Cognitive and motor skills in school-aged children following maternal vitamin A supplementation during pregnancy in rural Nepal: a follow-up of a placebo-controlled, randomised cohort

Vitamin A Requirements in Pregnancy and Lactation

Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.

The relationship between dietary micronutrients intake and cognition test performance among school-aged children in government-owned primary schools in Kumasi metropolis, Ghana

Nutrients are critical for optimal brain development, and good nutritional status is associated with cognitive development and improvement. The relationship between micronutrients intake and cognition in Ghanaian school-aged children has not been studied. The study investigated dietary intakes of micronutrients and cognition test performance of school-aged children. A cross-sectional study was undertaken among 438 school children, aged 9-13 years from ten randomly selected basic schools in Kumasi, Ghana. Socio-demographic data were obtained from a structured questionnaire. Dietary intakes of iron, zinc, vitamin B6, folate, vitamin B12, and vitamin A were determined from repeated 24-hr dietary recall data from 351 children, while cognition test was performed using a Raven's Coloured Progressive Matrices (RCPM), a 36-question test. Among 351 children, 156 (44.4%) had inadequate zinc intake, whereas 96 (27.4%) had inadequate iron intake. More than 1 in 2 children had inadequate vitamin A intake while 55.8% and 53.0% had inadequate vitamin B12 and folate intakes, respectively. More school-aged boys (66.3%) than girls (46.8%) had inadequate vitamin B12 intake (χ 2 = 13.393, p < .001), while for iron, folate, vitamin B6, zinc, and vitamin A, the differences were not significant. Mean RCPM test score differed significantly between school type (p < .001), but did not differ between the different ages, and between children with adequate and inadequate iron, zinc, vitamin B12, vitamin B6, and vitamin A intakes, except for folate intake (p = .050). Weak positive significant associations were observed between RCPM test score and zinc and folate intakes (p = .050). Dietary micronutrient intakes were inadequate in majority of these children, which put them at risk of weakened immune system and poor health, but did not show significant associations with RCPM performance. Further studies using other forms of cognition tests may help confirm our findings, and provide the impetus for the necessary interventions.

Prenatal nutrition, stimulation, and exposure to punishment are associated with early child motor, cognitive, language, and socioemotional development in Dar es Salaam, Tanzania

BACKGROUND

Despite growing evidence that early life experiences and exposures can impact child development, there is limited research on how prenatal and early life nutrition and early life parenting practices predict specific domains of child development in resource-limited settings. This study examines the association between prenatal factors, birth outcomes, and early life characteristics with motor, cognitive/language, and socioemotional development in Tanzania.

METHODS

We assessed motor, cognitive/language, and socioemotional development among a cohort of 198 children aged 20-39 months in Dar es Salaam, Tanzania, whose mothers were previously enrolled in a randomized, placebo-controlled trial of prenatal vitamin A and zinc supplementation. Linear regression models were used to assess standardized mean differences in child development scores for randomized prenatal regimen and pregnancy, delivery, and early childhood factors.

RESULTS

Children born to mothers randomized to prenatal vitamin A had significantly lower reported motor scores in minimally adjusted and multivariate analyses, -0.29 SD, 95% CI [-0.54, -0.04], p = 0.03, as compared with children whose mothers did not receive vitamin A. There was no significant effect of randomized prenatal zinc on any development domain. Greater caregiver-child stimulation was associated with 0.38 SD, 95% CI [0.14, 0.63], p < 0.01, better cognitive/language scores, whereas children who experienced both verbal and physical punishment had 0.29 SD, 95% CI [-0.52, -0.05], p = 0.02, lower scores in socioemotional development. Maternal completion of primary school was associated with higher reported motor and cognitive/language development. Further, children of mothers who were <155 cm tall had lower cognitive and language scores.

CONCLUSION

Prenatal vitamin A supplements in a setting with low levels of vitamin A deficiency may not provide child development benefits. However, integrated environmental, educational, parenting, and stimulation interventions may have large positive effects across child development domains in resource-limited settings.

Role of serum vitamin A and E in pregnancy

Serum levels of vitamin A and E in early, middle and late pregnancy were analyzed to evaluate vitamin nutritional status in pregnancy, and provide guidance for pregnant women about vitamin supplements in pregnancy. In total, 28,023 serum samples were randomly selected from pregnant women in early, middle and late pregnancy between January 2013 and June 2014 in Beijing. High performance liquid chromatography (HPLC) method was used to determine the concentration of serum vitamin A and E in pregnancy. The concentration of serum vitamin A in early, middle and late pregnancy was 0.33±0.08, 0.37±0.09 and 0.33±0.15 mg/l, respectively, total abnormal rate was 25.31%, and deficiency (24.98%) was the main feature. The rate of deficiency in the early pregnancy (38.22%) was greater than that in late pregnancy (35.13%). The serum vitamin E in early, middle and late pregnancy was 9.10±2.47, 14.24±3.66 and 15.80±5.01 mg/l, respectively, total abnormal rate was 5.60%, and excess (5.37%) was the main feature. The excess rate in early pregnancy was at the lowest level (0.50%), and reached the highest level (15.32%) in late pregnancy. The serum levels of vitamin A and E are different during pregnancy. Generally, vitamin A is deficient and vitamin E is in excess. Therefore, monitoring the vitamin A and E levels, and strengthening perinatal education and providing guidance for pregnant women to supply vitamins rationally play important role in guaranteeing maternal and fetal safety.

Does antenatal micronutrient supplementation improve children's cognitive function? Evidence from the follow-up of a double-blind randomised controlled trial in Nepal

Introduction

Multiple Micronutrient (MMN) supplementation during pregnancy can decrease the proportion of infants born low birth weight and small for gestational age. Supplementation could also enhance children's cognitive function by improving access to key nutrients during fetal brain development and increasing birth weight, especially in areas where undernutrition is common. We tested the hypothesis that children whose mothers received MMN supplementation during pregnancy would have higher intelligence in early adolescence compared with those receiving Iron and Folic Acid (IFA) only.

Methods

We followed up children in Nepal, whose mothers took part in a double-blind Randomised Controlled Trial (RCT) that compared the effects on birth weight and gestational duration of antenatal MMN versus IFA supplementation. We assessed children's Full Scale Intelligence Quotient (FSIQ) using the Universal Non-verbal Intelligence Test (UNIT), and their executive function using the counting Stroop test. The parent trial was registered as ISRCTN88625934.

Results

We identified 813 (76%) of the 1069 children whose mothers took part in the parent trial. We found no differences in FSIQ at 12 years between MMN and IFA groups (absolute difference in means (diff): 1.25, 95% CI -0.57 to 3.06). Similarly, there were no differences in mean UNIT memory (diff: 1.41, 95% CI -0.48 to 3.30), reasoning (diff: 1.17, 95% CI -0.72 to 3.06), symbolic (diff: 0.97, 95% CI -0.67 to 2.60) or non-symbolic quotients (diff: 1.39, 95% CI -0.60 to 3.38).

Conclusion

Our follow-up of a double-blind RCT in Nepal found no evidence of benefit from antenatal MMN compared with IFA for children's overall intelligence and executive function at 12 years.

Effect of maternal antenatal and newborn supplementation with vitamin A on cognitive development of school-aged children in rural Bangladesh: a follow-up of a placebo-controlled, randomized trial

Background: The impact of early vitamin A supplementation on neurodevelopmental function has not been adequately studied. In rural Bangladesh we examined cognitive and motor function and scholastic achievement in a cohort of children who were exposed to vitamin A in utero or at birth.Objective: The aim of this study was to examine independent and combined effects of antenatal and newborn supplementation with vitamin A on the cognitive function of children at 8 y of age.Design: A cohort of rural Bangladeshi children from 2 previous double-blind, placebo-controlled cluster-randomized trials were revisited at age 8 y between February 2013 and June 2014. Data on sociodemographic, social, and physical conditions; schooling; child care behavior; anthropometric measures; and cognitive function were collected with the use of various psychometric assessment tools.Results: Among 11,950 children from the parent trial who were last known to be alive, a subset of 1803 children balanced by treatment group in a selected contiguous study area were re-enrolled and 1613 (89%) provided consent for assessments. Of these, 1577 (87%) children had a complete cognitive evaluation. All groups were highly comparable on baseline variables collected in the previous trials and factors measured at re-enrollment. Overall, there was no impact of either maternal or newborn supplementation with vitamin A on intelligence, memory, and motor function. Compared with placebo, children who received both interventions had significantly better performance in reading, spelling, and math computation, with increased mean (95% CI) scores of 8.0 (2.2, 13.8), 6.8 (1.9, 11.7), and 4.8 (0.6, 9.0), respectively.Conclusions: General intelligence or memory and motor functions were not affected by antenatal or newborn supplementation with vitamin A. Scholastic performance and aspects of executive function improved when both interventions were provided. These trials were registered at clinicaltrials.gov as NCT00198822 and NCT00128557.

Early Childhood Nutrition Is Positively Associated with Adolescent Educational Outcomes: Evidence from the Andhra Pradesh Child and Parents Study (APCAPS)

BACKGROUND

India's Integrated Child Development Scheme, which provides supplementary nutrition and other public health services to >91 million women and children aged <6 y, is the largest program of its kind in the world.

OBJECTIVE

We estimated the long-term associations of maternal and early childhood nutrition provided under the Integrated Child Development Scheme with educational outcomes when the children became adolescents.

METHODS

We used longitudinal data from a controlled nutrition trial conducted near the city of Hyderabad, India. From 1987 to 1990, a balanced protein-energy supplement (corn-soya meal, called upma) was offered to pregnant women and children aged <6 y in 15 intervention villages, whereas no supplementation was offered in 14 control villages. Both groups had equal access to other public programs such as immunization and anemia control in pregnancy. Children born during the original trial period were resurveyed (654 intervention and 511 control group children) in 2003-2005. We used propensity score matching methods to correct for estimation bias in our regression models to assess the associations of supplementary nutrition with school enrollment, schooling grades completed, and academic test performance of these adolescents.

RESULTS

Children born in intervention villages were 7.8% (95% CI: 0.1%, 15.4%; P < 0.05) more likely to be enrolled in school and completed 0.84 (95% CI: 0.28, 1.39; P < 0.005) more schooling grades than children born in control villages. We found no association between supplementary nutrition and academic performance, as measured by school test scores.

CONCLUSION

Offering a nutritional supplement to pregnant women and children <6 y of age during the Hyderabad Nutrition Trial was associated with improved school enrollment and completion of more schooling grades when the children became adolescents.

Concurrent validation of the MABC-2 Motor Tests and MABC-2 Checklist according to the Developmental Coordination Disorder Questionnaire-BR

The Movement Assessment Battery for Children, 2nd Ed (MABC-2), comprised of motor tests and a questionnaire (Checklist), has been used by several nationalities to identify problems in children's motor behavior. However, the level of agreement between the motor tests and the checklist has been questioned. So, this study aimed to test the level of competition between the MABC-2 motor test and MABC-2 Checklist, controlled by the Developmental Coordination Disorder Questionnaire (DCDQ-BR) as the gold reference. Parents of 40 children and 16 teachers responded to the MABC-2 Checklist and the DCDQ-BR. Later 40 children were evaluated using the MABC-2 motor test. No significant congruence among a comparison of the MABC-2 motor tests, MABC-2 Checklist and DCDQ-BR was observed. The results indicated that there is no concurrent validity between the MABC-2 motor tests and the DCDQ-BR test, whereas the MABC-2 Checklist showed low levels of concurrent validity with the DCDQ-BR.

A review of environmental contributions to childhood motor skills

Although much of children's motor skills have a heredity component, at least half of the variance is likely to be influenced by the environment. It is important to ascertain features of the environment that are responsible so that toxins can be avoided, children at risk can be identified, and beneficial interventions initiated. This review outlines the results of published studies and recommends the areas where further research is required. We found much confusion with little comparability concerning the ages or measures used. Few studies had sufficient power and few allowed for confounders. We found that research to date implicates associations with prenatal drinking ≥4 drinks of alcohol per day; diabetes; taking antidepressant drugs; being deficient in iodine or iron; dietary fish; and postnatal depression. The child appearing to be most at risk was born of low birth weight (but not due to preterm delivery) or with neonatal problems.