Association of Antenatal Micronutrient Supplementation With Adolescent Intellectual Development in Rural Western China

Zhu, Zhonghai, Cheng, Yue, Zeng, Lingxia, Elhoumed, Mohamed, He, Guobin, Li, Wenhao, Zhang, Min, Li, Wenjing, Li, Danyang, Tsegaye, Sintayehu, Chang, Suying, Yan, Hong, Wang, Emma Yu, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Jaffar, Shabbar ORCID: https://orcid.org/0000-0002-9615-1588 and Dibley, Michael J. (2018) 'Association of Antenatal Micronutrient Supplementation With Adolescent Intellectual Development in Rural Western China'. JAMA Pediatrics, Vol 172, Issue 9, pp. 832-841.

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Abstract

Importance
The association of micronutrient supplementation during pregnancy with the intellectual development of adolescent offspring is unknown.
Objective
To assess the long-term association of antenatal micronutrient supplementation with adolescent intellectual development.
Design, Setting, and Participants
This 14-year follow-up study of a randomized clinical trial of micronutrient supplementation in pregnancy was conducted in 2 counties in rural western China in 2118 adolescent offspring (aged 10 to 14 years) of mothers who were randomized to take a daily capsule of either folic acid, folic acid plus iron, or multiple micronutrients from August 1, 2002, through February 28, 2006. Follow-up was conducted from June 1, 2016, through December 31, 2016. Data analyses took place from April 1, 2017, to June 20, 2017.
Main Outcomes and Measures
Adolescent full-scale intelligence quotient and aspects of verbal comprehension, working memory, perceptual reasoning, and processing speed indexes were assessed by the Wechsler Intelligence Scale for Children.
Results
Of 2118 adolescent offspring, 1252 (59.1%) were boys and 866 (40.9%) were girls, with a mean (SD) age of 11.7 (0.87) years, representing 47.2% of the 4488 single live births that were eligible to participate. Compared with folic acid supplementation, multiple micronutrient supplementation was associated with a 1.13-point higher full-scale intelligence quotient (95% CI, 0.15-2.10) and a 2.03-point higher verbal comprehension index (95% CI, 0.61-3.45); similar results were found in comparison with folic acid plus iron. When mothers initiated supplementation early (<12 weeks of gestation) and had an adequate dose (≥180 capsules), multiple micronutrient capsules were associated with a 2.16-point higher full-scale intelligence quotient (95% CI, 0.41-3.90) and 4.29-point higher verbal comprehension index (95% CI, 1.33-7.24) compared with folic acid capsules. The mean test scores were lower in the substratum of supplementation initiated late (≥12 weeks of gestation) and with an inadequate dose (<180 capsules). The multiple micronutrient group had higher scores than the other 2 treatment groups, and significant differences were observed for full-scale intelligence quotient (adjusted mean difference, 2.46; 95% CI, 0.98-3.94) when compared with the folic acid plus iron group.
Conclusions and Relevance
Compared with folic acid plus iron or folic acid capsules supplementation, antenatal multiple micronutrient supplementation appeared to be associated with increased adolescent intellectual development; initiating supplementation in the first trimester and then continuing for at least 180 days were associated with the greatest rewards.
Trial Registration isrctn.org Identifier: ISRCTN08850194

Item Type:	Article
Subjects:	QU Biochemistry > Vitamins > QU 145 Nutrition. Nutritional requirements QU Biochemistry > Vitamins > QU 160 Vitamins. Vitamin requirements WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 320 Child Welfare. Child Health Services. WQ Obstetrics > Childbirth. Prenatal Care > WQ 175 Prenatal care WQ Obstetrics > Pregnancy > WQ 200 General works WS Pediatrics > By Age Groups > WS 460 Adolescence (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1001/jamapediatrics.2018.1401
SWORD Depositor:	JISC Pubrouter
Depositing User:	Stacy Murtagh
Date Deposited:	19 Jul 2018 15:54
Last Modified:	24 Oct 2019 08:20
URI:	https://archive.lstmed.ac.uk/id/eprint/8919

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