Poster Topical Area: Maternal, Perinatal and Pediatric Nutrition

Location: Hall D

Poster Board Number: 336

P13-078 - Association between maternal aflatoxin exposure during pregnancy and adverse birth outcomes in Mukono, Uganda

Sunday, Jun 10
8:00 AM – 6:00 PM

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.



Funding Source:

• 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)


Correlation between maternal aflatoxin (AFB1) concentration and infant birth weight

Correlation between maternal aflatoxin (AFB1) concentration and infant head circumference at birth

CoAuthors: Christopher Duggan – Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Lynne Ausman – Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA; Jeffrey Griffiths – Tufts University School of Medicine, Boston, Massachusetts, USA ; Partick Webb – Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA ; Edgar Agaba – USAID Feed the Future Innovation Lab for Nutrition at Tufts University, Boston, Massachusetts, USA; Nathan Nshakira – Uganda Christian University, Mukono, Uganda; Shibani Ghosh – Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, Boston, Massachusetts, USA

Jacqueline M. Lauer

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