Biomarkers of maternal environmental enteric dysfunction are associated with shorter gestation and reduced length in newborn infants in Uganda

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ABSTRACT

Background

Adverse birth outcomes, including preterm birth and stunting at birth, have long-term health implications. The relation between adverse birth outcomes and chronic, asymptomatic gastrointestinal inflammation (environmental enteric dysfunction—EED) is poorly understood.

Objective

We aimed to examine the relation between maternal EED and adverse birth outcomes in a sample of pregnant Ugandan women and their newborn infants.

Design

We conducted a prospective cohort study in Mukono, Uganda. A total of 258 pregnant women were enrolled at their first prenatal visit (∼18 weeks of gestation). EED was measured by urinary lactulose:mannitol (L:M) ratio and serum concentrations of antibodies to the bacterial components flagellin and LPS. Covariates were obtained from survey data collected at 2 time points. Associations were assessed through the use of unadjusted and adjusted simple linear regression models.

Results

Complete birth outcome data were recorded for 220 infants within 48 h of delivery. Mean ± SD gestational age was 39.7 ± 2.1 wk, and 7% were born preterm. Mean ± SD length and length-for-age z score (LAZ) at birth were 48.1 ± 3.2 cm and −0.44 ± 1.07, respectively. L:M ratio was not associated with any birth outcome. In adjusted models, higher concentrations of natural log-transformed anti-flagellin immunoglobin G (IgG) and anti-LPS IgG were significantly associated with shorter length of gestation (β: −0.89 wk; 95% CI: −1.77, −0.01 wk, and β: −1.01 wk; 95% CI: −1.87, −0.17 wk, respectively) and with reduced length (β: −0.80 cm; 95% CI: −1.55, −0.05 cm, and β: −0.79 cm; 95% CI: −1.54, −0.04 cm, respectively) and LAZ at birth (β −0.44 z score; 95% CI: −0.83, −0.05, and β: −0.40 z score; 95% CI: −0.79, −0.01, respectively).

Conclusion

Maternal anti-flagellin and anti-LPS IgG concentrations in pregnancy, but not L:M ratio, were associated with shorter gestation and reduced infant length at birth. Further research on the relation between maternal EED and birth outcomes is warranted.

Key Words

environmental enteric dysfunction
inflammation
intestinal permeability
intestinal biomarkers
dual sugar absorption test
L:M test
anti-flagellin antibodies
anti-LPS antibodies
birth outcomes
Uganda

Abbreviations used

DBP
diastolic blood pressure
EED
environmental enteric dysfunction
HFIAS
Household Food Insecurity Access Scale
IBS
irritable bowel syndrome
LAZ
length-for-age z score
LBW
low birth weight
L:M
lactulose:mannitol
MHC IV
Mukono Health Center IV
MUAC
midupper arm circumference
SBS
short bowel syndrome
SGA
small for gestational age
WAZ
weight-for-age z score
WLZ
weight-for-length z score
%LE
percentage of lactulose excretion

Cited by (0)

Supported by the Feed the Future Innovation Lab for Nutrition at Tufts University in Boston, MA, supported by the United States Agency for International Development, award AID-OAA-L-10-00006. CD was supported in part by NIH grants K24DK104676 and 2P30 DK040561.

The funding sources had no role in the publication process including the analysis of data or the writing of the manuscript.