Longitudinal Assessment of Prenatal, Perinatal, and Early-Life Aflatoxin B1 Exposure in 828 Mother–Child Dyads from Bangladesh and Malawi

Joshua W. Smith, Andrew J. Matchado, Lee S.F. Wu, Charles D. Arnold, Sean M. Burke, Kenneth M. Maleta, Per Ashorn, Christine P. Stewart, Saijuddin Shaikh, Hasmot Ali, Alain B. Labrique, Keith P. West, Parul Christian, Kathryn G. Dewey, John D. Groopman, Kerry J. Schulze

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Background: In utero or early-life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy
and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked
longitudinal data collection and broad geographic representation.
Objectives: Aflatoxin exposure and selected determinants thereof were characterized in mother–child dyads with serial plasma/serum samples in
prenatal, perinatal, and early life in Malawi and Bangladesh.
Methods: Circulating aflatoxin B1 (AFB1)–lysine albumin adducts were measured in dyads from Bangladesh (n = 573; maternal first and third
trimester, 3 mo postpartum, cord blood, infant 24 mo) and Malawi (n = 255; maternal second and third trimester, 6 mo postpartum, infant 6 and 18
mo) with isotope dilution mass spectrometry. We examined AFB1-lysine adduct magnitude, persistence, seasonality, and associations with infant
feeding, and estimated daily AFB1 intake.
Results: Maternal AFB1-lysine was higher in Malawi (98% detectable; median: 0.469, IQR: 0.225–1.027 pg/μL) than in Bangladesh (59%; 0.030,
nondetectable [nd]–0.077 pg/μL). Although estimated dietary exposure in Malawi was temporally stable (648 ng AFB1/day), estimated intake in
Bangladesh was reduced by 94% between rainy and winter seasons (98 to 6 ng/day). AFB1-lysine was low in cord blood from Bangladesh (15%
detectable; 0.045, 0.031–0.088 pg/μL among detectable) and in Malawian infants at 6 mo of age (0.072, nd–0.236 pg/μL), but reached maternal
concentrations by 18 or 24 mo (Bangladesh: 0.034, nd–0.063 pg/μL; Malawi: 0.370, 0.195–0.964 pg/μL). In Malawian infants, exclusive
breastfeeding at 3 mo was associated with 58% lower AFB1-lysine concentrations at 6 mo compared with other feeding modes (P = 0.010).
Conclusions: Among pregnant women, aflatoxin exposure was persistently high in Malawi, while lower and seasonal in Bangladesh. Infants were
partially protected from exposure in utero and with exclusive breastfeeding, but exposures reached adult levels by 18–24 mo of age. The
Bangladesh and Malawi trials are registered at clinicaltrials.gov as NCT00860470 and NCT01239693. Curr Dev Nutr 2022;6:nzab153.
Original languageEnglish
Article numbernzab153
Number of pages17
JournalCurrent Developments in Nutrition
Issue number2
Publication statusPublished - 2022
Publication typeA1 Journal article-refereed


  • aflatoxin
  • breastfeeding
  • cord blood
  • diet
  • infancy
  • mass spectrometry
  • pregnancy
  • seasonality
  • toxicology

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science
  • Nutrition and Dietetics


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