Early Interventions: Tracing the Impact of Maternal Issues on Infant Health

According to the World Health Organization (WHO), more than 3 million child fatalities in 2017 could have been treated or prevented. Moreover, WHO reports that approximately 830 women die every day from preventable causes related to pregnancy and childbirth, and a startling 99 percent of maternal deaths occur in developing countries.

Korede K. Yusuf, MBBS, PhD, assistant professor in the College of Nursing and Public Health, has dedicated her career to changing these statistics. She aims to find solutions that address maternal and child health inequalities­—and save lives.

Korede K. Yusuf, MBBS, PhD, has written numerous articles on maternal/reproductive health, infant health and HIV. She is also a reviewer for a number of scientific journals, including the Journal of Health Care for the Poor and Underserved.

“Globally, women and children constitute a vulnerable population and experience public health problems at higher rates than the general population,” she said. “My goal is to understand how we can optimize growth and development of fetuses, improve child health and survival, reduce maternal experience of violence and generally reduce health disparities and improve the health of women and children across the world.”

Dr. Yusuf published a series of studies on links between maternal health and fetal development. “It is well known that the future health of individuals is determined long before they are born,” she said. “The health of a mother and what she eats, drinks or is exposed to environmentally not only affects her, but impacts her baby too.”

Dr. Yusuf’s article in the October 2018 issue of the Southern Medical Journal, “Effects of maternal carbohydrate and fat intake on fetal telomere length,” explores whether mothers’ high carbohydrate and fat consumption during pregnancy influences the length of telomeres in infants. Telomeres are nucleotide sequences at the ends of chromosomes that promote chromosomal stability. Notably, their length can be used as a biomarker of cellular aging and the development of diseases such as Alzheimer’s disease, cardiovascular disorders and cancer. “If we can identify modifiable factors that affect telomere length, especially in infants, we may be able to reduce the prevalence of certain diseases through health education and interventions,” said Dr. Yusuf.

Dr. Yusuf’s research team collected umbilical cord blood from 62 women at a university hospital and compared telomere length for those classified as high fat and high carbohydrate consumers. They found that high fat consumption had a significant negative effect on telomere length. “To our knowledge, this study was the first to show a relationship between maternal high fat consumption and shortened fetal telomere length,” she said. Their findings point to the importance of promoting a healthy diet during pregnancy.

Dr. Yusuf also recently published the results of two studies examining links between fetal health and folic acid given by doctors to pregnant women who smoke. Working with faculty members from the University of South Florida, she recruited 345 pregnant smokers at a community health center in Tampa, Florida, to participate in the clinical trial.

Appearing in the May 2019 issue of JAMA Pediatrics, “Comparing folic acid dosage strengths to prevent reduction in fetal size among pregnant women who smoked cigarettes: A randomized clinical trial” reported on how folate dosage could alter fetal body size. “We hoped to understand the effect of higher-strength folic acid versus standard-of-care folic acid on infants’ birth weight and the risks of small-for-gestational-age (SGA) infants,” said Dr. Yusuf.

Smokers on higher-dose folic acid delivered infants with a higher birth weight than smokers on a standard dose, and mothers who received the higher dose had a lower risk of having babies with SGA compared to those taking the standard dose. The findings suggest that higher-strength folic acid supplementation in pregnant smokers might be a safe, effective way to improve birth outcomes and reduce low birth weight.

Another 2019 article based on Dr. Yusuf’s research, “Folic Acid Intake, Fetal Brain Growth, and Maternal Smoking in Pregnancy: A Randomized Controlled Trial,” published in Current Developments in Nutrition, looked at the impact of high-strength folic acid on fetal brain growth. According to Dr. Yusuf, folic acid prevented a reduction in fetal body size, but not fetal brain size. Higher-dose folic acid, however, did cause a reduction in brain-body ratio (BBR).

“A high BBR signifies a larger brain weight for a given head circumference, and this is commonly observed in SGA infants and intrauterine growth restriction,” Dr. Yusuf noted. “Smokers in pregnancy may benefit from folate supplementation in reducing the risk of having infants with impaired brain-body proportionality.”

Dr. Yusuf hopes to further explore how pregnant smokers’ folic acid intake shapes infant brain growth. She is interested in studying the effect of starting folate supplementation early on, beginning even before conception and continuing until delivery, which could help ensure the proper development of fetuses. Equipped with Dr. Yusuf’s wide-ranging insights into maternal health, public health organizations and healthcare providers may be able to change the lives of women and children around the globe.