Mycotoxin exposure from food occurs globally but is more common in hot humid environments, especially in low-income settings, and might affect pregnancy outcomes. This study aimed to synthesize the evidence from epidemiological studies on the relationship between maternal or fetal exposure to different mycotoxins and the occurrence of adverse pregnancy outcomes. Multiple databases were systematically searched up to December 2018 to identify studies that assessed the association between mycotoxin exposure in pregnant women or fetuses and at least one pregnancy outcome. Studies were appraised and results were synthesized using standard methods for conducting systematic reviews. This review identified and included 17 relevant studies. There is some evidence to suggest that exposure to various Aspergillus mycotoxins (e.g., aflatoxin) during pregnancy may impair intrauterine fetal growth and promote neonatal jaundice. Findings were inconclusive concerning the influence of aflatoxin exposure on perinatal death and preterm birth. Only two studies assessed effects of maternal exposure to Fusarium mycotoxins (e.g., fumonisin) on adverse pregnancy outcomes. These studies found that maternal fumonisin exposure may be associated with hypertensive emergencies in pregnancy and with neural tube defects. Studies using grain farming and weather conditions as a proxy measure for mycotoxin exposure found that such exposure was associated with an increased risk of preterm birth and late-term miscarriage. In conclusion, there is already some evidence to suggest that exposure to mycotoxins during pregnancy may have detrimental effects on pregnancy outcomes. However, given the limited number of studies, especially on effects of Fusarium mycotoxins, more studies are needed for a more comprehensive understanding of the effects of different mycotoxins on maternal and fetal health and to guide public health policies and interventions.

Aflatoxins (AFs), ochratoxin A (OTA), citrinin (CIT), fumonisin B₁ (FB₁), zearalenone (ZEN), and deoxynivalenol (DON) are mycotoxins that may contaminate diets, especially in low-income settings, with potentially severe health consequences. This study investigates the exposure of 439 pregnant women in rural Bangladesh to 35 mycotoxins and their corresponding health risks and links their exposure to certain foods and local stimulants. Overall, 447 first-morning urine samples were collected from pregnant women between July 2018 and November 2019. Mycotoxin biomarkers were quantified by DaS-HPLC–MS/MS. Urinary concentration of frequently occurring mycotoxins was used to estimate dietary mycotoxin exposure. Median regression analyses were performed to investigate the association between the consumption of certain foods and local stimulants, and urinary concentration of frequently occurring mycotoxins. Only in 17 of 447 urine samples (4%) were none of the investigated mycotoxins detected. Biomarkers for six major mycotoxins (AFs, CIT, DON, FB₁, OTA, and ZEN) were detected in the urine samples. OTA (95%), CIT (61%), and DON (6%) were most frequently detected, with multiple mycotoxins co-occurring in 281/447 (63%) of urine samples. Under the lowest exposure scenario, dietary exposure to OTA, CIT, and DON was of public health concern in 95%, 16%, and 1% of the pregnant women, respectively. Consumption of specific foods and local stimulants—betel nut, betel leaf, and chewing tobacco—were associated with OTA, CIT, and DON urine levels. In conclusion, exposure to multiple mycotoxins during early pregnancy is widespread in this rural community and represents a potential health risk for mothers and their offspring.

There is limited and inconsistent evidence, primarily from cross-sectional studies, linking mycotoxins to adverse birth outcomes. This study investigates the potential role of maternal dietary exposure to multiple mycotoxins in the development of several adverse pregnancy and birth outcomes. We analyzed data from 436 singleton pregnancies enrolled in a prospective cohort study in the rural Habiganj district, Bangladesh, between July 2018 and November 2019. Thirty-five urinary mycotoxin biomarkers were quantified using liquid chromatography coupled with tandem mass spectrometry and used to estimate dietary mycotoxin exposure. Multivariable regression models, adjusted for potential confounding and clustering, were fitted to assess the associations between maternal exposure to frequently occurring mycotoxins (ochratoxin A-OTA, citrinin- CIT, and Deoxynivalenol- DON) and pregnancy loss, preterm birth (PTB), low birth weight (LBW), born small-for-gestational-age (SGA) and small-vulnerable newborn. The results indicate that only in 16 of 436 pregnancies (4%) were urine samples free from all investigated mycotoxins. Biomarkers for six major mycotoxins were detected in the urine samples. OTA (95%), CIT (61%), and DON (6%) were most frequently detected, with at least two mycotoxins co-occurring in the majority of women (63%). There was evidence that maternal dietary intake of OTA was associated with higher odds of having an LBW baby, with the odds increasing in a dose-dependent manner. We found no evidence of associations between pregnancy loss, PTB, SGA, small-vulnerable newborns, and maternal dietary exposure to OTA, CIT, and DON, albeit with large confidence intervals, so findings are consistent with protective as well as large harmful effects. Exposure to multiple mycotoxins during pregnancy is widespread in this rural community and represents a health risk for mothers and babies. Tailored public health policies and interventions must be implemented to reduce mycotoxin exposure to the lowest possible level.

Aside from specific environmental conditions, poor agricultural practices contribute to mold and thus the mycotoxin contamination of crops. This study investigated Bangladeshi farming households’ (i) awareness of and experience with mold contamination of food crops; (ii) knowledge and awareness of the timing, causes, and consequences of mold and mycotoxin contamination; and (iii) knowledge of the recommended agricultural practices for controlling and preventing mold contamination of food crops. A survey was conducted with 1280 households in rural areas of Habiganj district, Bangladesh. Basic descriptive statistics were calculated, and mixed-effects linear regression analyses were performed to examine associations between household characteristics and overall knowledge scores. The awareness of mold contamination of food crops was very high (99%; 95% CI: 98–100%) and a shared experience among households (85%; 95% CI: 80–88%). Yet, the majority (80%; 95% CI: 76–84%) demonstrated a low level of knowledge of the timing, causes, and preventive practices regarding mold contamination of crops. Knowledge scores were similar over demographic groups and better for households with more arable land. The findings suggest a generally insufficient knowledge of the conditions that favor mold contamination and the measures for preventing mold contamination of food crops. These findings underline the need for tailored interventions to promote good agricultural practices and reduce mold contamination of food crops.

Micronutrient deficiencies affect over half of young children and two‐thirds of reproductive‐aged women worldwide. Nutrition‐sensitive agriculture interventions have the potential to increase nutrient‐dense food intake and thus improve micronutrient status. We evaluated the impact of a homestead food production (HFP) programme on micronutrient status and anaemia of women and their children (registered secondary outcomes) in the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial, additionally assessing its impact on inflammation. We conducted a 1:1 parallel two‐arm cluster‐randomized controlled trial in Sylhet, Bangladesh, with 96 clusters. The 3‐year HFP intervention included gardening, poultry, nutrition, and hygiene components. In 2015, we conducted the baseline survey. We enrolled 2705 women and their children up to 3 years of age, and in 2019, we evaluated impacts on anaemia, iron, vitamin A, zinc and inflammation status through blood measures of these women (aged 19–44 years) and their 6‐ to 37‐month‐old children, using multilevel regression. Anaemia was common (nonpregnant women: 20%, pregnant women: 35%, children: 16%), while iron deficiency was rare among nonpregnant women (3%), 12% among pregnant women and 20% among children. Vitamin A deficiency ranged from 1% to 5%, and zinc deficiency was very common (nonpregnant women: 43%, pregnant women: 69%, children: 25%). We found no evidence of an intervention impact on micronutrient status, anaemia or inflammation among the 2483 women and 930 children measured. The moderate improvements in dietary intake achieved by the intervention were thus not sufficient, and more substantial hygiene improvements and targeted dietary changes may be needed to improve micronutrient status. This trial was registered at Clinicaltrials.gov (NCT02505711).

Matrix effects (ME) during LC-ESI-MS analysis are a commonly acknowledged issue for a variety of matrices and analytes. Although sample preparation techniques are steadily evolving to reduce ME, the complexity and variability of the urine matrix remain a challenge, especially for multi-analyte methods. To investigate the extent of ME implications on method performance and quantification, we used stable isotope-labelled standards (SIL-IS) of 11 mycotoxins to evaluate the magnitude and variability of ME in urine samples from two cohorts: Bangladeshi adult women (n = 50) and Swedish children of both sexes (n = 340). Significant ME differences were observed between the two cohorts for eight of the 11 mycotoxins. Additionally, intra-cohort ME variability turned out to be very high with interquartile ranges (IQR) above 15% for 14 out of 22 analyte-cohort combinations. Maximum IQR values were observed for sterigmatocystin in the Bangladeshi cohort (318%), strongly impacting quantitative results obtained with matrix(-matched) calibration. Further experiments on a small German cohort of four subjects, each providing four to five urine samples, revealed high variability of ME within each individual. Factors influencing ME were investigated, showing little to no impact of sex and a moderate impact of age for some analytes in the Swedish cohort. Nonetheless, especially the more polar analytes, showing stronger signal suppression, demonstrated clear correlation of ME with density and creatinine concentration of the urine samples. As a result, urine samples with very high or low density or creatinine values require careful handling in regard to sensitivity or quantification errors when matrix(-matched) calibration without SIL-IS is applied.