PONAll (Pregnancy, Offspring, NCDs and Anemia)

​The impact of anemia and malaria in pregnancy on the child's DNA and later health – How do we prevent non-communicable diseases across generations? 

Low- and middle-income countries such as Tanzania experience a high prevalence of non-communicable diseases (NCDs), including anemia, obesity, hypertension and diabetes, as well as a high prevalence of communicable diseases such as malaria. Anemia and malaria during pregnancy affect placental development and fetal growth and thereby decreasing birth weight. Low birth weight is associated with an increased risk of a range of NCDs later in life, including obesity and diabetes. Fetal “programming” is meant to be one pathway increasing the risk of NCDs in adult life. 

By taking advantage of two already well-established pregnancy cohorts (the FOETALforNCD study and STOPPAM study) in rural, North-Eastern Tanzania, we will conduct a follow-up study of 500 children (aged 4-12 years) and their mothers, in order to investigate long-term consequences of anemia and malaria. The mother-child pairs will be invited to participate in the follow-up examination, including anthropometrics and fasting blood samples, and collection of DNA for epigenetic measurements. 

This project will provide new knowledge on how health, even before conception, might modify the risk of developing NCDs and how to promote better health during pregnancy, childhood and pre-adolescent age.

Description of health problem

Anemia is a global health problem affecting 36-60% of pregnant women in low- and middle-income countries (LMICs) such as Tanzania, and even 24% of pregnant women in Denmark, translating into 15.000 Danish and 1.400.000 Tanzanian pregnancies every year. Anemia in pregnancy may decrease birthweight, and low birthweight (LBW) is associated with an increased risk of a range of NCDs later in life, including obesity and cardio-metabolic disorders. Tanzania is experiencing a fast epidemiological transition from a population affected by anemia and infectious diseases, to moving towards NCDs within one generation. Indeed, malaria is prevalent in both Tanzania and many other LMICs, and is a major risk factor for anemia and LBW. 


To evaluate the effect of anemia and malaria during pregnancy on the mother-child pair´s health, and the children´s growth, development and susceptibility to non-communicable diseases (NCDs).
Furthermore, we want to investigate if epigenetic mechanisms may be involved in regulating this susceptibility and how these epigenetic changes, including DNA methylation, may be used as biomarkers to determine children at high disease risk. Hereby, new knowledge is gained on how to promote health during pregnancy and prevention of NCDs later in the children’s lives.


  • Principal Investigator, postdoc, Line Hjort (Center for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet).
  • Senior researcher, Louise Groth Grunnet (Pregnancy and Childhood Health team, Clinical Prevention Research, Steno Diabetes Center Copenhagen).
  • Ass. Prof. Christentze Schmiegelow (Centre for Medical Parasitology, Dept. of Immunology and Microbiology, Copenhagen University).
  • Prof. Ib Bygbjerg, Ass. Prof. Dirk Lund Christensen, (Section of Global Health, Copenhagen University)
  • Dr. Omari Msemo, Dr. Daniel Minja, Prof. John Lusingu (National Institute of Medical Research, Tanga Research Centre, Tanzania). 
  • Prof. Richard Saffery and Prof. David Burgner (Murdoch Children’s Research Institute, The Royal Children´s Hospital, Melbourne, Australia). 

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