Soil-transmitted helminth infection in pregnancy andlong-term child neurocognitive andbehavioral development: A prospective mother-child cohort in Benin

Abstract

Background Anestimated 30%of womeninSub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was asso ciated with impaired cognitive and gross motor development scores in 635 one-year-old chil dren. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Principal findings: Ourprospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP wasassessedat three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2 nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% atthe 1 st ANV,9% at the 2 nd ANV,and1%at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQinternalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2 nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Conclusions Ourstudy shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention andtreatment protocols should be enforced in low- and middle-income countries.