Mother-child hemoglobin at preconception and first 1000 days and child development at 6 years

贫血是一个重要的全球健康问题。对截止值的有效性的担忧 世界卫生组织于1968年发布的血红蛋白(Hb)已有所提高。几次系统的审查，包括最近的一次 杨博士(PI)的一项研究揭示了缺乏数据和不充分的证据表明贫血和 功能后果，特别是儿童健康和发展(CHD)。世卫组织呼吁进行分析 这可以为包括CHD在内的各种结果的临界值的适当性提供信息。我们有一个 独一无二的机会来检查母婴之间的关系 先入为主、怀孕和儿童早期的连续体，以及一系列CHD措施。我们将提供的数据 使用来自先入性微量营养素的随机、双盲、安慰剂对照试验 补充(NCT01665378；PRECONCEPT研究；PI：Ramakrishnan)在越南进行。 有1599名妇女的前瞻性数据，从先入为主(n=5011名妇女)到怀孕和分娩 活产，1290名儿童从出生到6岁。评估母亲/孩子Hb的特定时间影响，有效 需要统计方法来生成不相关的Hb随时间变化的估计。我们会申请 创新条件建模方法，回答以下问题。1：是母性成见吗 从出生到6岁，Hb浓度与CHD相关吗？母亲先入为主的Hb 血药浓度与CHD结局呈正相关[1.出生大小，2.3、12和24个月的Hb，3. 运动和智力发展(12个月和24个月的贝利婴儿发育量表，韦氏婴儿发育量表 6岁时的全球智力、表现和语言得分)。2：变更时机的作用是什么？ 孕妇的Hb跨越先入为主的先天疾病吗？母体Hb在冠心病中的相对重要性 将在四个阶段有所不同：先入为主、先入为主--第1个月，第1-2个月，第2-3个月。 3：儿童出生后两年内Hb的时间变化对儿童认知的作用是什么 6岁？儿童Hb对认知的相对重要性在三个阶段会有所不同：3mo、3mo-1y和1y-2y。 这项拟议的研究将填补目前关于母体和母体之间关系的重要空白 出生前和出生后1000天内的儿童Hb和6岁以下儿童的认知功能。 重要优势包括可获得关于大样本母子配对的预期高质量数据 从先入为主到6岁，应用创新的统计方法和高度合格的 团队包括来自埃默里的初级调查员(PI：年轻的早期调查员)和经验丰富的高级调查员 和越南的泰国阮氏医药学大学。

Anemia is an important global health problem. Concerns about the validity of the cut-off values for hemoglobin (Hb) that WHO issued in 1968 have been raised. Several systematic reviews, including a recent one by Dr. Young (PI), reveal a paucity of data and insufficient evidence on relationships between anemia and functional consequences, especially child health and development (CHD). WHO has issued a call for analyses that can inform the appropriateness of its cut-off values for a variety of outcomes, including CHD. We have a unique opportunity to examine the relationships between maternal and child Hb measured across the continuum of preconception, pregnancy and early childhood and a battery of CHD measures. The data we will use are from a randomized, double-blinded, placebo-controlled trial of preconceptional micronutrient supplementation (NCT01665378; PRECONCEPT study; PI: Ramakrishnan) conducted in Vietnam. Prospective data are available from preconception (n=5011 women), through pregnancy and delivery for 1599 livebirths, and from birth to 6 y for 1290 children. To assess timing-specific influences of mother/child Hb, valid statistical methods are needed to generate uncorrelated estimates of Hb changes over time. We will apply innovative conditional modeling methods to answer the following questions. 1: Are maternal preconception Hb concentrations associated with CHD from birth through age 6y? Maternal preconception Hb concentrations will be positively associated with CHD outcomes [1. birth size, 2. Hb at 3, 12 and 24 mo, 3. motor and mental development (Bayley scales for infant development at 12 and 24 mo, and Wechsler scale for global intelligence, performance and verbal scores at 6y). 2: What is the role of timing of changes in maternal Hb across preconception to delivery on CHD? The relative importance of maternal Hb for CHD will vary across four periods: preconception, preconception - trimester 1, trimester 1 - 2, and trimester 2 - 3. 3: What is the role of timing of child Hb changes across the first 2 years of life on child cognition at 6y? The relative importance of child Hb on cognition will vary across three periods: 3mo, 3mo - 1y, and 1y - 2y. The proposed research will fill important gaps in current knowledge about relationships between maternal and child Hb before and during the 1st 1000 days of life and child cognitive functioning through the age of 6 years. Important strengths include availability of prospective, high quality data on a large sample of mother-child pairs from preconception through age 6 y, the application of innovative statistical methods and a highly qualified team that includes junior (PI: Young, early stage investigator) and senior experienced investigators from Emory University and Thai Nguyen University of Medicine and Pharmacy in Vietnam.