scholar
  23. Looker, A. C., Dallman, P. R., Carroll, M. D., Gunter, E. W., & Johnson, C. L. (1997). Prevalence of iron deficiency in the United States. JAMA: The Journal of the American Medical Association, 277, 973–976.CrossRefGoogle Scholar
  24. Lozoff, B., & Georgieff, M. K. (2006). Iron deficiency and brain development. Seminars in Pediatric Neurology, 13, 158–165.PubMedCrossRefGoogle Scholar
  25. Mihaila, C., Schramm, J., Strathmann, F. G., Lee, D. L., Gelein, R. M., Luebke, A. E., et al. (2011). Identifying a window of vulnerability during fetal development in a maternal iron restriction model. PloS One, 6(3), e17483.PubMedCrossRefGoogle Scholar
  26. MMWR PiCD. (1990, February 9). Prevention anemia during pregnancy in low-income women. United States, 1987. MMWR PiCD, 39(5), 73–76, 81.Google Scholar
  27. Morton, R. E., Nysenbaum, A., & Price, K. (1988). Iron status in the 1st year of life. Journal of Pediatric Gastroenterology and Nutrition, 7, 707–712.PubMedCrossRefGoogle Scholar
  28. Ouédraogo, S. K. G., Accrombessi, M., Massougbodji, A., Bodeau-Livinec, F., & Cot, M. (2012). Maternal anaemia at first antenatal visit: Prevalence and aetiologies in a West African malaria endemic area. The American Journal of Tropical Medicine and Hygiene, 87(3), 418–424.PubMedCrossRefGoogle Scholar
  29. Perez, E. M., Hendricks, M. K., Beard, J. L., Murray-Kolb, L. E., Berg, A., Tomlinson, M., et al. (2005). Mother-infant interactions and infant development are altered by maternal iron deficiency anemia. The Journal of Nutrition, 135, 850–855.PubMedGoogle Scholar
  30. Pollitt, E. (1993). Iron-deficiency and cognitive function. Annual Review of Nutrition, 13, 521–537.PubMedCrossRefGoogle Scholar
  31. Preziosi, P., Prual, A., Galan, P., Daouda, H., Boureima, H., & Hercberg, S. (1997). Effect of iron supplementation on the iron status of pregnant women: Consequences for newborns. The American Journal of Clinical Nutrition, 66, 1178–1182.PubMedGoogle Scholar
  32. Sazawal, S., Black, R. E., Ramsan, M., Chwaya, H. M., Stoltzfus, R. J., Dutta, A., et al. (2006). Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: Community-­based, randomised, placebo-controlled trial. Lancet, 367, 133–143.PubMedCrossRefGoogle Scholar
  33. Scanlon, K. S., Yip, R., Schieve, L. A., & Cogswell, M. E. (2000). High and low hemoglobin levels during pregnancy: Differential risks for preterm birth and small for gestational age. Obstetrics and Gynecology, 96, 741–748.PubMedCrossRefGoogle Scholar
  34. Siza, J. E. (2008). Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in northern Tanzania. Tanzania Journal of Health Research, 10, 1–8.PubMedCrossRefGoogle Scholar
  35. Strauss, M. B. (1933). Anemia of infancy from maternal iron deficiency in pregnancy. The Journal of Clinical Investigation, 12, 345–353.PubMedCrossRefGoogle Scholar
  36. Tamura, T., Goldenberg, R. L., Hou, J. R., Johnston, K. E., Cliver, S. P., Ramey, S. L., et al. (2002). Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. The Journal of Pediatrics, 140, 165–170.PubMedCrossRefGoogle Scholar
  37. van den Broek, N. (2003). Anaemia and micronutrient deficiencies. British Medical Bulletin, 67, 149–160.PubMedCrossRefGoogle Scholar
  38. Vaughn, J., Brown, J., & Carter, J. P. (1986). The effects of maternal anemia on infant behavior. Journal of the National Medical Association, 78, 963–968.PubMedGoogle Scholar
  39. Walker, S. P., Wachs, T. D., Gardner, J. M., Lozoff, B., Wasserman, G. A., Pollitt, E., et al. (2007). Child development in developing countries 2 – Child development: Risk factors for adverse outcomes in developing countries. Lancet, 369, 145–157.PubMedCrossRefGoogle Scholar
  40. Walker, S. P., Wachs, T. D., Grantham-McGregor, S., Black, M. M., Nelson, C. A., Huffman, S. L., et al. (2011). Child development 1 inequality in early childhood: Risk and protective factors for early child development. Lancet, 378, 1325–1338.PubMedCrossRefGoogle Scholar
  41. WHO. (1998). Global database on child growth and malnutrition. Geneva: WHO.Google Scholar
  42. WHO. (2001). Iron deficiency anaemia: Assessment, prevention and control. Geneva: World Health Organization.Google Scholar
  43. WHO/UNICEF/UNU. (1997). Indicators for assessing iron deficiency and strategies for its prevention. Geneva: WHO.Google Scholar
  44. Xiong, X., Buekens, P., Alexander, S., Demianczuk, N., & Wollast, E. (2000). Anemia during pregnancy and birth outcome: A meta-analysis. American Journal of Perinatology, 17, 137–146.PubMedCrossRefGoogle Scholar
  45. Yip, R. (2000). Significance of an abnormally low or high hemoglobin concentration during pregnancy: Special consideration of iron nutrition. The American Journal of Clinical Nutrition, 72, 272S–278S.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Florence Bodeau-Livinec
    • 1
    • 2
    • 3
  • Michel Cot
    • 1
    • 2
  • Ghislain K. Koura
    • 1
    • 2
  • Michael J. Boivin
    • 4
    • 5
  1. 1.IRD UMR 216, Mère et enfant face aux infections tropicalesParisFrance
  2. 2.Faculté de PharmacieUniversité Paris DescartesParisFrance
  3. 3.Ecole des Hautes Etudes en Santé PubliqueRennesFrance
  4. 4.Departments of Psychiatry and Neurology/OphthalmologyMichigan State UniversityEast LansingUSA
  5. 5.Department of PsychiatryNeuropsychology SectionAnn ArborUSA

Personalised recommendations