Abstract
Some evidence suggests that aflatoxin may contribute to the high prevalence of stunting observed in low‐income countries. Whereas several studies have been conducted in West Africa, fewer exist in East Africa and even fewer in nonagricultural contexts. We analyzed serum samples from 400 iron‐replete, nonanemic pregnant women from a cohort in Dar es Salaam, Tanzania to determine the extent and magnitude of exposure to aflatoxin and to study the relationship between levels of aflatoxin exposure in utero and infant birth and growth outcomes. Ninety‐nine percent of women had detectable concentrations of aflatoxin B1‐lysine (AFB1‐lysine), with a median level of 1.4‐pg/mg albumin, indicating a much lower level compared to studies of rural populations in sub‐Saharan Africa. Our results do not show a statistically significant relationship between AFB1‐lysine levels and birth weight, small for gestational age, or prematurity. We observe a small statistically significant reduction in gestational age at delivery (0.47 weeks; 95% CI: −0.86, −0.07) as the natural log of AFB1‐lysine levels increases by 1 unit of pg/mg of albumin, after controlling for potential confounders. Among a nonrandom set of infants who had measurements for placental weight, haemoglobin at delivery, and follow‐up z‐score measurements, we find no association between aflatoxin plasma concentrations and these variables. These findings suggest a high prevalence of chronic low‐level exposure to aflatoxin, though its effect on birth outcomes in this population remains unclear. Our research adds to a growing body of literature finding mixed associations between aflatoxins on pregnancy outcomes and child growth.
Highlights
Aflatoxins are a family of potent fungal toxins produced by the fungi Aspergillus flavus and Aspergillus parasiticus that contaminate soil, vegetation, and stored crops (Kitya, Bbosa, & Mulogo, 2010)
The levels found in our analysis are similar to a study of two cohorts in southwestern Uganda, using the high performance liquid chromatography (HPLC)‐fluorescence method; in one cohort of 713 individuals, 90% of samples were positive for aflatoxin B1 (AFB1)‐lysine, with a median level of 1.58‐pg/mg albumin, whereas in the other, 92.5% of samples had detectable levels, with a median of 1.18‐pg/mg albumin (Kang et al, 2015)
Some have argued that the HPLC method for detecting aflatoxin levels is less sensitive than the enzyme‐linked immunosorbent assay (ELISA) and liquid chromatography with tandem mass spectrometry methods (McCoy et al, 2008), and Yard et al (2013) found that the estimated AFB1‐lysine adduct values from the ELISA method are typically 4.6 times higher than those from the HPLC‐fluorescence measurement (Yard et al, 2013)
Summary
Aflatoxins are a family of potent fungal toxins produced by the fungi Aspergillus flavus and Aspergillus parasiticus that contaminate soil, vegetation, and stored crops (Kitya, Bbosa, & Mulogo, 2010). Humans are exposed to aflatoxins through the ingestion of contaminated crops, through the consumption of products from exposed animals, or through vertical transmission in utero or in breast milk (Denning, Allen, Wilkinson, & Morgan, 1990). In addition to their acute hepatotoxic and immunosuppressive effects, cumulative long‐term exposure to aflatoxins has been associated with liver cancers, disturbances in the absorption and metabolism of several vitamins and minerals, adverse pregnancy outcomes, and growth faltering (Paul Craig Turner, 2013). The health implications of aflatoxin contamination are expected to become increasingly significant as climate change allows for more favourable conditions for aflatoxin biosynthesis in certain settings, and population growth continues to increase the demand for food production (Baranyi, Kocsubé, & Varga, 2015; Medina, Rodriguez, & Magan, 2014)
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