Relatively Low Maternal Aflatoxin Exposure Is Associated with Small-for-Gestational-Age but Not with Other Birth Outcomes in a Prospective Birth Cohort Study of Nepalese Infants

Abstract

Background Exposure to aflatoxin has garnered increased attention as a possible contributor to adverse birth outcomes. Objective The objective of this study was to investigate the relation of maternal aflatoxin exposure with adverse birth outcomes such as birth weight, birth length, anthropometric z scores, low birth weight (LBW), small-for-gestational-age (SGA), stunting, and preterm birth (PTB). Methods This study used maternal and newborn data from the AflaCohort Study, an ongoing birth cohort study in Banke, Nepal (n = 1621). Data on aflatoxin B1 (AFB1)-lysine adducts in maternal serum were collected once during pregnancy (at mean ± SD: 136 ± 43 d of gestation). Maternal serum AFB1-lysine adduct concentration was measured via HPLC. Linear and logistic regression analyses were used to determine if maternal aflatoxin exposure was associated with 1) birth weight and length (primary outcomes) and 2) anthropometric z scores, LBW (weight <2.5 kg), SGA (weight <10th percentile for gestational age and sex), stunting at birth (length-for-age z score less than −2), or PTB (born <37 weeks of gestation) (secondary outcomes). Results The geometric mean of maternal serum AFB1-lysine adduct concentration was 1.37 pg/mg albumin (95% CI: 1.30, 1.44 pg/mg albumin). Twenty percent of infants were of LBW and 32% were SGA. Sixteen percent of infants were stunted at birth. In addition, 13% of infants were born preterm. In logistic multivariate regression models, mean maternal serum AFB1-lysine adduct concentrations were significantly associated with SGA (OR: 1.13; 95% CI: 1.00, 1.27; P < 0.05). Conclusions Findings from this study suggest a small but significant association between serum AFB1-lysine adduct concentrations in pregnant women and SGA. Maternal aflatoxin exposure was not associated with other birth outcomes. These results highlight the need for future research on a threshold level of aflatoxin exposure needed to produce detectable adverse birth outcomes. This trial was registered at clinicaltrials.gov as NCT03312049.

Risk of dietary and breastmilk exposure to mycotoxins among lactating women and infants 2–4 months in northern India

“…Finally, there is a need for longitudinal cohort studies, complemented with total diets data to examine exposure to mycotoxins across the different stages of lactation, particularly in light of mixed evidence regarding their effects on birth outcomes including small‐for‐gestational age (SGA), infant growth faltering and stunting (Andrews‐Trevino et al, 2019; Hoffman et al, 2018; LeRoy et al, 2018; Passarelli et al, 2019).…”

Validation of the INDDEX24 mobile app v. a pen-and-paper 24-hour dietary recall using the weighed food record as a benchmark in Burkina Faso

“…In low-and middle-income countries (LMICs), the framing of food security and nutrition problems increasingly encompasses not only undernutrition, but also diet quality (1) and overweight and obesity, with their attendant chronic diseases (2,3) . Concern for the safety of the food supply, including microbiological and mycotoxin contamination (4,5) and potentially risky additives (6) , are emerging concerns of food policy in LMICs. Detailed information on individual food consumption, collected in a survey that is appropriately representative of the relevant population, is critical for making informed policies and developing effective programmatic responses to assure nutritional health (7,8) ; lack of individual level dietary data is a barrier to developing effective solutions (9) .…”

Aflatoxin exposure in pregnant women of mixed status of human immunodeficiency virus infection and rate of gestational weight gain: a Ugandan cohort study

“…A recent study found the mutagenic effect of in utero AF exposure in 14-day-old C57BL/6 mouse embryos was 20-fold greater than in parallel-dosed adult mice [27]. While there are relatively few human studies examining the relationship between AF exposure and foetal outcomes, a limited number of studies have demonstrated an association between maternal exposure and lower infant birthweight, small for gestational age [28][29][30][31][32] and subsequent stunted growth [33].…”