The Impact of Maternal Anaemia on Neurodevelopmental Outcomes Among Infants: A Prospective Maternal-Infant Birth Cohort Follow Up Study In Low-And Middle-Income Countries (ReMIND)

November 20, 2024 | Ongoing Project | Reading time: 5 min

Investigators
Dr. Kwaku Poku Asante, Dr. Kenneth Ae-Ngibise, Solomon Nyame, Francis Agbokey, Veronica Agyemang, Stephaney Gyaase, Charlotte Tawiah and Prof Sam Kofi Newton.

Introduction

The Kintampo Health Research Centre (KHRC), with funding from the Bill and Melinda Gates Foundation, is leading a study to assess the impact of maternal anaemia on infant brain development and early childhood health. This three-year study, titled, “The Impact of Maternal Anaemia on Neurodevelopmental Outcomes Among Infants: A Prospective Maternal-Infant Birth Cohort Follow Up Study in Low-And Middle-Income Countries” (ReMIND) is a sub-study under the “Pregnancy Risk, Infant Surveillance, and Measurement Alliance” (PRISMA) Study. This initiative, first of its kind, is being carried out across four research sites in Ghana, India, Kenya, Pakistan, and Zambia, and seeks to identify infants under 12 months old who may have developmental challenges linked to maternal anaemia, allowing for early detection and timely intervention.

Background

Women of reproductive age (WRA), particularly those who are pregnant or lactating, face a heightened risk of anaemia. Globally, approximately 33% of WRA—equivalent to around 613 million women—are estimated to be anaemic. The prevalence of anaemia among WRA is particularly high in low- and middle-income countries (LMICs). months old who may have developmental challenges linked to maternal anaemia, allowing for early detection and timely intervention.

In 2016, the World Health Organization (WHO) reported anaemia rates of 46% in South-East Asia and 39% in sub-Saharan Africa among WRA. Low haemoglobin levels during pregnancy are associated with adverse maternal and neonatal health outcomes.

While many low- and middle-income countries bear a high burden of disease with increased risk of poor neurodevelopmental outcomes in children, access to Magnetic Resonance Imaging (MRI) is limited. Neurodevelopment is a clinical and functional outcome of early childhood development. Adequate iron during pregnancy and infancy is critical for neurodevelopment, as highlighted by animal studies. To address this challenge, the Ultra Low-Field Neuroimaging In The Young (UNITY) consortium is advancing scalable low-field MRI tools for use in under-resourced settings.

The ReMIND sub-study is a prospective observational study designed to evaluate the impact of maternal anaemia on infant neurodevelopment and brain morphology. Conducted as part of a larger birth cohort study and plans to recruit 1,600 to 2,000 mother-infant pairs in all four research sites. Data will be collected using the Global Scale for Early Development (GSED) and a portable Swoop® Magnetic Resonance Imaging (MRI) system.

Objectives
This study has three main objectives:
1. To evaluate the impact of maternal anaemia on infant neurodevelopment and brain morphology.
2. To assess the feasibility, usability, and acceptability of using low-field Magnetic Resonance Imaging (MRI) technology in LMICs.

Expected Outcomes
This study is expected to characterise the relationship between maternal anaemia and infant neurological developmental outcomes, as well as brain microstructure, at 3 or 6 months and 12 months of age. It will also assess the impact of maternal anaemia on these outcomes. Additionally, the study will generate comparable data to validate the use of the GSED scale for assessing infant neurodevelopment across diverse settings. Importantly, the ReMIND study seeks to identify infants under 12 months of age with potential neurodevelopmental deficiencies linked to maternal anaemia across the study sites, enabling early detection and intervention.

Study Methodology and Rationale
The ReMIND sub-study is a prospective observational study designed to evaluate the impact of maternal anaemia on infant neurodevelopment and brain morphology. The study will recruit 1,600 to 2,000 mother-infant pairs in the Kintampo North and South Districts. The study involves data collection using the Global Scale for Early Development (GSED) Short and Long Forms, the Family Care Indicator (FCI), Qualitative research on the usability of the Hyperfine Low-Field Scanner and Brain imaging using the portable Swoop® MRI system to assess structural and functional brain development patterns in a subset of infants. This approach aims to identify potential variations linked to neurological, psychiatric, and cognitive developmental outcomes. The GSED short form will be administered to all participants, while the long form will be administered to 300 participants randomly sampled.

Funders
Bill and Melinda Gates Foundation

Collaborators
Ghana: Kintampo Health Research Centre, Ghana Health
Kenya: Kenya Medical Research Institute (KEMRI)-Center for Global Health Research (KEMRI-CGHR)
Zambia: University of Zambia School of Medicine, UNC Global Projects Zambia, University of North Carolina School of Medicine
India: Christian Medical College, Vellore Society for Applied Studies, New Delhi
Pakistan: Aga Khan University
USA: George Washington University

Conclusion
By developing a “climate cohort” in Ghana, this study will build a critical evidence base on the health impacts of climate change in West Africa, informing health and climate policies that aim to enhance resilience against climate-related health risks. The findings will serve as a valuable resource for climate-health research across sub-Saharan Africa. This initiative represents a critical step in regional climate resilience, with potential implications for improving health and quality of life across the continent.