Neurodevelopment, vision and auditory outcomes at age 2 years in offspring of participants in the 'Women First' maternal preconception nutrition randomised controlled trial

Michelle Fernandes; Nancy F Krebs; Jamie Westcott; Antoinette Tshefu; Adrien Lokangaka; Melissa Bauserman; Ana L Garcés; Lester Figueroa; Sarah Saleem; Sumera A Aziz; Robert L Goldenberg; Shivaprasad S Goudar; Sangappa M Dhaded; Richard J Derman; Jennifer F Kemp; Marion Koso-Thomas; Amaanti Sridhar; Elizabeth M McClure; K Michael Hambidge; Women First Preconception Nutrition Trial Study Group

doi:10.1136/archdischild-2023-325352

Neurodevelopment, vision and auditory outcomes at age 2 years in offspring of participants in the 'Women First' maternal preconception nutrition randomised controlled trial

Arch Dis Child. 2023 Aug;108(8):622-631. doi: 10.1136/archdischild-2023-325352. Epub 2023 May 4.

Authors

Michelle Fernandes^{1

2

3}, Nancy F Krebs⁴, Jamie Westcott⁴, Antoinette Tshefu⁵, Adrien Lokangaka⁵, Melissa Bauserman⁶, Ana L Garcés⁷, Lester Figueroa⁷, Sarah Saleem⁸, Sumera A Aziz⁸, Robert L Goldenberg⁹, Shivaprasad S Goudar¹⁰, Sangappa M Dhaded¹⁰, Richard J Derman¹¹, Jennifer F Kemp⁴, Marion Koso-Thomas¹², Amaanti Sridhar¹³, Elizabeth M McClure¹³, K Michael Hambidge⁴; Women First Preconception Nutrition Trial Study Group

Collaborators

Women First Preconception Nutrition Trial Study Group:
Carl L Bose, Aura Arevalo, Gelen Gomez, Marta Lidia Aguilar, Zahid Abbasi, Sumera Ali, Sumaira Fatima, Deepa Metgud, Spurthi Mastiholi, Robert Kpado, Croco Gbenge, Matthieu Gbozo, Philippe Zolia, Papy Fakadanga, Joel Eay, Vanessa R Thorsten, Dhuly Chowdhury, Abhik Das, Kristen Stolka, Omrana Pasha

Affiliations

¹ MRC Lifecourse Epidemiology Centre and Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK m.c.fernandes@soton.ac.uk.
² Nuffield Department of Women's and Reproductive Health, John Radcliffe Hospital, University of Oxford, Oxford, UK.
³ Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
⁴ Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA.
⁵ Kinshasa School of Public Health, Kinshasa, The Democratic Republic of the Congo.
⁶ The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA.
⁷ Instituto de Nutricion de Centroamerica y Panama, Guatemala, Guatemala.
⁸ Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan.
⁹ Columbia University, New York, New York, USA.
¹⁰ KLE Academy of Higher Education and Research (Deemed-to-be-University) Jawaharlal Nehru Medical College, Belagavi, Karnataka, India.
¹¹ Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
¹² Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
¹³ RTI International, Durham, North Carolina, USA.

Abstract

Background: Maternal nutrition in preconception and early pregnancy influences fetal growth. Evidence for effects of prenatal maternal nutrition on early child development (ECD) in low-income and middle-income countries is limited.

Objectives: To examine impact of maternal nutrition supplementation initiated prior to or during pregnancy on ECD, and to examine potential association of postnatal growth with ECD domains.

Design: Secondary analysis regarding the offspring of participants of a maternal multicountry, individually randomised trial.

Setting: Rural Democratic Republic of the Congo, Guatemala, India and Pakistan.

Participants: 667 offspring of Women First trial participants, aged 24 months.

Intervention: Maternal lipid-based nutrient supplement initiated preconceptionally (arm 1, n=217), 12 weeks gestation (arm 2, n=230) or not (arm 3, n=220); intervention stopped at delivery.

Main outcome measures: The INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) cognitive, language, gross motor, fine motor, positive and negative behaviour scores; visual acuity and contrast sensitivity scores and auditory evoked response potentials (ERP). Anthropometric z-scores, family care indicators (FCI) and sociodemographic variables were examined as covariates.

Results: No significant differences were detected among the intervention arms for any INTER-NDA scores across domains, vision scores or ERP potentials. After adjusting for covariates, length-for-age z-score at 24 months (LAZ₂₄), socio-economic status, maternal education and FCI significantly predicted vision and INTER-NDA scores (R²=0.11-0.38, p<0.01).

Conclusions: Prenatal maternal nutrition supplementation was not associated with any neurodevelopmental outcomes at age 2 years. Maternal education, family environment and LAZ₂₄ predicted ECD. Interventions addressing multiple components of the nurturing care model may offer greatest impact on children's developmental potential.

Trial registration number: NCT01883193.

Keywords: child development; growth.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Anthropometry
Child
Child Development*
Child, Preschool
Dietary Supplements*
Female
Gestational Age
Humans
Infant
Poverty
Pregnancy

Associated data

ClinicalTrials.gov/NCT01883193

Abstract

Publication types

MeSH terms

Associated data

Grants and funding