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Prenatal supplements for moms in Nepal associated with improved functional outcomes of children

The JAMA Network Journals

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In an area where iron deficiency is prevalent, children of mothers in rural Nepal who received prenatal iron, folic acid and vitamin A supplementation performed better on measures of intellectual and motor functioning compared to offspring of mothers who received vitamin A alone, according to a study in the December 22/29 issue of JAMA.

"Micronutrient inadequacy is a critical concern among pregnant women and young children throughout the world. Gestation and the early postnatal period are considered sensitive periods for brain development, and nutritional deprivation during this period may lead to functional impairments," according to background information in the article. Early iron deficiency has been shown to alter neuroanatomy and metabolism, which may lead to changes in processes that support cognitive development. "Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children's later functioning," the authors write.

Parul Christian, Dr. P.H., of Johns Hopkins University, Baltimore, and colleagues conducted a study to assess intellectual and motor functioning in a group of 676 children, aged 7 to 9 years in June 2007-April 2009, who had been born to women in 4 of 5 groups of a community-based, randomized controlled trial of prenatal micronutrient supplementation conducted between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial. Women whose children were followed up had been randomly assigned to receive daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A, vs. a control group of vitamin A alone from early pregnancy through 3 months postpartum. These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation. Through various tests, intellectual (including memory and reasoning), executive (such as processing speed) and motor function (such as manual dexterity and balance) were assessed.

The researchers found that maternal prenatal supplementation with iron and folic acid was positively associated with general intellectual ability, some aspects of executive function, and motor function, including fine motor control, in offspring in a rural area where iron deficiency is prevalent. In general, the differences in test scores between the other intervention groups and controls were not statistically significant.

"Antenatal iron/folic acid use per international guidelines should be expanded in many low- and middle-income settings where program coverage continues to be poor. Further follow-up studies are required to examine whether the observed benefits in early school age persist into adolescence and adulthood," the researchers conclude.

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(JAMA. 2010;304[24]:2716-2723. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

To contact Parul Christian, Dr. P.H., call Tim Parsons at 410-955-7619 or email tmparson@jhsph.edu.

For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.

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