Poster Topical Area: Maternal, Perinatal and Pediatric Nutrition

Location: Hall D

Poster Board Number: 336

Objectives: Aflatoxins are toxic metabolites of Aspergillus molds and are widespread in the food supply in Africa. In-utero and infant exposure to aflatoxin B1 (AFB1) have been linked to poor child growth and development. Our objective was to investigate the association between maternal exposure to aflatoxin during pregnancy and adverse birth outcomes in Uganda.


Methods: This was a prospective cohort study conducted in Mukono, Uganda. A total of 258 pregnant women were enrolled at their first prenatal visit. Maternal aflatoxin exposure was assessed at 17.9 ± 3.4 (mean ± SD) weeks gestation by measuring serum levels of AFB1-lysine adduct using high performance liquid chromatography (HPLC). Birth outcomes (sex, gestational age, weight, length, and head circumference) for 220 live infants were obtained within 48 hours of delivery. Associations between maternal exposure and birth outcomes were assessed using multivariate linear regression models adjusted for confounding.


Results: Median maternal serum AFB1-lysine adduct level was 5.71 pg/mg albumin (range: 0.71-95.60 pg/mg albumin). Mean ± SD infant birth weight (kg), length (cm), and head circumference (cm) were 3.25 ± 0.43, 48.68 ± 2.02, and 35.19 ± 1.53, respectively. Elevations in natural log transformed maternal serum AFB1 levels were associated with lower weight (adjusted β: -0.07; 95% CI: -0.13, -0.002; p=0.045), lower birth weight-for-age Z-score (WAZ) (adjusted β: -0.16; 95% CI: -0.30, -0.03; p=0.021), and smaller head circumference (adjusted β: -0.27; 95% CI: -0.51, -0.03; p=0.029) in infants at birth. No significant associations were observed between maternal AFB1 levels and infant length, length-for-age Z-score (LAZ), or gestational age at birth.


Conclusion: Mid-gestation exposure to aflatoxin was significantly associated with lower birth weight, WAZ, and head circumference. These adverse outcomes, all indicators of poor prenatal development, predict poor long-term physical, motor, and cognitive development. Initiatives to reduce aflatoxin exposure in women of reproductive age may result in improved birth outcomes and child development in LMICs.

• Feed the Future Innovation Lab for Nutrition at Tufts University in Boston, MA, supported by the United States Agency for International Development (award AID-OAA-L-10-00006)
• CD was supported in part by National Institutes of Health (NIH) (grants K24DK104676 and 2P30 DK040561)

Presenting Author

• Jacqueline Lauer

  PhD Candidate
  Tufts University Friedman School of Nutrition Science and Policy
  Durham, North Carolina