Association of Antenatal Micronutrient Supplementation With Adolescent Intellectual Development in Rural Western China 14-Year Follow-up From a Randomized Clinical Trial

作者：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; Jaffar, Shabbar; Dibley, Michael J.

来源：JAMA Pediatrics, 2018, 172(9): 832-841.

DOI：10.1001/jamapediatrics.2018.1401

• SCHOOL-AGED CHILDREN
• DOUBLE-BLIND
• MENTAL-DEVELOPMENT
• IRON-DEFICIENCY
• LOW-INCOME
• PREGNANCY
• UNDERNUTRITION
• INTERVENTIONS
• MORTALITY
• STANDARDS

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.

• 出版日期2018-9
• 单位西安交通大学