Pregnancy anaemia, child health and development: A cohort study in rural India

Objective To assess how pregnancy anaemia affects the offspring's early childhood development, child haemoglobin (Hb) levels child growth and diseases incidence 2 years after birth in a low-income setting. Furthermore, we investigate the mediating role of childhood Hb levels with disease incidences and skills. Design Prospective cohort study. Setting and participants The study participants are 941-999 mother-child dyads from rural Madhepura in Bihar, India. In 2015, the women were recruited during pregnancy from registers in mother-child centres of 140 villages for the first wave of data collection. At the time of the second wave in 2017, the children were 22-32 months old. Primary and secondary outcome measures The recruited women were visited at home for a household survey and the measurement of the women's and child's Hb level, child weight and height. Data on the incidence of diarrhoea and respiratory diseases or fever were collected from interviews with the mothers. To test motor, cognitive, language and socioemotional skills of the children, we used an adapted version of the child development assessment FREDI. Results The average Hb during pregnancy was 10.2 g/dL and 69% of the women had pregnancy anaemia. At the age of 22-32 months, a 1 g/dL increase in Hb during pregnancy was associated with a 0.17 g/dL (95% CI: 0.11 to 0.23) increase in Hb levels of the child. Children of moderately or severely anaemic women during pregnancy showed 0.57 g/dL (95% CI:-0.78 to-0.36) lower Hb than children of non-anaemic women. We find no association between the maternal Hb during pregnancy and early skills, stunting, wasting, underweight or disease incidence. While childhood anaemia does not correlate with childhood diseases, we find an association of a 1 g/dl increase in the child's Hb with 0.04 SDs higher test scores. Conclusions While pregnancy anaemia is a risk factor for anaemia during childhood, we do not find evidence for an increased risk of infectious diseases or early childhood development delays.