Impact of helminth infection during pregnancy on cognitive and motor functions of one-year-old children

Objective To determine the effect of helminth infection during pregnancy on the cognitive and motor functions of one-year-old children. Methods Six hundred and thirty five singletons born to pregnant women enrolled before 29 weeks of gestation in a trial comparing two intermittent preventive treatments for malaria were assessed for cognitive and motor functions using the Mullen Scales of Early Learning, in the TOVI study, at twelve months of age in the district of Allada in Benin. Stool samples of pregnant women were collected at recruitment, second antenatal care (ANC) visit (at least one month after recruitment) and just before delivery, and were tested for helminths using the Kato-Katz technique. All pregnant women were administered a total of 600 mg of mebendazole (100 mg two times daily for 3 days) to be taken after the first ANC visit. The intake was not directly observed. Results Prevalence of helminth infection was 11.5%, 7.5% and 3.0% at first ANC visit, second ANC visit and at delivery, respectively. Children of mothers who were infected with hookworms at the first ANC visit had 4.9 (95% CI: 1.3–8.6) lower mean gross motor scores compared to those whose mothers were not infected with hookworms at the first ANC visit, in the adjusted model. Helminth infection at least once during pregnancy was associated with infant cognitive and gross motor functions after adjusting for maternal education, gravidity, child sex, family possessions, and quality of the home stimulation. Conclusion Helminth infection during pregnancy is associated with poor cognitive and gross motor outcomes in infants. Measures to prevent helminth infection during pregnancy should be reinforced

Malaria and gravidity interact to modify maternal haemoglobin concentrations during pregnancy

Abstract Background Primigravidity is one of the main risk factors for both malaria and anaemia. Since the implementation of intermittent preventive treatment (IPTp) in sub-Saharan Africa, the relationship between anaemia and gravidity and its evolution during pregnancy has been little explored. This study aimed to evaluate the impact of gravidity on the variation of haemoglobin during pregnancy according to the timing of gestation. Methods Data from three studies carried out in nearby areas in south Benin (Ouidah, Comé, Allada) between 2005 and 2012 were analysed. At inclusion (first antenatal visit, ANV1) women’s age, area of residence, schooling, gravidity, gestational age, weight and height were recorded. Thick blood smears were performed on ANV1, second visit (ANV2) and at delivery. In Allada, women’s serum ferritin and CRP concentrations were also assessed. The impact of gravidity on maternal haemoglobin (Hb) was analysed using a logistic or linear regression depending on the outcome. The statistical significance was set to P Results In total, data from 3,591 pregnant women were analysed. Both univariate and multivariate analyses showed a constant association between Hb concentrations and gravidity in the three periods of Hb assessment (ANV1, ANV2 and delivery). Mean Hb concentration was significantly lower in primigravidae than in multigravidae at ANV1 (mean difference = -2.4 g/L, CI 95%: [-3.4, -1.4], P Conclusion In a context of IPTp, Hb levels improved progressively throughout pregnancy in primigravidae, likely as a result of reduction in malaria infection. In multigravidae, the improvement was less perceptible and anaemia was mainly due to iron deficiency.</p

Association between maternal and infant socio-demographic and anthropometric characteristics and early learning composite (ELC) and gross motor scores.

<p>ANC- Antenatal Care</p><p>BMI-Body Mass Index</p><p>^a N = 629</p><p>^bN = 588</p><p>^c N = 594</p><p>^dN = 627</p><p>^eN = 182</p><p>^b Represented as Correlation coefficients not means</p><p>Association between maternal and infant socio-demographic and anthropometric characteristics and early learning composite (ELC) and gross motor scores.</p

Flowchart outlining the follow-up of participating pregnant women until their children were one year old.

<p>The rate of follow-up of eligible children from birth till age one was 76.7%.</p

Comparison of maternal baseline characteristics at first ANC visit and infant characteristics between children fully assessed and those not fully assessed for cognitive function.

<p>Figures are number (percentage) unless otherwise indicated</p><p>^aN = 797</p><p>^bN = 828</p><p>^cN = 626</p><p>BMI-Body Mass Index</p><p>Comparison of maternal baseline characteristics at first ANC visit and infant characteristics between children fully assessed and those not fully assessed for cognitive function.</p

Relationship between helminth infection during pregnancy and mean scores of infant cognitive and gross motor function at age 1 year.

<p>Unless otherwise stated, reference group were children of women who were not infected at either 1^st ANC visit, 2^nd ANC visit or at delivery</p><p>ANC- Antenatal Care ref-reference category</p><p>*<i>P</i>-value <0.05</p><p>** <i>P</i>-value <0.01</p><p>*** <i>P</i>-value <0.001</p><p>^a Adjusted for maternal education, child sex and HOME score</p><p>^b Adjusted for maternal education, child sex, HOME score, preterm status and child weight-for-age</p><p>^c Adjusted for maternal education, gravidity, child sex, family possessions and HOME score</p><p>^d Adjusted for maternal education, gravidity, child sex, family possessions, HOME score, preterm status and child weight-for-age</p><p>^e Only one assessed child had a mother with malaria-helminth co-infection at 2^nd ANC visit.</p><p>Relationship between helminth infection during pregnancy and mean scores of infant cognitive and gross motor function at age 1 year.</p

Association between helminth infection at ANC visits and maternal and infant characteristics.

<p>BMI-Body Mass Index</p><p>^a Represented as median scores for women with helminth infection (median scores for uninfected women)</p><p>Association between helminth infection at ANC visits and maternal and infant characteristics.</p

Descriptive assessment of helminth infection in enrolled mother- infants pairs from Benin with follow-up from 29 weeks gestation through child's 1st year of life.

<p>epg- eggs per gram of stool</p><p>—indicates no egg found on laboratory examination</p><p>ANC- Antenatal Care</p><p>Descriptive assessment of helminth infection in enrolled mother- infants pairs from Benin with follow-up from 29 weeks gestation through child's 1st year of life.</p