Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

Infant motor development in rural Vietnam and intrauterine exposures to anaemia, iron deficiency and common mental disorders: a prospective community-based study

Authors: Thach D Tran, Tuan Tran, Julie A Simpson, Ha T Tran, Trang T Nguyen, Sarah Hanieh, Terence Dwyer, Beverley-Ann Biggs, Jane Fisher

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

Background

Antenatal anaemia, iron deficiency and common mental disorders (CMD) are prevalent in low- and middle-income countries. The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development.

Methods

A cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 randomly-selected rural communes in Ha Nam province was recruited. Participants provided data twice during pregnancy (early and late gestation) and twice after giving birth (8 weeks and 6 months postpartum). The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD (score ≥ 4). Maternal anaemia (Hb < 11 g/dL) and iron deficiency (ferritin < 15 ng/mL) were evaluated at early and late gestation. Infants’ motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales (BSID-M) at the age of six months. Direct and indirect effects of the exposures on the outcome were examined with Path analysis.

Results

In total, 497 of 523 (97%) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses. The prevalence of anaemia was 21.5% in early pregnancy and 24.4% in late pregnancy. There was 4.1% iron deficiency at early pregnancy and 48.2% at late pregnancy. Clinically significant symptoms of CMD were apparent among 40% women in early pregnancy and 28% in late pregnancy. There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy (an estimated mean reduction of 2.61 points, 95% Confidence Interval, CI, 0.57 to 4.65) and CMD in early pregnancy (7.13 points, 95% CI 3.13 to 11.13). Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy.

Conclusions

Antenatal anaemia, iron deficiency, and CMD have a negative impact on subsequent infant motor development. These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries.
Appendix
Available only for authorised users
Literature
1.
Berk LE: Child Development. 2009, Boston: Pearson Education/Allyn & Bacon, 8
2.
Gallahue DL, Ozmun JC: Understanding Motor Development: Infants, Children, Adolescents, Adults. 2012, Dubuque, Iowa: McGraw-Hill, 7
3.
Walker SP, Wachs T, Meeks Gardner J, Lozoff B, Wasserman G, Pollitt E, Carter J: Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007, 369: 145-157. 10.1016/S0140-6736(07)60076-2.CrossRefPubMed
4.
De Regnier R-A, Desai S: Fetal Development. The Wiley-Blackwell Handbook of Infant Development. Volume 2. Edited by: Bremner JG, Wachs TD. 2010, Chichester, West Sussex: Wiley-Blackwell, 2
5.
Barker DJ: In utero programming of chronic disease. Clin Sci (Lond). 1998, 95 (2): 115-128. 10.1042/CS19980019.CrossRef
6.
Valero De Bernabe J, Soriano T, Albaladejo R, Juarranz M, Calle ME, Martinez D, Dominguez-Rojas V: Risk factors for low birth weight: a review. Eur J Obstet Gynecol Reprod Biol. 2004, 116 (1): 3-15. 10.1016/j.ejogrb.2004.03.007.CrossRefPubMed
7.
UNICEF WHO: Low Birthweight: Country, Regional and Global Estimates. 2004, New York: United Nations Children’s Fund
8.
Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, Baker-Henningham H, Chang SM, Hamadani JD, Lozoff B, et al: Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011, 378 (9799): 1325-1338. 10.1016/S0140-6736(11)60555-2.CrossRefPubMed
9.
Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV: Anaemia in low-income and middle-income countries. Lancet. 2011, 378 (9809): 2123-2135. 10.1016/S0140-6736(10)62304-5.CrossRefPubMed
10.
WHO: Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. 2011, Geneva: World Health Organization
11.
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Peña-Rosas JP, Bhutta ZA, Ezzati M: Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health. 2013, 1 (1): e16-e25. 10.1016/S2214-109X(13)70001-9.CrossRefPubMedPubMedCentral
12.
Zhou LM, Yang WW, Hua JZ, Deng CQ, Tao X, Stoltzfus RJ: Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China. Am J Epidemiol. 1998, 148 (10): 998-1006. 10.1093/oxfordjournals.aje.a009577.CrossRefPubMed
13.
Allen LH: Biological mechanisms that might underlie iron’s effects on fetal growth and preterm birth. J Nutr. 2001, 13 (2S-2): 581S-589S.
14.
Chang S, Zeng L, Brouwer ID, Kok FJ, Yan H: Effect of iron deficiency anemia in pregnancy on child mental development in rural china. Pediatrics. 2013, 131 (3): e755-e763. 10.1542/peds.2011-3513.CrossRefPubMed
15.
Tamura T, Goldenberg RL, Hou J, Johnston KE, Cliver SP, Ramey SL, Nelson KG: Cord serum ferritin concentrations and mental and psychomotor development of children at five years of age. J Pediatr. 2002, 140 (2): 165-170. 10.1067/mpd.2002.120688.CrossRefPubMed
16.
Hernández-Martínez C, Canals J, Aranda N, Ribot B, Escribano J, Arija V: Effects of iron deficiency on neonatal behavior at different stages of pregnancy. Early Hum Dev. 2011, 87 (3): 165-169. 10.1016/j.earlhumdev.2010.12.006.CrossRefPubMed
17.
Fisher J, De Mello MC, Patel V, Rahman A, Tran T, Holton S, Holmes W: Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012, 90 (2): 139-149G. 10.2471/BLT.11.091850.CrossRef
18.
Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ: A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010, 67 (10): 1012-1024. 10.1001/archgenpsychiatry.2010.111.CrossRefPubMedPubMedCentral
19.
Littleton HL, Bye K, Buck K, Amacker A: Psychosocial stress during pregnancy and perinatal outcomes: a meta-analytic review. J Psychosom Obstet Gynaecol. 2010, 31 (4): 219-228. 10.3109/0167482X.2010.518776.CrossRefPubMed
20.
O’Connor TG, Heron J, Glover V: Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry. 2002, 41 (12): 1470-1477. 10.1097/00004583-200212000-00019.CrossRefPubMed
21.
Davis EP, Glynn LM, Schetter CD, Hobel C, Chicz-Demet A, Sandman CA: Prenatal exposure to maternal depression and cortisol influences infant temperament. J Am Acad Child Adolesc Psychiatry. 2007, 46 (6): 737-746. 10.1097/chi.0b013e318047b775.CrossRefPubMed
22.
Bergman K, Sarkar P, Glover V, O’Connor TG: Quality of child–parent attachment moderates the impact of antenatal stress on child fearfulness. J Child Psychol Psychiatry. 2008, 49 (10): 1089-1098. 10.1111/j.1469-7610.2008.01987.x.CrossRefPubMedPubMedCentral
23.
Davis EP, Glynn LM, Waffarn F, Sandman CA: Prenatal maternal stress programs infant stress regulation. J Child Psychol Psychiatry. 2011, 52 (2): 119-129. 10.1111/j.1469-7610.2010.02314.x.CrossRefPubMed
24.
Josefsson A, Sydsjo G: A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years. Arch Womens Ment Health. 2007, 10 (4): 141-145. 10.1007/s00737-007-0185-9.CrossRefPubMed
25.
Feldman R, Granat A, Pariente C, Kanety H, Kuint J, Gilboa-Schechtman E: Maternal depression and anxiety across the postpartum year and infant social engagement, fear regulation, and stress reactivity. J Am Acad Child Adolesc Psychiatry. 2009, 48 (9): 919-927. 10.1097/CHI.0b013e3181b21651.CrossRefPubMed
26.
McMahon CA, Boivin J, Gibson FL, Hammarberg K, Wynter K, Saunders D, Fisher J: Pregnancy-specific anxiety, ART conception and infant temperament at 4 months post-partum. Hum Reprod. 2013, 28 (4): 997-1005. 10.1093/humrep/det029.CrossRefPubMed
27.
Bergman K, Sarkar P, O’Connor TG, Modi N, Glover V: Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry. 2007, 46 (11): 1454-1463. 10.1097/chi.0b013e31814a62f6.CrossRefPubMed
28.
Bergman K, Sarkar P, Glover V, O’Connor TG: Maternal prenatal cortisol and infant cognitive development: moderation by infant-mother attachment. Biol Psychiatry. 2010, 67 (11): 1026-1032. 10.1016/j.biopsych.2010.01.002.CrossRefPubMedPubMedCentral
29.
DiPietro JA, Novak MF, Costigan KA, Atella LD, Reusing SP: Maternal psychological distress during pregnancy in relation to child development at age two. Child Dev. 2006, 77 (3): 573-587. 10.1111/j.1467-8624.2006.00891.x.CrossRefPubMed
30.
Servili C, Medhin G, Hanlon C, Tomlinson M, Worku B, Baheretibeb Y, Dewey M, Alem A, Prince M: Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort. BMC Public Health. 2010, 10: 693-10.1186/1471-2458-10-693.CrossRefPubMedPubMedCentral
31.
Nasreen HE, Kabir ZN, Forsell Y, Edhborg M: Impact of maternal depressive symptoms and infant temperament on early infant growth and motor development: results from a population based study in Bangladesh. J Affect Disord. 2013, 146 (2): 254-261. 10.1016/j.jad.2012.09.013.CrossRefPubMed
32.
National Institute of Nutrition/UNICEF: A Review of the Nutrition Situation in Viet Nam 2009–2010. 2011, Hanoi: Medical Public House
33.
Trinh L, Dibley M, Byles J: Antenatal care procedures and information reported by women in three rural areas of Vietnam. Southeast Asian J Trop Med Public Health. 2007, 38 (5): 927-935.PubMed
34.
Fisher J, Tran T, La BT, Kriitmaa K, Rosenthal D, Tuan T: Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use. Bull World Health Organ. 2010, 88 (10): 737-745. 10.2471/BLT.09.067066.CrossRefPubMedPubMedCentral
35.
Fisher J, Morrow MM, Ngoc NT, Anh LT: Prevalence, nature, severity and correlates of postpartum depressive symptoms in Vietnam. BJOG. 2004, 111 (12): 1353-1360. 10.1111/j.1471-0528.2004.00394.x.CrossRefPubMed
36.
Niemi M, Falkenberg T, Petzold M, Chuc NT, Patel V: Symptoms of antenatal common mental disorders, preterm birth and low birthweight: a prospective cohort study in a semi-rural district of Vietnam. Trop Med Int Health. 2013, 18 (6): 687-695. 10.1111/tmi.12101.CrossRefPubMed
37.
Coelho HF, Murray L, Royal-Lawson M, Cooper PJ: Antenatal anxiety disorder as a predictor of postnatal depression: a longitudinal study. J Affect Disord. 2011, 129 (1–3): 348-353.CrossRefPubMed
38.
Fisher J, Rahman A, Cabral De Mello M, Chan SW, Herrman H: Mental Health of Parents and Infant Health and Development in Resource-Constrained Settings: Evidence Gaps and Implications for Facilitating ‘Good Enough parenting’ in the Twenty-First-Century World. Parenthood and Mental Health: A Bridge Between Infant and Adult Psychiatry. Edited by: Tyano S, Keren M, Herrman H, Cox J. 2010, West Sussex: Wiley-Blackwell, 429-442.CrossRef
39.
Nasreen HE, Kabir ZN, Forsell Y, Edhborg M: Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural Bangladesh. BMC Womens Health. 2011, 11: 22-10.1186/1472-6874-11-22.CrossRefPubMedPubMedCentral
40.
Trinh LT, Dibley M: Anaemia in pregnant, postpartum and non pregnant women in Lak district, Daklak province of Vietnam. Asia Pac J Clin Nutr. 2007, 16 (2): 310-315.PubMed
41.
Aikawa R, Ngyen CK, Sasaki S, Binns CW: Risk factors for iron-deficiency anaemia among pregnant women living in rural Vietnam. Public Health Nutr. 2006, 9 (4): 443-448.CrossRefPubMed
42.
Van Mil NH, Tiemeier H, Bongers-Schokking JJ, Ghassabian A, Hofman A, Hooijkaas H, Jaddoe VW, De Muinck Keizer-Schrama SM, Steegers EA, Visser TJ, et al: Low urinary iodine excretion during early pregnancy is associated with alterations in executive functioning in children. J Nutr. 2012, 142 (12): 2167-2174. 10.3945/jn.112.161950.CrossRefPubMed
43.
Bayley N: Bayley Scales of Infant and Toddler Development–Third Edition. 2006, San Antonio: TX: Harcourt Assessment
44.
Bayley N: Bayley Scales of Infant and Toddler Development–Third Edition: Technical Manual. 2006, San Antonio: TX: Harcourt Assessment
45.
Bayley N: Bayley Scales of Infant and Toddler Development–Third Edition: Administration Manual. 2006, San Antonio: TX: Harcourt Assessment
46.
WHO/UNICEF/UNU: Iron Deficiency Anaemia, Assessment, Prevention and Control: A Guide for Programme Managers. 2001, Geneva: World Health Organization
47.
WHO: Serum Ferritin Concentrations for the Assessment of Iron Status and Iron Deficiency in Populations. 2011, Geneva, Switzerland: World Health Organization
48.
WHO/UNICEF/ICCIDD: Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination: A Guide for Programme Managers, WHO/NHD/01.1. 2001, Geneva: World Health Organization, 2
49.
Cox J, Holden J, Sagovsky R: Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry. 1987, 150: 782-786. 10.1192/bjp.150.6.782.CrossRefPubMed
50.
Tran TD, Tran T, La B, Lee D, Rosenthal D, Fisher J: Screening for perinatal common mental disorders in women in the north of Vietnam: a comparison of three psychometric instruments. J Affect Disord. 2011, 133 (1–2): 281-293.CrossRefPubMed
51.
O’Donnell O, Doorslaer E, Wagstaff A, Lindelow M: Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation. 2008, Washington, D.C: The World Bank
52.
Garcia-Moreno C, Jansen H, Ellsberg M, Heise L, Watts C: WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women: Initial Results on Prevalence, Health Outcomes and Women’s Reponses. 2005, Geneva: World Health Organization
53.
Long JS: Regression Models for Categorical and Limited Dependent Variables, vol. 7. 1997, Sage Publications, Inc
54.
Kline RB, Ebooks Corporation: Methodology in the Social Sciences. Principles and Practice of Structural Equation Modeling. 2011, New York: Guilford Press, xvi, 427-3
55.
Waxler E, Thelen K, Muzik M: Maternal perinatal depression - impact on infant and child development. Eur Psychiatr Rev. 2011, 4 (1): 41-47.
56.
Wadhwa PD: Psychoneuroendocrine processes in human pregnancy influence fetal development and health. Psychoneuroendocrinology. 2005, 30 (8): 724-743. 10.1016/j.psyneuen.2005.02.004.CrossRefPubMed
57.
Gitau R, Cameron A, Fisk NM, Glover V: Fetal exposure to maternal cortisol. Lancet. 1998, 352 (9129): 707-708. 10.1016/S0140-6736(05)60824-0.CrossRefPubMed
58.
Gitau R, Fisk NM, Teixeira JM, Cameron A, Glover V: Fetal hypothalamic-pituitary-adrenal stress responses to invasive procedures are independent of maternal responses. J Clin Endocrinol Metab. 2001, 86 (1): 104-109.PubMed
59.
Petraglia F, Florio P, Nappi C, Genazzani AR: Peptide signaling in human placenta and membranes: autocrine, paracrine, and endocrine mechanisms. Endocr Rev. 1996, 17 (2): 156-186.PubMed
60.
Talge NM, Neal C, Glover V: Antenatal maternal stress and long-term effects on child neurodevelopment: how and why?. J Child Psychol Psychiatry. 2007, 48 (3–4): 245-261.CrossRefPubMed
61.
Dallman PR: Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr. 1986, 6: 13-40. 10.1146/annurev.nu.06.070186.000305.CrossRefPubMed
62.
Gulmezoglu AM, Mahomed K, Hofmeyr GJ, Nikodem VC, Kramer T: Fetal and maternal catecholamine levels at delivery. J Perinat Med. 1996, 24 (6): 687-691. 10.1515/jpme.1996.24.6.687.CrossRefPubMed
63.
WHO CDC: Assessing the Iron Status of Populations: Including Literature Reviews: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. 2007, Geneva, Switzerland: World Health Organization
Metadata
Title
Infant motor development in rural Vietnam and intrauterine exposures to anaemia, iron deficiency and common mental disorders: a prospective community-based study
Authors
Thach D Tran
Tuan Tran
Julie A Simpson
Ha T Tran
Trang T Nguyen
Sarah Hanieh
Terence Dwyer
Beverley-Ann Biggs
Jane Fisher
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-8

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

Postnatal growth outcomes and influence of maternal gestational weight gain: a prospective cohort study in rural Vietnam

Research article

Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences

Research article

Timing and factors associated with first antenatal care booking among pregnant mothers in Gondar Town; North West Ethiopia

Research article

Obstetric outcomes for nulliparous women who received routine individualized treatment for severe fear of childbirth - a retrospective case control study

Research article

Ultrasound study of carotid and cardiac remodeling and cardiac-arterial coupling in normal pregnancy and preeclampsia: a case control study

Research article

Maternal obesity and its relation with the cesarean section: A hospital based cross sectional study in Iraq