The role of nutrients in human neurodevelopment and their potential to prevent neurodevelopmental adversity

Utility of genome sequencing in exome-negative pediatric patients with neurodevelopmental phenotypes

Exome sequencing (ES) has emerged as an essential tool in the evaluation of neurodevelopmental disorders (NDD) of unknown etiology. Genome sequencing (GS) offers advantages over ES due to improved detection of structural, copy number, repeat number and non-coding variants. However, GS is less commonly utilized due to higher cost and more intense analysis. Here, we present nine cases of pediatric NDD that were molecularly diagnosed with GS between 2017 and 2022, following non-diagnostic ES. All individuals presented with global developmental delay or regression. Other features present in our cohort included epilepsy, white matter abnormalities, brain malformation and dysmorphic features. Two cases were diagnosed on GS due to newly described gene-disease relationship or variant reclassification (MAPK8IP3, CHD3). Additional features missed on ES that were later detected on GS were: intermediate-size deletions in three cases who underwent ES that were not validated for CNV detection, pathogenic variants within the non-protein coding genes SNORD118 and RNU7-1, pathogenic variant within the promoter region of GJB1, and a coding pathogenic variant within BCAP31 which was not sufficiently covered on ES. GS following non-diagnostic ES led to the identification of pathogenic variants in this cohort of nine cases, four of which would not have been identified by reanalysis alone.

Food Records Show Daily Variation in Diet During Pregnancy: Results From the Temporal Research in Eating, Nutrition, and Diet during Pregnancy (TREND-P) Study

BACKGROUND

Diet is critical for pregnant individuals and their offspring, but insight into diet during pregnancy mainly comes from questionnaires and recalls.

OBJECTIVE

Obtain detailed real-time dietary data during pregnancy to evaluate intra- and inter-individual variation in intakes.

METHODS

Pregnant individuals were recruited from a New York City health system December 2020-June 2023. Participants collected dietary intakes for 14 days (mean gestational weeks = 17.6) and again roughly 4 weeks later (mean gestational weeks = 24.5). Participants logged each eating occasion using a smartphone and study-developed app, and wore a smartwatch capturing physiologic data.

RESULTS

In total 150 individuals completed at least one data collection round, with 134 completing both rounds. Mean daily eating window was 10.82 hours, with weekends having a significantly shorter window than weekdays (p<0.001). Eating window was correlated with energy intake (r = 0.401, p<0.001), driven by later last eating occasions. There was high intraindividual variation in macro- and micro-nutrient intakes (intraclass correlation coefficient, ICC, range 0.11-0.40) and food type (ICC range: 0.08-0.34), and differences between weekdays and weekends (less protein and micronutrients on weekends). Few participants' mean intakes met daily recommended dietary allowances (RDA) for key micronutrients (under 15% for iron, magnesium, vitamin D, and vitamin E; under 30% for calcium, folate, zinc, and vitamin A).

CONCLUSIONS

Dietary intakes varied substantially within and between individuals, and mean nutrient intake estimates did not capture nutrient adequacy for individuals or populations. Future work that examines individual daily dietary intakes throughout pregnancy among diverse populations is needed.

Maternal Nutrition during Pregnancy and Offspring Brain Development: Insights from Neuroimaging

Maternal nutrition during pregnancy is known to be important for offspring growth and health and has also been increasingly recognized for shaping offspring brain development. On the other hand, recent advancements in brain imaging technology have provided unprecedented insights into fetal, neonatal, and pediatric brain morphometry and function. This review synthesizes the current literature regarding the impact of maternal nutrition on offspring brain development, with a specific focus on findings from neuroimaging studies. The diverse effects of maternal nutrients intake or status during pregnancy on neurodevelopmental outcomes in children are discussed. Neuroimaging evidence showed associations between maternal nutrition such as food categories, macronutrients, and micronutrients including vitamins and minerals during pregnancy and child brain imaging features measured using imaging techniques such as ultrasound, magnetic resonance imaging (MRI), electroencephalography (EEG), and magnetoencephalography (MEG). This review demonstrates the capability of neuroimaging in characterizing how maternal nutrition during pregnancy impacts structure and function of the developing brain that may further influence long-term neuropsychological, cognitive, and behavioral outcomes in children. It aims to inspire future research utilizing neuroimaging to deepen our understanding of the critical impacts of maternal nutrition during pregnancy on offspring brain development.

Polar Lipids Supplementation Enhances Basal Excitatory Synaptic Transmission in Primary Cortical Neuron

SCOPE

Polar lipids, such as gangliosides and phospholipids, are fundamental structural components that play critical roles in the development and maturation of neurons in the brain. Recent evidence has demonstrated that dietary intakes of polar lipids in early life are associated with improved cognitive outcomes during infancy and adolescence. However, the specific mechanisms through which these lipids impact cognition remain unclear.

METHODS AND RESULTS

This study examines the direct physiological impact of polar lipid supplementation, in the form of buttermilk powder, on primary cortical neuron growth and maturation. The changes are measured with postsynaptic current response recordings, immunohistochemical examination of functional synapse localization and numbers, and the biochemical quantification of receptors responsible for neuronal synaptic neurotransmission. Chronic exposure to polar lipids increases primary mouse cortical neuron basal excitatory synapse response strength attributed to enhanced dendritic complexity and an altered expression of the excitatory α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor subunit 2 (GluR2).

CONCLUSION

The present finding suggests that dietary polar lipids improve human cognition through an enhancement of neuronal maturation and/or function.

Prenatal Vitamin B12 and Children's Brain Development and Cognitive, Language and Motor Outcomes: A Scoping Review

Adequate maternal nutrient intake of vitamin B12 is critical to fetal brain development and subsequent neurodevelopmental outcomes. We conducted a scoping review to map the current state of knowledge from human epidemiological studies on the associations between maternal vitamin B12 during pregnancy and children's brain, cognitive, language, and motor development to identify gaps in the literature and suggest directions for future research. PubMed and OVID MEDLINE were searched. Search terms were vitamin B12, prenatal or maternal, neurodevelopment or cognitive development or brain. Animal studies were excluded. In total, 148 publications were identified, of which 19 met our inclusion criteria: (1) maternal vitamin B12 assessed via a measure of status, dietary intake, supplementation, or deficiency; and (2) an outcome related to brain development or cognitive, language, or motor development in children less than 18 years of age was assessed. This scoping review suggests that evidence supporting a relationship between maternal vitamin B12 during pregnancy and children's neurodevelopmental outcomes is inconclusive. Further longitudinal research is needed to clarify the effects of maternal vitamin B12 supplementation, status, and intake on children's brain development and neurodevelopmental outcomes.

Exploring the impact of antenatal micronutrients used as a treatment for maternal depression on infant temperament in the first year of life

Antenatal depression and maternal nutrition can influence infant temperament. Although broad-spectrum-micronutrients (BSM: vitamins and minerals) given above Recommended Dietary Allowances during pregnancy can mitigate symptoms of antenatal depression, their associated effects on infant temperament are unknown. One hundred and fourteen New Zealand mother-infant dyads (45 infants exposed to BSM during pregnancy (range of exposure during pregnancy: 12-182 days) to treat antenatal depressive symptoms (measured by Edinburgh Postnatal Depression Scale) and 69 non-exposed infants) were followed antenatally and for 12 months postpartum to determine the influence of in utero BSM exposure on infant temperament. The Infant Behavior Questionnaire-Revised: Very Short-Form assessed temperament at 4 (T1), 6 (T2) and 12 (T3) months postpartum via online questionnaire. Latent growth curve modeling showed BSM exposure, antenatal depression and infant sex did not statistically significantly predict initial levels or longitudinal changes in orienting/regulatory capacity (ORC), positive affectivity/surgency (PAS) or negative affectivity (NEG). Higher gestational age was positively associated with initial PAS, and smaller increases between T1 and T3. Breastfeeding occurrence was positively associated with initial NEG. Although not significant, BSM exposure exerted small, positive effects on initial NEG (β = -0.116) and longitudinal changes in ORC (β = 0.266) and NEG (β = -0.235). While BSM exposure did not significantly predict infant temperament, it may mitigate risks associated with antenatal depression. BSM-exposed infants displayed temperamental characteristics on par with typical pregnancies, supporting the safety of BSM treatment for antenatal depression.

Impact of Maternal Environment and Inflammation on Fetal Neurodevelopment

During intrauterine life, external stimuli including maternal nutrition, lifestyle, socioeconomic conditions, anxiety, stress, and air pollution can significantly impact fetal development. The human brain structures begin to form in the early weeks of gestation and continue to grow and mature throughout pregnancy. This review aims to assess, based on the latest research, the impact of environmental factors on fetal and neonatal brain development, showing that oxidative stress and inflammation are implied as a common factor for most of the stressors. Environmental insults can induce a maternal inflammatory state and modify nutrient supply to the fetus, possibly through epigenetic mechanisms, leading to significant consequences for brain morphogenesis and neurological outcomes. These risk factors are often synergic and mutually reinforcing. Fetal growth restriction and preterm birth represent paradigms of intrauterine reduced nutrient supply and inflammation, respectively. These mechanisms can lead to an increase in free radicals and, consequently, oxidative stress, with well-known adverse effects on the offspring's neurodevelopment. Therefore, a healthy intrauterine environment is a critical factor in supporting normal fetal brain development. Hence, healthcare professionals and clinicians should implement effective interventions to prevent and reduce modifiable risk factors associated with an increased inflammatory state and decreased nutrient supply during pregnancy.

The Influence of Vitamin D on Pregnancy and Outcomes: Current Knowledge and Future Perspectives

INTRODUCTION

The purpose of the research was to explore the relationship between pathology and pregnancy outcomes with serum 25-hydroxycholecalciferol levels and vitamin D supplementation.

METHODS

A literature search was performed for systematic literature reviews published between January 2018 and February 2023. Forty-two publications were selected for further analysis.

RESULTS

This study demonstrates that elevated maternal serum 25(OH)D levels are associated with a decreased risk of preterm labour and various pregnancy-related health issues, highlighting the protective benefits of adequate vitamin D during pregnancy.

CONCLUSION

Vitamin D supplementation during pregnancy at a dose of 2,000 IU or higher is preventive for pre-eclampsia, insulin resistance, and the development of bronchial asthma in early childhood. Vitamin D screening is indicated for all pregnant women. Dosages of vitamin D preparations should be determined individually, considering laboratory tests and risk factors.

Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data

Importance

Many known correlates of kindergarten readiness are captured in developmental and social screenings in primary care; little is known about how primary care data predicts school readiness.

Objective

To identify early Kindergarten Readiness Assessment (KRA) correlates by linking electronic health record (EHR) data with school district KRA data and to examine potential outcomes of the COVID-19 pandemic using KRA scores between 2018 and 2021.

Design, Setting, and Participants

This was a retrospective cohort study linking a large primary care practice (PCP) with school assessment data. Linkage used patient name, date of birth, and address. The setting was an urban school district and PCP affiliated with an academic medical center. Students had a KRA score from fall of 2018, 2019, or 2021 (no 2020 KRA due to the COVID-19 pandemic) and at least 1 prior well-child visit at the PCP.

Exposures

Exposures included year KRA administered, reported child race and ethnicity, child sex, interpreter for medical visits, child ever failed Ages & Stages Questionnaire (ASQ) 18 to 54 months, ever rarely read to, Medicaid status, food insecurity, housing insecurity, problems with benefits, and caregiver depressive symptoms.

Main Outcomes and Measures

KRA score (continuous), with a possible range of 0 to 300 (passing score = 270).

Results

A total of 3204 PCP patients (mean [SD] age, 67 [4] months; 1612 male [50.3%]; 2642 Black [82.5%]; 94 Hispanic [2.9%]; 244 White [7.6%]) were matched to their KRA score. Mean (SD) KRA scores were significantly lower in 2021 (mean [SD], 260.0 [13.0]; 214 of 998 [21.4%]) compared with 2019 (mean [SD], 262.7 [13.5]; 317 of 1114 [28.5%]) and 2018 (mean [SD], 263.5 [13.6]; 351 of 1092 [32.1%]), a pattern mirrored in the larger school district. In the linear regression final model (n = 2883), the following binary variables significantly lowered the child's KRA score (points lowered [95% CI]) below a mean passing score of 270.8: child ever failed ASQ after 18 months (-6.7; 95% CI, -7.7 to -5.6), Medicaid insured (-5.7; 95% CI, -9.0 to -2.3), Hispanic ethnicity (-3.8; 95% CI, -6.9 to -0.6), requires interpreter (-3.6; 95% CI, -7.1 to -0.1), 2021 year (-3.5; 95% CI, -4.7 to -2.3), male sex (-2.7; 95% CI, -3.7 to -1.8), ever rarely read to (-1.5; 95% CI, -2.6 to -0.4), and food insecurity (-1.2; 95% CI, -2.4 to -0.1). Race, caregiver depression, housing insecurity, and problems receiving benefits were not associated with KRA scores in final model.

Conclusions and Relevance

Findings of this cohort study suggest a deleterious association of the COVID-19 pandemic with early learning and development. There may be potential for PCPs and school districts to collaborate to identify and mitigate risks much earlier.

Effect of antenatal micronutrient or antidepressant exposure on Brazelton neonatal behavioral assessment scale (NBAS) performance within one-month of birth

BACKGROUND

Antenatal depression is a risk factor for poor infant outcomes. Broad-spectrum-micronutrients (vitamins and minerals) have shown efficacy in treating psychiatric symptoms in non-pregnant populations and are associated with reduced incidence of adverse birth outcomes, and improvements in neonatal development. We investigated the effects of treatment of antenatal depression with micronutrients above the Recommended Dietary Allowance on infant development compared to treatment with antidepressant medications and controls.

METHOD

One-hundred-and-three infants were assessed using the Brazelton Neonatal Behavioral Assessment Scale (NBAS) within 28 days of birth: 37 exposed to micronutrients in-utero (50-182 days exposure), 18 to antidepressants in-utero (exposure for full gestation), and 48 controls whose mothers received neither treatment nor experienced depressive symptoms.

RESULTS

Controlling for gestational age and parity, there were significant group differences on habituation, orientation, motor, state regulation, autonomic stability and reflexes (p < .05). Micronutrient-exposed performed better than antidepressant-exposed and controls on habituation, motor and autonomic stability (p < .05), effect sizes ranged 1.0-1.7 and 0.5-1.0, respectively. Antidepressant-exposed performed significantly worse on orientation and reflexes compared to micronutrient-exposed and controls. Micronutrient-exposed had significantly better state regulation compared to antidepressant-exposed. There was an association between micronutrient exposure length and better habituation (r = 0.41, p = .028). Micronutrient exposure was generally identified as a stronger predictor of neonatal performance over maternal depression, social adversity, gestational age and infant sex.

CONCLUSION

In-utero micronutrient exposure appears to mitigate risks of depression on infant outcomes showing positive effects on infant behavior, on par with or better than typical pregnancies and superior to antidepressants. Limitations include differential exposure to micronutrients/antidepressants and lack of group blinding.

Maternal hsa-miR-423-5p associated with the cognitive development of babies in pregnant women without mental disorders

Background

MicroRNAs (miRNAs) are small non-coding RNAs capable of regulating gene expression post-transcriptionally. MiRNAs are recognized as key regulators of diverse biological and developmental processes. During the pregnancy-puerperal cycle, numerous changes occur in the female body for the formation, growth, and development of the baby. After birth, there is a critical period in child development, as rapid gains in the physical, cognitive, and socio-emotional domains constitute the "building blocks" of children's later growth.

Objective

The aim of this study was to investigate the association between maternal expression of hsa-miR-423-5p during the first and second trimesters of pregnancy and neurocognitive development at 90 days of life in infants. Methods: This is a longitudinal study included in a population-based cohort study, carried out in a city in southern Brazil. The Bayley III was used to assess the babies' cognitive development. Blood samples from mothers were obtained for RNA extraction from serum and analysis of miRNA expression by qRT-PCR.

Results

In total, 87 dyads (mother-baby) were included. The average gestational age was 15.86 weeks (SD ± 5.55). An association of maternal miRNA with infant cognitive development was found; as maternal miR-423-5p increases, infants' cognitive development increases by 2.40 (95% CI 0.37; 4.43, p = 0.021) points at 3 months of age.

Conclusion

In this context, it is suggested to use this miRNA as a biomarker of child neurocognitive development detectable in the prenatal period, thus allowing the planning of early interventions.

The Umbilical Cord Creatine Flux and Time Course of Human Milk Creatine across Lactation

(1) Background: The aim of the present paper was to study fetal and infant creatine (Cr) supply to improve nutrition and neuroprotection in term and especially in preterm infants. The primary outcomes were the placental Cr flux at the end of pregnancy and the time course of human milk (HM) Cr. (2) Methods: The estimation of placental Cr flux was based on umbilical arterial and venous cord blood Cr in 10 term infants after elective caesarian section. HM Cr, creatinine (Crn), and macronutrients were measured longitudinally in 10 mothers across the first 6 months of breastfeeding. (3) Results: At the end of pregnancy, the mean fetal Cr flux was negative (-2.07 mmol/min). HM Cr was highest in colostrum, decreased significantly within the first 2 weeks of breastfeeding (p < 0.05), and did not change significantly thereafter. HM Cr was not correlated with HM Crn or macronutrient composition. (4) Conclusions: The present data suggest that fetal endogenous Cr synthesis covers the needs at the end of pregnancy. However, high colostrum Cr and HM Cr levels, independent of macronutrient composition, suggest that there may be a critical Cr demand immediately after birth that needs to be covered by enteral supply.

The Role of Choline in Neurodevelopmental Disorders-A Narrative Review Focusing on ASC, ADHD and Dyslexia

Neurodevelopmental disorders appear to be rising in prevalence, according to the recent Global Burden of Disease Study. This rise is likely to be multi-factorial, but the role of certain nutrients known to facilitate neurodevelopment should be considered. One possible contributing factor could be attributed to deficits in choline intake, particularly during key stages of neurodevelopment, which includes the first 1000 days of life and childhood. Choline, a key micronutrient, is crucial for optimal neurodevelopment and brain functioning of offspring. The present narrative review discusses the main research, describing the effect of choline in neurodevelopmental disorders, to better understand its role in the etiology and management of these disorders. In terms of findings, low choline intakes and reduced or altered choline status have been reported in relevant population subgroups: pregnancy (in utero), children with autism spectrum disorders, people with attention deficit hyperactivity disorder and those with dyslexia. In conclusion, an optimal choline provision may offer some neuronal protection in early life and help to mitigate some cognitive effects in later life attributed to neurodevelopmental conditions. Research indicates that choline may act as a modifiable risk factor for certain neurodevelopmental conditions. Ongoing research is needed to unravel the mechanisms and explanations.

Prenatal folic acid supplement/dietary folate and cognitive development in 4-year-old offspring from the Japan Environment and Children's Study

We evaluated the association between maternal prenatal folic acid supplement use/dietary folate intake and cognitive development in 4-year-old offspring (N = 3445) using data from the Japan Environment and Children's Study. Cognitive development was evaluated using the Kyoto Scale of Psychological Development 2001. Multiple regression analysis revealed that offspring of mothers who started using folic acid supplements pre-conception had a significantly higher language-social developmental quotient (DQ) (partial regression coefficient 1.981, 95% confidence interval 0.091 to 3.872) than offspring of mothers who did not use such supplements at any time throughout their pregnancy (non-users). Offspring of mothers who started using folic acid supplements within 12 weeks of gestation had a significantly higher cognitive-adaptive (1.489, 0.312 to 2.667) and language-social (1.873, 0.586 to 3.159) DQ than offspring of non-users. Regarding daily dietary folate intake from preconception to early pregnancy, multiple regression analysis revealed that there was no significant association with any DQ area in the 200 to < 400 µg and the ≥ 400 µg groups compared with the < 200 µg group. Maternal prenatal folic acid supplementation starting within 12 weeks of gestation (but not adequate dietary folate intake from preconception to early pregnancy) is positively associated with cognitive development in 4-year-old offspring.

Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018-2023)

Depression is classified as one of the most common mental disorders. Its prevalence has recently increased, becoming a growing public health threat. This review focuses on clarifying the role and importance of individual nutrients in the diet and the impact of nutrient deficiencies on the risk of depression. Deficiencies in nutrients such as protein, B vitamins, vitamin D, magnesium, zinc, selenium, iron, calcium, and omega-3 fatty acids have a significant impact on brain and nervous system function, which can affect the appearance of depressive symptoms. However, it is important to remember that diet in itself is not the only factor influencing the risk of or helping to treat depression. There are many other aspects, such as physical activity, sleep, stress management, and social support, that also play an important role in maintaining mental health. The data review observed that most of the available analyses are based on cross-sectional studies. Further studies, including prospective cohort, case-control studies, are recommended to draw more reliable conclusions.