@article{01GM39M0X0TPNCJR7RVDB820HD,
  abstract     = {{Background Aflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed. Objectives In the present study, we examined the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia. Methods In a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 wk of gestation. Serum aflatoxin B-1-lysine concentration was measured using LC-tandem MS. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean +/- SD gestational age weeks of 19.1 +/- 3.71, 28.5 +/- 3.51, and 34.5 +/- 2.44. Estimated fetal weight was expressed in centiles using the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B-1-lysine concentration above or equal to the limit of detection) and unexposed mothers in the study. Results Mothers had a mean +/- SD age of 26.0 +/- 4.58 y. The median (25th, 75th percentile) serum aflatoxin B-1-lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the females enrolled provided at least 2 ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational-age centile than the unexposed group (ss = -0.92; 95% CI: -1.77, -0.06 centiles/week; P = 0.037). Conclusions Chronic maternal aflatoxin exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development.}},
  author       = {{Hadush, Kokeb Tesfamariam and  Gebreyesus, Seifu H. and Lachat, Carl and Hanley-Cook, Giles and  Roro, Meselech and  Getnet, Yalemwork and  Shikur, Bilal and  Belachew, Tefera and Kolsteren, Patrick and De Saeger, Sarah and De Boevre, Marthe and Argaw, Alemayehu}},
  issn         = {{0002-9165}},
  journal      = {{AMERICAN JOURNAL OF CLINICAL NUTRITION}},
  keywords     = {{aflatoxin,fetal growth restriction,low-income setting,mycotoxins,pregnancy,BIRTH-WEIGHT,IN-UTERO,OUTCOMES,DEOXYNIVALENOL,UNDERNUTRITION,STANDARDS,ALBUMIN,INCOME,WOMEN,LIFE}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1634--1641}},
  title        = {{Chronic aflatoxin exposure during pregnancy is associated with lower fetal growth trajectories : a prospective cohort from the Butajira Nutrition, Mental Health, and Pregnancy (BUNMAP) Study in rural Ethiopia}},
  url          = {{http://doi.org/10.1093/ajcn/nqac280}},
  volume       = {{116}},
  year         = {{2022}},
}

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