(P27-006-25) Maternal Aflatoxin Exposure, Birth Weight and Infant Growth in Uganda

Objectives: We investigated the effect of maternal aflatoxin exposure on infant anthropometric birth outcomes, adjusting for known mediators that included environmental enteropathy (EED) and systemic inflammation. We also assessed the effect of infant aflatoxin exposure on growth from 3 to 6 months of age, taking other mediators into account.

Methods: Pregnant women (n=1210) from 16 Ugandan sub-counties were enrolled in a study to track birth outcomes (cross-sectional at birth) and growth of infants (3 to 6 months) as a function of maternal and infant serum aflatoxin levels. Serum concentrations of aflatoxin FB₁-lysine adduct, EED biomarkers (anti-LPS and anti-flagellin IgG and IgA), and markers of systemic inflammation (C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP)) were measured in mothers at birth and infants at 6 months of age. Questionnaires provided information about household and women’s characteristics. We used linear regression to model the relationship of maternal aflatoxin blood concentration with birth weight and height, length-for-age Z-score (LAZ), weight-for-age Z-score (WAZ), and weight-for-length Z-score (WLZ), as well as adjustment for EED, along with women's and household characteristics. Similar variables were employed to assess the impact of infant aflatoxin blood exposure on growth outcomes between 3 and 6 months of age.

Results: Birth weight (p = 0.037) and WAZ at birth (p = 0.034) were both negatively associated with maternal aflatoxin levels at parturition. Neither LAZ nor WLZ were significantly associated with maternal aflatoxin blood levels. In addition, aflatoxin did not emerge as a significant factor in relation to SGA, preterm birth, or stunting at birth. In longitudinal analyses, there was no observed association between serum AFB₁ and infant growth.

Conclusions: After accounting for EED and women’s and household characteristics, serum aflatoxin concentrations in pregnant women at parturition were associated with reduced birth weight and WAZ, but not with LAZ or WLZ. Aflatoxin concentrations in infants at 6 months were not associated with change in weight, height, WAZ, LAZ or WLZ from 3 to 6 months of age.

Funding Sources: Supported by the United States Agency for International Development (USAID) under Grant number [AID-OAA-L-10-00006].  CPD was supported in part by P30 DK040561.