Abstract
Background
We evaluated: (1) associations of prenatal manganese (Mn) levels with child neurodevelopment at 4–6 years; (2) effect modification by maternal anemia and iron deficiency; and (3) sex-specific effects.
Methods
We measured blood Mn, hemoglobin, and serum ferritin in mothers at the second trimester, third trimester, and at birth, and in cord blood from a prospective birth cohort in Mexico City (n = 571). McCarthy Scales of Children’s Abilities were measured at 4–6 years. Using linear regression, we estimated associations between prenatal Mn and neurodevelopment, examined anemia and iron deficiency as effect modifiers, and analyzed associations by child sex.
Results
No direct associations were observed between Mn, anemia, or iron deficiency and McCarthy Scales. Second trimester iron deficiency and third trimester anemia modified the effect of Mn on child neurodevelopment. For instance, second trimester Mn was positively associated child memory scores in mother’s with normal ferritin (1.85 (0.02, 3.45)), but negatively associated in mother’s with low ferritin (−2.41 (−5.28, 0.47), interaction P value = 0.01), a pattern observed across scales. No effect modification at birth or in cord blood was observed.
Conclusions
Anemia/iron deficiency during pregnancy may modify Mn impacts on child neurodevelopment, particularly in boys.
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Acknowledgements
We thank the American British Cowdray Hospital in Mexico City for providing research facilities. Work was supported by NIH grants: R01ES014930; R01ES013744; R01ES021357, P30ES009089, P30ES023515, and R24ES028522. Co-investigators at the INSP received partial funding from the National Institute of Public Health/Ministry of Health of Mexico.
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A.K. conceived the study design, performed the data analysis, interpreted the results, and drafted the manuscript. G.E.-G., A.C., L.S., I.P., C.A., and K.S. provided substantial contributions to data acquisition. D.C.B., M.M.T.-R., A.A.B., and R.O.W., each contributed substantially to study desgin and data interpretation, and critically revised the manuscript intelectual content. All authors provided final approval of the version to be published.
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Kupsco, A., Estrada-Gutierrez, G., Cantoral, A. et al. Modification of the effects of prenatal manganese exposure on child neurodevelopment by maternal anemia and iron deficiency. Pediatr Res 88, 325–333 (2020). https://doi.org/10.1038/s41390-020-0754-4
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DOI: https://doi.org/10.1038/s41390-020-0754-4
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