Maternal EED and Aflatoxin Birth Outcomes Study Uganda
Condition: Birth Weight; Pregnancy Preterm; Aflatoxins Toxicity; Inflammatory Response
MeSH terms: Birth Weight
Study type: Observational

Summary: 
      This prospective cohort study focuses on the relationship between maternal environmental
      enteric dysfunction (EED) and maternal aflatoxin B1 exposure and birth outcomes, particularly
      infant anthropometry and gestational age, in Mukono, Uganda.
    

Detailed description: 
      The problem of stunting, which has long-term health and economic consequences both at the
      individual and population level, persists in low and middle income countries (LMICs). It has
      been recognized that an estimated 20% of stunting begins in-utero. Although poor maternal
      nutrition during pregnancy is often blamed, it has been hypothesized that maternal EED status
      and maternal aflatoxin exposure during pregnancy may also play a role. However, to date,
      there have been no studies which have attempted to show the association between EED in
      pregnant women and negative birth outcomes. Furthermore, few studies have examined the
      association between maternal aflatoxin exposure during pregnancy and negative birth outcomes.

      In this prospective cohort study, pregnant women were enrolled at their first prenatal visit
      and birth outcome data was assessed within 48 hours of delivery. EED was measured via
      lactulose: mannitol (L:M) ratios and serum concentrations of antibodies to the bacterial
      components flagellin and lipopolysaccharide (LPS). Aflatoxin exposure was assessed by
      measuring the serum concentration of AFB1-lysine adduct from a blood sample taken at
      enrollment. Data on covariates were obtained from two surveys, one at enrollment and one
      three weeks prior to participant's estimated date of delivery.

      The specific aims of this study were as follows:

        1. To evaluate the relationship between markers of EED in pregnancy and negative birth
           outcomes, including low birth weight, stunting at birth, small head circumference, and
           premature delivery.

        2. To evaluate the relationship aflatoxin B1 exposure in pregnancy and negative birth
           outcomes, including low birth weight, stunting at birth, small head circumference, and
           premature delivery.
    

Intervention name(s): Exposures of interest: Maternal EED and Aflatoxin Exposure
Intervention type(s): Other
Intervention description(s): Maternal EED, measured via lactulose: mannitol (L:M) ratios and serum concentrations of antibodies to the bacterial components flagellin and lipopolysaccharide (LPS); Maternal aflatoxin exposure, measured via serum concentration of AFB1-lysine adduct
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All pregnant women aged 18-45 years who visited Mukono Health Center IV in Mukono, Uganda
        for their first prenatal visit and who qualified for the study based on inclusion/exclusion
        criteria were invited to join the study until enrollment target was met.
      
Biospecimen description: 
      Serum samples, Urine samples
    
Keywords: Aflatoxin B1; Environmental Enteric Dysfunction; L:M Test; Pregnancy; Linear Growth Faltering; Birth Outcomes; Uganda