Association between maternal hemoglobin concentration and educational attainment in mid-childhood in a high-resource obstetric setting: a prospective cohort study

Abstract

BackgroundAlthough maternal Hb levels during pregnancy are commonly associated with perinatal outcomes, their link to childhood neurodevelopment remains uncertain. ObjectiveThis study aimed to examine the associations between maternal hemoglobin (Hb) in early and late pregnancy with offspring mid-childhood educational attainment in a high-resource obstetric setting. Study DesignPregnancy data from a prospective birth cohort (Pregnancy Outcome Prediction Study, Cambridge, UK, 2008-2012, N=3285) were linked to mid-childhood educational outcomes (Department for Education, UK). Regression models adjusted for maternal, child, and socioeconomic factors were used to determine associations between maternal Hb, pregnancy complications, and offspring educational outcomes (ages 5-7). ResultsNo association was observed between maternal Hb at 12 weeks and the likelihood of either adverse pregnancy outcomes or children meeting expected educational standards between ages 5-7. Higher maternal Hb at 28 weeks was associated with an increased risk of small-for-gestational age infants (aOR1.26, 95%CI 1.11-1.59; p=0.002) and preterm birth (aOR1.38, 95%CI 1.11-1.81; p=0.005). There were no adverse birth outcomes associated with anemia. However children of mothers who were anaemic at 28 weeks had ∼40% increased risk of not attaining expected educational standards at age 5 (aOR1.42, 95%CI 1.03-1.95; p=0.03). There was no association between maternal anemia at 28 weeks and educational performance at ages 6-7. No associations were found between high maternal Hb concentrations (top decile) or change Hb concentrations between 12-28 weeks and childhood educational attainment. ConclusionsMaternal anemia at 28 weeks of pregnancy is associated with reduced educational attainment aged 5, but not at older ages (6-7 years). A proactive approach to increasing maternal hemoglobin in high-resource settings is unlikely to impact on long-term childhood educational attainment.