title: Prenatal micronutrient supplementation and intellectual and motor function in early school-aged children in Nepal.
abstract: BACKGROUND
  Iron and zinc are important for the development of both intellectual and motor skills. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children's later functioning.
  
  
  OBJECTIVE
  To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy.
  
  
  METHODS
  Cohort follow-up 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, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial.
  
  
  METHODS
  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.
  
  
  METHODS
  Children's intellectual functioning, assessed using the Universal Nonverbal Intelligence Test (UNIT); tests of executive function, including go/no-go, the Stroop test, and backward digit span; and motor function, assessed using the Movement Assessment Battery for Children (MABC) and finger-tapping test.
  
  
  RESULTS
  The difference across outcomes was significant (Bonferroni-adjusted P < .001) for iron/folic acid vs control but not for other supplement groups. The mean UNIT T score in the iron/folic acid group was 51.7 (SD, 8.5) and in the control group was 48.2 (SD, 10.2), with an adjusted mean difference of 2.38 (95% confidence interval [CI], 0.06-4.70; P = .04). Differences were not significant between the control group and either the iron/folic acid/zinc (0.73; 95% CI, -0.95 to 2.42) or multiple micronutrient (1.00; 95% CI, -0.55 to 2.56) groups. In tests of executive function, scores were better in the iron/folic acid group relative to the control group for the Stroop test (adjusted mean difference in proportion who failed, -0.14; 95% CI, -0.23 to -0.04) and backward digit span (adjusted mean difference, 0.36; 95% CI, 0.01-0.71) but not for the go/no-go test. The MABC score was lower (better) in the iron/folic acid group compared with the control group but not after adjustment for confounders (mean difference, -1.47; 95% CI, -3.06 to 0.12; P = .07). Finger-tapping test scores were higher (mean difference, 2.05; 95% CI, 0.87-3.24; P = .001) in the iron/folic acid group.
  
  
  CONCLUSIONS
  Aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00115271.
authors.affiliation: Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room W2041, Baltimore, MD 21205, USA. pchristi@jhsph.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.forename: Laura E
authors.initials: LE
authors.lastname: Murray-Kolb
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Schaefer
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Cole
authors.forename: Steven C
authors.initials: SC
authors.lastname: Leclerq
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D000328:Adult; D002490:Central Nervous System / Q000196:embryology / Q000254:growth & development; D002648:Child; D002657:Child Development; D003071:Cognition; D015331:Cohort Studies; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence; D007361:Intelligence Tests; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D008568:Memory; D018977:Micronutrients / Q000008:administration & dosage*; D009048:Motor Skills; D009390:Nepal; D011247:Pregnancy; D011295:Prenatal Care; D014801:Vitamin A / Q000008:administration & dosage; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D005492:Folic Acid; D007501:Iron; D015032:Zinc