Intra-uterine exposure to lower maternal haemoglobin concentration is associated with impaired cognitive function in stunted adolescents: results from a 17-year longitudinal cohort study in Indonesia

Abstract

The long-term impact of maternal anaemia on cognitive performance remains unknown. Indonesian longitudinal cohort data of 363 paired pregnant mothers and their 10–14-year-old offspring were used to investigate the association between maternal haemoglobin (Hb) concentration and their offspring’s cognitive function (assessed by Raven’s Progressive Matrices test) during adolescence. The weighted anaemia prevalence was 49.3% in pregnant mothers and 22.2% in adolescents. Adolescents who were stunted, anaemic, or living in a rural area had significantly lower cognitive scores than their counterparts. Maternal Hb was not associated with adolescent cognitive function (β: 0.14; 95%CI: −0.052–0.340). However, the effect of maternal Hb concentration on offspring’s cognitive function was modified by stunting status (β, stunted: 0.44; 95%CI: 0.05–0.82; non-stunted: 0.01; 95%CI: −0.02–0.24). This study shows adverse cognitive outcomes at adolescent age are likely multi-causal and can be partially explained by intra-uterine exposure to low maternal Hb concentrations.

Keywords:

• Pregnancy
• anaemia
• adolescent
• cognition
• Indonesia

Authors’ contributions

All authors had an essential role in formulation of the research questions; MA, HH, and AMB wrote the first draft of the paper, MA analysed the data; MA, MLH, SM, AMB, and EJMF were involved in interpretation of the data and revision of the manuscript. All authors have read and approved the final paper.

Disclosure statement

No potential conflicts of interest are reported by the author(s).

Data availability statement

The data are available online at https://www.rand.org/well-being/social-and-behavioural-policy/data/FLS/IFLS.html

Additional information

Funding

This study was performed as part of the PhD studies of the first author (MA) for which a scholarship from Lembaga Pengelola Dana Pendidikan (LPDP), Republic of Indonesia was received. LPDP had no role in the design, data analysis, or interpretation of the data and writing process of this article.