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FOETAL for NCD—FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life: a prospective preconception study in rural Tanzania
  1. Line Hjort1,
  2. Sofie Lykke Møller2,
  3. Daniel Minja3,
  4. Omari Msemo3,
  5. Birgitte Bruun Nielsen4,
  6. Dirk Lund Christensen2,
  7. Thor Theander5,
  8. Karsten Nielsen6,
  9. Lise Grupe Larsen7,
  10. Louise Groth Grunnet1,2,
  11. Leif Groop8,9,
  12. Rashmi Prasad8,
  13. John Lusingu3,5,
  14. Christentze Schmiegelow5,
  15. Ib C Bygbjerg2
  1. 1 Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
  2. 2 Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
  3. 3 National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
  4. 4 Departmentof Obstetrics and Gynecology, Aarhus University Hospital, Århus, Denmark
  5. 5 Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
  6. 6 Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark
  7. 7 Department of Pathology, Naestved Hospital, Naestved, Denmark
  8. 8 Department of Clinical Sciences, Clinical Research Centre, Lunds Universitet, Lund, Sweden
  9. 9 Finnish Institute of Molecular Medicine, Helsinki University, Helsinki, Finland
  1. Correspondence to Dr Line Hjort; line.hjort{at}


Purpose Low-income and middle-income countries such as Tanzania experience a high prevalence of non-communicable diseases (NCDs), including anaemia. Studying if and how anaemia affects growth, placenta development, epigenetic patterns and newborns’ risk of NCDs may provide approaches to prevent NCDs.

Participants The FOETALforNCD (FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life) Study is a population-based preconception, pregnancy and birth cohort study (n=1415, n=538, n=427, respectively), conducted in a rural region of North-East Tanzania. All participants were recruited prior to conception or early in pregnancy and followed throughout pregnancy as well as at birth. Data collection included: maternal blood, screening for NCDs and malaria, ultrasound in each trimester, neonatal anthropometry at birth and at 1 month of age, cord blood, placental and cord biopsies for stereology and epigenetic analyses.

Findings to date At preconception, the average age, body mass index and blood pressure of the women were 28 years, 23 kg/m2 and 117/75 mm Hg, respectively. In total, 458 (36.7%) women had anaemia (haemoglobin Hb <12 g/dL) and 34 (3.6%) women were HIV-positive at preconception. During pregnancy 359 (66.7%) women had anaemia of which 85 (15.8%) women had moderate-to-severe anaemia (Hb ≤9 g/dL) and 33 (6.1%) women had severe anaemia (Hb ≤8 g/dL). In total, 185 (34.4%) women were diagnosed with malaria during pregnancy.

Future plans The project will provide new knowledge on how health, even before conception, might modify the risk of developing NCDs and how to promote better health during pregnancy. The present project ended data collection 1 month after giving birth, but follow-up is continuing through regular monitoring of growth and development and health events according to the National Road Map Strategic Plan in Tanzania. This data will link fetal adverse event to childhood development, and depending on further grant allocation, through a life course follow-up.

  • anemia
  • malaria
  • embryology
  • developmental programming
  • epigenetics

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  • Contributors Study design: SM, DM, OM, BBN, DLC, TT, KN, LGL, JL, CS and ICB. Epigenetic study design: LH, LGG, LG and RP. Project management: SM, DM, OM, JL, CS and ICB. Field work and data collection: LH, SM, DM, OM and CS. Statistical analysis: CS. Manuscript writing: LH, SM, DLC, LGG, CS and ICB. All authors approved the final manuscript.

  • Funding The study and core analyses were funded by the Danish Council for Strategic Research, grant number 1309-00003B.

  • Disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Ethics approval Medical Research Coordinating Committee of the National Institute for Medical Research (reference number NIMR/HQ/R.8a/Vol. IX/1717).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets obtained and analysed in the current study are available from the last authors (Dr. Schmiegelow and Prof. Bygbjerg) on reasonable request.

  • Collaborators The FOETALforNCD data set is administrated by the Section of Global Health, Department of Public Health and the Centre for Medical Parasitology, Department of Immunology and Microbiology, both University of Copenhagen, Denmark. Data will be available and can be accessed upon reasonable request to the Section of Global Health, University of Copenhagen, and the senior authors of the present paper. Collaborations are encouraged with researchers working with similar cohorts or interested in initiating new future cohorts with the potential of complementing or replicating the findings in the FOETALforNCD cohort. Restrictions and requirements for reuse of the collected data include approval from the Tanzanian Medical Research Coordinating Committee of the National Institute for Medical Research ethics, and compliance to the signed consent form. Sharing of any data or biospecimens needs to be approved by the FOETALforNCD consortium.

  • Patient consent for publication Not required.

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