Association between anaemia and aflatoxin B1 and fumonisin B1 exposure in HIV-infected and HIV-uninfected pregnant women from Harare, Zimbabwe.

Abstract

Aflatoxin B₁ (AFB₁) and fumonisin B₁ (FB₁) are poisons that contaminate poorly stored staple foods in resource-limited settings. Antenatal AFB₁ and FB₁ exposure may cause anaemia. We aimed to determine the associations of urinary aflatoxin M₁ (AFM₁) and FB₁, biomarkers of AFB₁ and FB₁ exposure, respectively, with erythrocyte parameters and anaemia. A retrospective cross-sectional study was conducted in 68 HIV-infected and 61 HIV-uninfected pregnant women ≥ 20 weeks gestational age in Harare, Zimbabwe. AFM₁ and FB₁ were measured in urine via competitive ELISA, and levels were grouped into tertiles. The erythrocyte parameters assessed were haemoglobin (Hb), mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, red blood cell (RBC), haematocrit (HCT), and red blood cell distribution width. Associations of urinary AFM₁ and FB₁ with erythrocyte parameters, and anaemia were assessed in a multiple regression controlled for potential confounders. The presence of FB₁ in urine decreased Hb levels in all women (β= -0.98, 95% CI: -1.94, 0.02) and HIV-uninfected (β= -1.99, 95% CI: -3.71, -0.26). FB₁ tertile 3 decreased Hb levels (β= -0.88, 95% CI: -1.74, 0.01) and HCT levels (β= -2.65, 95% CI: -5.26, 0.03) in HIV-infected. AFM₁ tertile 2 decreased RBC levels in HIV-infected (β= -0.34, 95% CI: -0.71, -0.03). The presence of FB₁ in urine increased anaemia risk in HIV-uninfected (OR: 10.68 95% CI: 1.02, 112.34). AFM₁ tertile 2 increased macrocytic anaemia risk in HIV-infected (OR: 13.72, 95% CI: 0.92, 203.55). There is need to ensure food safety through monitoring and nutritional interventions to improve maternal-infant health outcomes.