Chronic aflatoxin exposure during pregnancy is associated with lower fetal growth trajectories: a prospective cohort from the Butajira Nutrition, Mental Health, and Pregnancy (BUNMAP) Study in rural Ethiopia

Abstract

Background Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed. Objectives In the present study, we examine the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia. Methods In a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 weeks of gestation. Serum aflatoxin B1-lysine concentration was measured using liquid chromatography-tandem mass spectrometry. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean (SD) gestational age weeks of 19.1 (3.71), 28.5 (3.51), and 34.5 (2.44). Estimated fetal weight was expressed in centiles using the INTERGROWTH-21st reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1-lysine concentration above or equal to the limit of detection) and unexposed mothers in the study. Results Mothers had a mean (SD) age of 26.0 (4.58) years. The median (P25, P75) serum aflatoxin B1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five % of the females enrolled provided at least two ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational age centile than the unexposed group (ß = -0.92 centiles/week, 95% CI: -1.77, -0.06, p = 0.037). Conclusions Chronic maternal AF exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development.

Ochratoxin A status at birth is associated with reduced birthweight and ponderal index in rural Burkina Faso

“…A study from Ethiopia found an association between chronic maternal AF exposure and lower fetal growth trajectories using fetal biometry from ultrasound estimates. However, the same study did not find an association of AF exposure with birth anthropometry (56). A systematic review of studies that evaluated mycotoxin exposure and infant growth also found inconsistent results (28).…”

A Multi-Omics and Human Biomonitoring Approach to Assessing the Effectiveness of Fortified Balanced Energy–Protein Supplementation on Maternal and Newborn Health in Burkina Faso: A Study Protocol

“…Children are vulnerable due to their lower body mass, higher metabolic rate and developing detoxification system [107] (Peraica, Richter and Rašić, 2014). A study in Ethiopia reported a high occurrence of long-tern maternal aflatoxin exposure and an associated risk of poorer fetal growth trajectories [111] ( Tesfamariam et al, 2022). In Burkina Faso, limited biological and toxicological food contamination data are available [101] (Kpoda et al, 2022), and regulations or legislation concerning mycotoxins are often not implemented [115,116] (FAO, 2003; Warth et al, 2012).…”

Evaluation of Aflatoxins Occurrence and Exposure in Cereal-Based Baby Foods: An Update Review

“…In another prospective cohort study conducted by Tesfamariam et al, the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories was examined. In this study, aflatoxin was found in 86.6% of maternal blood samples ( n , 492), and the aflatoxin-exposed group showed a significantly lower change in fetal weight-for-gestational-age centile change over time than the unexposed group [ 38 ].…”