Background
Methods
Eligibility criteria, search strategy and identification of literature
Exposure: Maternal nutritional status during pregnancy | Outcome: Childhood and adolescent cognitive function | ||
---|---|---|---|
MeSH terms | Text word terms | MeSH terms | Text word terms |
“exp body weight/or exp body mass index/or exp anthropometry/or exp body size/or exp skinfold thickness/or exp nutrition assessment/or exp nutritional status/or exp mothers/or exp pregnancy/or exp malnutrition/or exp diet vegetarian/or exp haemoglobin/or pregnancy complications/or exp anemia/or exp folic acid/or exp folic acid deficiency/or exp vitamin b12 deficiency/or exp ferritin/or exp iron, dietary/or exp cholecalciferol/or exp pyridoxine/or exp vitamin b complex/or exp riboflavin/or exp thiamine/or exp vitamin D/” | “maternal nutrition or maternal anthropometry or pregnancy nutrition or antenatal nutrition or intrauterine nutrition or gestational nutrition or maternal undernutrition or prenatal nutrition or maternal BMI or maternal micronutrients or vegan mothers or vegetarian mothers or macrobiotic mothers or maternal folate or maternal folic acid or maternal vitamin b12 or maternal cobalamin or maternal vitamin D or 25 hydoxy vitamin D or maternal cholecaliciferol or maternal haemoglobin or maternal iron or maternal B vitamins or maternal vitamin b1 or maternal vitamin b6 or maternal vitamin b9 or maternal b vitamins or maternal anaemia or maternal diet” | “exp child/or exp child development/or exp adolescent/or exp neurobehavioral manifestations/or exp child, preschool/or exp cognition, physiology/or exp attention/or exp memory, long-term/or exp memory, short-term/or exp memory/or exp intelligence tests/or exp psycho motor performance/or exp child psychology/or exp decision making/or exp psychometrics/or exp intelligence/or exp mental competence/or exp cognition/or exp motor skills/or exp language development/or exp learning/or exp verbal learning/or exp problem solving/or exp perception/or exp thinking/or exp executive function/or exp function/or exp human development/or exp adolescent development/or exp speech/or exp mental processes/ | Cognitive function or intelligence or IQ or executive function or psychomotor development or cognitive performance or cognition or educational attainment or cognitive ability or cognitive deficits or intellectual ability or learning or memory or language development. |
Data extraction and quality assessment
Results
Author, Year, Sample size, Age, Country, Study design | Maternal anthropometry | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
8Neggers YH; 2003
N = 355 Age 5.3 years USA Prospective Low income African- Americans; mothers participated in Zinc supplementation trial | Pre-pregnancy BMI (kg/m2) BMI 4 categories Underweight (BMI < 19.8): 6.5 % Normal (19.8-26.0): 39.2 Overweight (26.1-29.0): 14.4 % Obese(>29): 39.9 % Gestational weight gain (kg) | Differential Ability Scale –general IQ (intelligence quotient), verbal and non-verbal abilities Peabody Gross Motor Scales | ↑Pre-pregnancy BMI -↓ general IQ (β = -0.25) and non-verbal score (β = 0.29) Compared to children of normal weight mothers, children of obese mothers scored lower in general IQ (β = -4.7) and non-verbal abilities (β = -5.6) but not in verbal or motor skills Compared to children of normal weight mothers, children of underweight mothers scored lower in general IQ, verbal and non-verbal abilities but not significant No association between pregnancy weight gain and cognitive or motor skills Confounders adjusted for: Child’s BWT, GA, current age, MA, MS, maternal alcohol intake, MIQ, HE, child care status, zinc supplementation status | 14 Medium |
9Heikura U; 2008 Two birth cohorts 1966
N = 12058 Age 11.5 years Finland 1986 birth cohort
N = 9432 Age 11.5 years Finland | Pre-pregnancy BMI (kg/m2) BMI 4 Categories 1966 cohort Thin (BMI < 20): 13.4 % Normal (BMI 20-24.9): 65 % Overweight (BMI 25.0–29.9): 17.9 % Obese (BMI ≥30): 3.8 % 1986 cohort Thin (BMI < 20): 24.3 % Normal (BMI 20-24.9): 58.7 % Overweight (BMI 25.0–29.9): 13.1 % Obese (BMI ≥30): 3.8 % | IQ (Standardised psychometric test or clinical developmental assessment): Test battery used not reported Intellectual disability (ID)-IQ < 70 severe ID (IQ < 50) mild (IQ 50-70) | Maternal pre-pregnancy obesity predicted ID in 1986 cohort (OR = 2.8) but not in 1966 birth cohort Low BMI associated with mild ID in 1966 cohort (OR = 2.1) Interaction between parity*BMI in 1966 cohort Higher risk of ID (OR = 2.9) in children of multiparous mothers with low BMI in 1986 cohort Confounders adjusted for: MA, SES (occupation), parity, place of residence, marital status | 15 Medium |
10Tanda R; 2012
N = 3412 Age 5-7 years USA Longitudinal | Pre-pregnancy BMI (kg/m2) and gestational weight gain (kg) BMI 4 categories Underweight (BMI < 18.5): 7.2 % Normal (BMI 18.5-24.9): 65.6 % Overweight (BMI 25.0-29.9): 17.6 % Obese (BMI ≥30): 9.6 % | Peabody Individual Achievement Test Reading and Mathematics scores | Pre-pregnancy obesity, but not overweight, was negatively associated with cognitive skills Compared to children of normal weight mothers, children of obese mothers scored 3 points lower (0.23 SD) in reading and 2 points lower (0.16 SD) in mathematics score ↑gestational weight gain - ↓ cognitive skills but not significant Confounders adjusted for: the child’s sex, GA, current age and body size, ethnicity, parity, SES (income), MA, ME, MIQ, HE | 15 Medium |
11Hinkle SN; 2012
N = 6850 Age 2 years USA Population based Longitudinal-Birth cohort | Pre-pregnancy BMI (kg/m2) and Gestational weight gain (kg) BMI 5 categories Underweight (BMI < 18.5): 5 % Normal (BMI 18.5-24.9): 56 % Overweight (BMI 25.0-29.9): 25 % Obese1(BMI 30.0-34.9): 8 %. Obese2 and 3(BMI > =35.0-39.9): 6 % | Bayley Scales of Infant Development –II (Mental Development Index (MDI) and Psychomotor Development Index (PDI)) | Compared to the children of normal BMI mothers, children of mothers in all the other categories scored lower MDI, but significant in obese2 and 3 categories (β = 2.13 points) Risk of delayed mental development (<-1SD v > 1SD) observed in children of mothers with underweight (RR = 1.36) and extreme obese (RR = 1.38) categories No association between pre-pregnancy BMI and PDI Confounders adjusted for: the child’s sex, BWT, GA, BF, MA, ethnicity, marital status, parity, DM, PIH, ME, MS, SES (income) | 16 Medium |
12Basatemur E; 2012 Age 5 years (n = 11025) Age 7 years (n = 9882) UK Prospective population based birth cohort | Pre-pregnancy BMI (kg/m2) BMI continuous and categories BMI 4 categories Underweight (BMI < 18.5): 5.3 % Normal (BMI 18.5-24.9): 65.6 % Overweight (BMI 25.0-29.9): 20.1 % Obese (BMI ≥30): 9 % Excluded BMI < 16 | 5 Y-British ability scales-II Expressive language, nonverbal reasoning and spatial visualization 7 Y- British ability scales-II spatial visualization, verbal ability, and number skills test (National foundation for educational research progress in Math tests) | Children of underweight, overweight and obese mothers scored lower mean scores (0.1-0.3 SD) Maternal pre-pregnancy BMI is negatively associated with children’s general cognitive ability at 5 years (β = -0.075) and 7 years (β = -0.17) 5 years - ↑maternal BMI -↓Spatial visualization but no association with expressive language and nonverbal reasoning 7 years- ↑maternal BMI -↓Spatial visualization, verbal ability and number skills Confounders adjusted for: The child’s sex, current age, BWT, BMI, ethnicity, MA, ME, PE, SES, income, MS, DM | 15 Medium |
13Buss C; 2012
N = 174 Age 7.3 years USA Population based prospective Longitudinal-Birth cohort | Pre-pregnancy BMI (kg/m2) and Gestational weight gain (kg) BMI continuous and categories BMI 3 categories Normal (BMI 18.5-24.9): 58 % Overweight (BMI 25.0-29.9): 25.9 % Obese (BMI ≥30): 16.1 % Excluded underweight mothers | Executive function Continuous Performance Task (Go/No go task) | Higher pre-pregnancy BMI (continuous and categorical) was associated with impaired performance on the Go/No go task (F1.157 = 8.37 and F2.156 = 3.57 respectively) Children of obese mothers scored higher in performance measure (higher score indicates poor performance) compared to children of normal weight mothers. No difference in scores of performance efficiency between children of obese mothers vs children of overweight/normal weight mothers (Chen’s d effect size 0.62 SD) Gestational weight gain was not associated with child performance on the Go/No go task (F1.157 = 0.27) Confounders adjusted for: The child’s sex, current age, BMI, ethnicity, GA, parity, BWT, ME, MIQ, depression, obstetric risk (PIH, DM) | 13 Medium |
14Brion M; 2011 ALSPAC: population based prospective cohort UK
N = ~5000 Age 38 months; Age 8 years Generation R: Population based pregnancy cohort Netherlands.
N = ~2500 Age 30 Months | Pre-pregnancy BMI (kg/m2) Underweight (BMI < 18.5) Normal (BMI 18.5-24.9) Overweight (BMI 25.0-29.9) Obese (BMI ≥30) ALSPAC Normal BMI: 78.7 % Overweight/obese: 21.3 % Generation R Normal BMI: 77.9 % Overweight/obese: 22.1 % Excluded obese group (cognitive assessment at age 30-38 months) | ALSPAC-Verbal skills-MacArthur Toddler Communication Questionnaire maternal report Non-verbal skills-Diagnostic Analysis of Non-verbal Accuracy Test General intelligence-Wechsler Intelligence Scale for Children-II at 8-years Generation-R-Verbal skills-Dutch translation of the Language Development Survey Non-verbal-Dutch version of parent report of children’s abilities | ALSPAC: No association of maternal overweight with verbal and non-verbal skills. Maternal obesity was associated with ↓IQ (OR = 0.84) at 8 years Generation-R: no association between maternal overweight with verbal and non-verbal skills. Confounders adjusted for: ME, PE, occupation, income, social class (ALSPAC only), MS, BF | 15 Medium |
15Casas M; 2013 INMA: population based prospective birth cohort Spain
N = ~1967 Age 11-22 months RHEA: Population based prospective cohort Greece
N = 412 Age 17-20 months | Pre-pregnancy BMI (kg/m2) Underweight (BMI < 18.5) Normal (BMI 18.5-24.9) Overweight (BMI 25.0-29.9) Obese (BMI ≥30) INMA: 72.9 %, 19.2 % and 8 % normal, overweight and obese respectively RHEA: 68.3 %, 20.1 %, and 11 % normal, overweight and obese respectively Excluded underweight | INMA: Bayley Scales of Infant Development –I (Mental and Psychomotor scale) RHEA: Bayley Scales of Infant Development –III (Cognitive and fine and gross motor development scale) | Pre-pregnancy obesity, but not overweight, was negatively associated with cognitive skills Compared to children of normal weight mothers, children of obese mothers scored 2.67 points lower (INMA) and 3.57 points lower (RHEA and not significant) in mental (INMA) and cognitive development (RHEA) Cognitive score ↓ with increasing BMI (INMA -0.17 per kg/m2; RHEA -0.26 per kg/m2(not significant) No association of overweight/obesity with motor development in both cohorts Confounders adjusted for: gender, parental education, age, social class (only in INMA), maternal country of birth, breast-feeding duration, MS, employment status during pregnancy and after birth, parity, nursery attendance and main child minder | 14 Medium |
16Craig WY; 2013 Study 1- USA Population based cohort
N = 101 Age 2 years Study 2- USA Population based cohort
N = 118 Age 8 years In both studies participants were from control group of a case–control study | Pregnancy BMI (kg/m2; 2nd trimester) Normal (BMI 18.5-24.9) Overweight (BMI 25.0-29.9) Obese (BMI ≥30) Study 1: 31.6 %, 38.6 % and 29.7 % normal, overweight and obese respectively Study 2: 64.4 %, 25.4 %, and 10.2 % normal, overweight and obese respectively No underweight category | Study 1- Bayley Scales of Infant Development –III Cognitive, language and motor (gross and fine) domains Study 2-Wechsler Intelligence Scale for Children (WISC)-III Full-scale IQ, verbal and performance IQ | Study 1: ↑BMI categories- ↓scores for cognitive, language and motor domains (not significant) Percentage of children with ≥ 1 score below BSID-III score of 85 increased with BMI category and was higher among children of obese mothers compared to children of normal BMI mothers (OR 3.9) Study 2: ↑BMI categories- ↓scores for performance IQ but not for full-scale and verbal IQ Percentage of children with ≥ 1 score below WISC-III score of 85 increased with BMI category and was higher among children of obese mothers compared to children of normal BMI mothers (OR 5.2) Confounders adjusted for: gender, maternal age, smoking, number of prior births, SES (based on occupation and education) | 14 Medium |
17Huang L; 2014
N = 30212 Age 7 years USA Population based prospective cohort | Pre-pregnancy BMI (kg/m2) Gestational weight gain (lb) Underweight (BMI < 18.5)-9.1 % Normal (BMI 18.5-24.9)-69.2 % Overweight (BMI 25.0-29.9)-16.0 % Obese (BMI ≥30)-5.7 % | Wechsler Intelligence Scale for Children-I Full-scale, verbal and performance IQ | Pre-pregnancy obesity, but not overweight, was negatively associated with offspring IQ Compared to children of normal mothers, children of obese mothers scored 2 points lower in full-scale IQ and 2.5 points lower verbal IQ; compared to normal mothers children of underweight mothers scored ~0.6 points lower in full-scale IQ Suboptimal, inadequate or excessive weight gain in normal mothers-↓ full-scale IQ scores (~1-3 points) in children Excessive, but not inadequate, weight gain in obese mothers-↓ IQ scores in children Compared to children of normal mothers who gained 21-25 lb, children of obese mothers who gained >40 lb scored 6.5 points lower in full-scale IQ scores Confounders adjusted for: Maternal race, parity, MA, ME, MS, SES, marital status | 15 Medium |
18Tavris DR; 1982
N = 2789 Age 5 years USA Prospective longitudinal | Maternal gestational weight gain (difference in weight between first and last prenatal visits) 3 categories of weight gain 1) -24 to 4 lb, 2) 5 to 29 lb 3) ≥30 lb | Raven’s Coloured Progressive Matrices Details of cognitive domains assessed not mentioned | Children of mothers who gained <5 lb and >30 lb scored poorly compared to 2nd category (F = 3.23) Compared to 1st and 2nd category – no difference. Compared to 2nd and 3rd category- second category scored better (F = 4.31) Confounders adjusted for: Ethnicity, MA, parity, pre-pregnancy weight/height ratio, GA, ME, PE, income | 13 Medium |
19Gage SH; 2013 ALSPAC: population based prospective cohort-UK.
N = 5832: Age 4 years
N = 5191; Age 8 years
N = 7339; Age 16 years | Maternal gestational weight gain (kg) 3 categories of weight gain 1: less than recommended 2: As recommended 3: more than recommended Pre-pregnancy weight (kg) | School Entry Assessment Score-4 years IQ- Wechsler Intelligence Scale for Children -III-8 years Adequate final exam results-16 years | Children of women gained weight < expected-↓ school entry assessment score (-0.075 SD) and adequate final-exam results (OR = 0.88); ↑Weight gain - early and mid pregnancy -↑school entry assessment score (0.072 and 0.077 SD) ↑ Weight gain in all three periods of pregnancy-↑ IQ at 8 years (0.070 to 0.078 SD) and ↑Pre-pregnancy weight-↓ school entry assessment score (-0.004 SD/kg), IQ (-0.004 SD) and the odds (OR = 0.99) of achieving adequate final exam results Confounders adjusted for: the child’s sex, current age, MA; ME, parity, pre-pregnancy BMI, smoking and mode of delivery | 16 Medium |
Author, Year, Sample size, Age, Country, Study design | Nutrient | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
20Gale C; 2008
N = 178 Age 9 years UK Prospective longitudinal | Serum vitamin D concentrations assessed at 28-42 weeks gestation 21.2 % had <27.5 nmol/L 28.3 % had 27.5-50 nmol/L | Wechsler Abbreviated Scale of Intelligence Full-scale, verbal or performance IQ | No association between vitamin D concentrations and offspring IQ (full-scale, verbal or performance) Confounders adjusted for: Unadjusted | 16 Medium |
21Whitehouse AJO; 2012 Age 5 years (n = 534) Age 10 years (n = 474) Australia Prospective longitudinal | Serum vitamin D concentrations assessed at 18 weeks gestation 25.2 % mothers had insufficiency (≤46 nmol/L) (lowest quartile) | Peabody Picture Vocabulary Test Receptive language | Children of mothers with vitamin D insufficiency (lowest quartile (≤46 nmol/L) were at increased risk (OR = 1.97) of language impairment compared to children of mothers without insufficiency (highest quartile (≥72 nmol/L; OR = 1.00) Confounders adjusted for: MA, MS, parity, family income, season of maternal blood sampling | 13 Medium |
22Morales E; 2012
N = 1820 Age 11-23 Months Spain Prospective population based cohort study | Plasma vitamin D concentrations assessed during 12-23 weeks gestation 19.5 % mothers had deficiency (<20 ng/ml) 31.5 % had insufficiency (20-30 ng/ml) | Bayley Scales of Infant Development (mental (MDI) and psychomotor (PDI) developmental score) | A positive linear association between vitamin D concentrations and MDI and PDI Per 10 ng/ml increase in vitamin D concentrations MDI and PDI score increased by β = 0.79 and β = 0.88 points respectively Compared to infants of deficient mothers, infants of mothers with normal level scored higher MDI (β = 2.60) and PDI (β = 2.32) points respectively Confounders adjusted for: The child’s sex, BWT, area of study, maternal country of origin, MA, parity, pre-pregnancy BMI, SES, ME, MS, alcohol and season | 15 Medium |
Author, Year, Sample size, Age, Country, Study design | Nutrient | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
23WU BTF; 2012
N = 154 Age 18 Months Canada Prospective | Plasma folate and tHcy concentrations assessed at 16 and 36 weeks gestation No folate deficiency (plasma folate <6.8 nmol/l) High tHcy not reported | Bayley Scales of Infant Development Receptive language, expressive language, cognitive skills, fine motor and gross motor | No association of folate and tHcy with cognitive function Confounders adjusted for: The child’s sex, BF, ethnicity, MA, MIQ, maternal fatty acid level | 13 Medium |
24Tamura T; 2005
N = 355 Age 5 years USA Prospective Mothers participated in zinc supplementation trial during pregnancy | Red cell and plasma folate concentrations – 19, 26 and 37 weeks gestation and tHcy concentrations-26 and 37 weeks Low folate-(plasma folate <11 nmol/L) 19 weeks- 7.4 %; 26 weeks- 8.2 %; 37 weeks- 14.0 % Red cell folate <430 nmol/L) 19 weeks- 7.2 %; 26 weeks- 3.8 %; 37 weeks- 3.3 % High tHcy (tHcy > 7 μmol/L) 26 weeks- 8.4 %; 37 weeks- 22.1 % | Differential Ability Scale (verbal, nonverbal and General IQ), Visual and Auditory Sequential Memory (visual and auditory memory span) Knox Cube (attention span and short-term memory) Gross Motor Scale (Gross motor development and Grooved Pegboard (manipulative dexterity) | No difference in the mental and psychomotor developmental scores between children of mothers with normal and deficient folate and tHcy groups. No difference in test scores even across range of folate status (quartiles) Confounders adjusted for: The child’s sex, GA, BWT, MA, BMI, MS, MIQ, alcohol and drug use, HE | 15 Medium |
25Bhate V; 2008
N = 108 Age 9 years India Prospective community based birth cohort | Erythrocyte folate and tHcy concentrations assessed at 28 weeks gestation No details about low folate or high tHcy concentrations | Raven’s Coloured Progressive Matrices-Intelligence; Visual recognition Colour Trial Test-sustained attention and executive function Digit-span test-short-term or working memory | No association of erythrocyte folate, tHcy with any of the cognitive tests Confounders adjusted for: The child’s sex, age, education, weight and head circumference, B12 level, SES, education of the head of the family | 14 Medium |
26Veena SR; 2010
N = 536 Age 9-10 years India Prospective birth cohort | Plasma folate and tHcy concentrations assessed at 30 ± 2 weeks gestation Low folate-(folate <11 nmol/L)-4 % High tHcy (tHcy > 7 μmol/L)-3 % | Kauffman Assessment Battery for Children-II Learning, long-term retrieval, short-term memory and reasoning Wechsler Intelligence Scale for Children-III attention and concentration Koh’s block design visuo-spatial ability Verbal fluency | No difference in all the cognitive test scores between folate deficient and normal groups. ↑folate concentrations (SD)-↑learning (0.10 SD), visuo-spatial ability (0.10 SD) and attention and concentration (0.10 SD) No association between tHcy concentrations across the entire range or hyperhomocysteinemia and cognitive function Confounders adjusted for: The child’s sex, GA, age, education, weight and head circumference at birth, parity, MA, maternal BMI, ME, PE, SES, religion, rural/urban residence, the child’s current head circumference, BMI and folate concentrations | 16 Medium |
27Gross RL; 1974
N = 32 Age 6 weeks to 4 years Africa Case–control study | Folic acid deficiency (based on bone marrow exam or serum folate level) (Hb 3.2-8.9 g %) | Denver Developmental Screening Test (gross motor, fine motor, language and personal-social) | Folic acid deficiency was associated with abnormal or delayed development on one or more of the 4 areas examined Confounders adjusted for: No information | 6 High |
28Del Rio Garcia; 2009
N = 253 Age Infancy (1- 12 months) Mexico Prospective birth cohort | Daily dietary intake of folate (first trimester FFQ) Deficient daily folate intake (<400 μg) -70 % | Bayley Scales of Infant Development -II (Mental Development Index(MDI) and Psychomotor Development Index (PDI)) | Folate intake deficiency-↓ MDI (β = -1.8) in infants of mothers who were carriers of MTHFR677 TT genotype Confounders adjusted for: BWT, BF, current age, energy intake at age 6 months, maternal BMI, pregnancy hypertension, ME, HE and MTHFR 1298A > C genotype | 16 Medium |
29Villamor E; 2012
N = 1210 Age 3 years USA Prospective pre-birth cohort | Average daily intake of folate at 1st and 2nd trimester (FFQ + Supplements) Peri-conceptional intake of folate from supplements (LMP-4 weeks gestation) | Peabody Picture Vocabulary Test-Receptive Language Wide Range Assessment of Visual Motor Abilities-visual-motor; visual-spatial and fine motor | First but not 2nd trimester folate intake (food + supplement) positively related to receptive language but not with visuo-motor abilities. Every increment of 600 μg/day folate intake -↑1.6 points receptive language. No association of peri-conceptional folate intake with cognitive function Confounders adjusted for: MA, parity, ethnicity, MS, pre-pregnancy BMI, ME, PE, MIQ, energy, fish and iron intake, income, the child’s sex and English as primary language | 15 Medium |
30Boeke C; 2013
N = 895 Age 7 years USA Prospective pre-birth cohort | Average daily intake of folate at 1st and 2nd trimester (FFQ + Supplements) | Peabody Picture Vocabulary Test-Receptive Language Wide Range Assessment of Memory and Learning-II edition, Design and Picture Memory subtests: visuo-spatial memory Kaufman Brief Intelligence Test-II edition Verbal and non-verbal intelligence | No association of folate intake with cognitive function Confounders adjusted for: MA, parity, ethnicity, MS, pre-pregnancy BMI, ME, PE, MIQ, energy, fish and iron intake, income, the child’s sex and English as primary language | 16 Medium |
31Wehby GL; 2008
N = 6774 Age 3 years USA Population based longitudinal | Folic acid supplements (3 months prior to pregnancy and/or during the following 3 months) 3 % used supplement | Denver developmental screening-language, personal-social, gross motor and fine motor | Folic acid use was associated with improved gross motor development (OR = 0.5) Confounders adjusted for: The child’s sex, age, ethnicity, MA, ME, MS, alcohol, drug abuse, income, maternal health status | 11 High |
32Roth C; 2011
N = 38954 Age 3 years Prospective observational Norway | Folic acid supplements with or without other supplements (4 wks before to 8 wks after conception) 18.9 % used only folic acid 50 % used folic acid + other supplements | Language Grammar Rating scale - Language delay (severe and moderate) Severe-children with minimal expressive language i.e. only 1 word or unintelligible utterances; Moderate-children can produce 2-3 word phrases Gross motor skills-Ages and Stages questionnaire | Use of folic acid resulted in reduced risk of severe (OR = 0.55) and moderate language delay (OR = 0.80) No association between folic acid intake and delay in gross motor skills Confounders adjusted for: Maternal marital status, BMI, parity and education | 17 Low |
33Forns J; 2012
N = 393 Age 11 years Population based prospective birth cohort; Spain | Folic acid supplements with or without other vitamins Dose and duration: No information. 66.8 % used folic acid + other supplements | Continuous Performance Test (Attention function) Omission error; Commission error HRT-mean response time (for correct hits) | Supplementation with folic acid reduced the incidence rate ratio (IRR = 0.80) of omission errors No association with commission and HRT Confounders adjusted for: Parity, PE, social class, MIQ, maternal mental health, MS, BWT, BF | 14 Medium |
34Julvez J; 2009
N = 420 Age 4 years Population based prospective birth cohort Spain | Folic acid supplements with or without other vitamins Dose and duration: No information 34 % used only folic acid 24 % used folic acid + other supplements | McCarthy Scales of Children’s Abilities General cognitive scale and subscales (Verbal, perceptive-performance, memory, quantitative and motor) and executive function (Verbal and perceptive-performance) | Use of maternal folic acid supplement was positively associated with verbal (general cognitive) score (β = 3.98) and verbal (executive function (β = 3.97)), motor skills (β = 4.55) Confounders adjusted for: The child’s sex, age, school season, area of residence, GA, BF, parity, maternal marital status, MS, use of calcium and iron supplements, ME, PE and social class | 14 Medium |
35Holmes-Siedle; 1992
N = 96 Age 2-5 years UK Prospective observational | Peri-conceptional multivitamin containing folic acid (0.36 mg) supplements daily with other vitamins and minerals (Minimum 28 days before conception until the second missed menstrual period) | Denver developmental screening test (DDST) (language, motor and social skills) | No significant difference in development score among supplemented group compared to general population Confounders adjusted for: No information | 12 Medium |
36Campoy C; 2011
N = 154 Age 6.5 years Double blind randomized controlled trial European centres (Germany, Spain and Hungary) | 4 supplement (milk based) groups Fish oil (N = 37) 5-methyl tetrahydrofolate-400 μg (N = 37) Fish oil + 5-methyl tetrahydrofolate (N = 35) Placebo (N = 45) Daily supplementation from 20th week of gestation until delivery Plasma/erythrocyte folate concentrations during 2nd and 3rd trimester and at the time of delivery; No information about compliance | Kaufman Assessment Battery for Children (KABC): Sequential processing scale Simultaneous processing scale Mental Processing Composite (MPC) | No significant difference in cognitive scores between supplement groups No association of maternal plasma or erythrocyte folate concentrations during pregnancy and at the time of delivery with cognitive function Confounders adjusted for: Unadjusted | 19 Low |
Author, Year, Sample size, Age, Country, Study design | Nutrient | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
23WU BTF; 2012
N = 154 Age 18 Months Canada Prospective | Plasma vitamin B12 and holotranscobalamin concentrations assessed at 16 and 36 weeks gestation 7.8 % low B12 (<148 pmol/l) | Bayley Scales of Infant Development Receptive language, expressive language, cognitive skills, fine motor and gross motor | No association of B12 and holotranscobalamin with cognitive function Confounders adjusted for: The child’s sex, BF, ethnicity, MA, MIQ, maternal fatty acid level | 13 Medium |
25Bhate V; 2008
N = 108 Age 9 years India Prospective community based | Plasma Vitamin B12 concentrations assessed at 28 weeks gestation B12 status 2 groups Lowest <77 pmol/L Highest >224 pmol/L | Raven’s Coloured Progressive Matrices-Intelligence Visual recognition Colour Trial Test-sustained attention and executive function Digit-span test-short-term or working memory | Children in group 1 performed slowly in sustained attention (182 seconds Vs 159) and short-term memory (2.6 digits Vs 2.9) No association with other tests Confounders adjusted for: The child’s sex, age, education, weight and head circumference, B12 level, SES, education of the head of the family | 14 Medium |
26Veena SR; 2010
N = 536 Age 9-10 years India Prospective birth cohort | Plasma vitamin-B12 concentrations assessed at 30 ± 2 weeks gestation Low B12-(B12 < 150 pmol/L)-42 % | Kauffman Assessment Battery for Children-II-Learning, long-term retrieval, short-term memory and reasoning Wechsler Intelligence Scale for Children-III-attention and concentration Koh’s block design-visuo-spatial ability Verbal fluency | No association between B12 concentrations and cognitive function No difference in mean score between children of mothers with low and normal B12 status Confounders adjusted for: The child’s sex, GA, weight and head circumference at birth, parity, MA, maternal BMI, ME, PE, SES, religion, rural/urban residence, the child’s current age, education, head circumference, BMI and B12 concentrations | 16 Medium |
28Del Rio Garcia; 2009
N = 253 Age Infancy (1- 12 months) Mexico Prospective birth cohort | Daily dietary intake of vitamin B12 (first trimester FFQ) Deficient daily dietary intake (B 12 < 2.0 μg/day) – 21.3 % | Bayley Scales of Infant Development -II (Mental Development Index(MDI) and Psychomotor Development Index (PDI)) | B12 intake deficiency-↓mental development (β = -1.6 points) Confounders adjusted for: BWT, BF, current age, energy intake at age 6 months, maternal BMI, pregnancy hypertension, ME, HE and MTHFR 1298A > C genotype | 16 Medium |
29Villamor E; 2012
N = 1210 Age 3 years USA Prospective pre-birth cohort | Average daily intake of vitamin B12 - 1st and 2nd trimester (FFQ + Supplements) Peri-conceptional B12 intake from supplements (LMP - 4Wks gestation) | Peabody Picture Vocabulary Test-Receptive Language Wide Range Assessment of Visual Motor Abilities-visual-motor; visual-spatial and fine motor | ↑ B12 intake (2.6 μg/day) during 2nd trimester (not 1st trimester) -↓ (0.4 points) receptive language No association of peri-conceptional B12 intake with cognitive function Confounders adjusted for: MA, parity, ethnicity, MS, pre-pregnancy BMI, ME, PE, MIQ, energy, fish and iron intake, income, the child’s sex and English as primary language | 15 Medium |
30Boeke C; 2013
N = 895 Age 7 years USA Prospective pre-birth cohort | Average daily intake of B12 at 1st and 2nd trimester (FFQ + Supplements) | Peabody Picture Vocabulary Test-Receptive Language Wide Range Assessment of Memory and Learning-II edition, Design and Picture Memory subtests: visuo-spatial memory Kaufman Brief Intelligence Test-II edition Verbal and non-verbal intelligence | No association of B12 intake with cognitive function Confounders adjusted for: MA, parity, ethnicity, MS, ME, PE, MIQ, HE, intake of energy, fish and other methyl donors, the child’s sex and current age | 16 Medium |
37Bonilla C; 2012
N = 6259 Age 8 years UK Population based prospective birth cohort | Daily dietary vitamin B12 intake. (FFQ; 3rd trimester-32 weeks) | Wechsler Intelligence Scale for Children-III- Full-scale IQ | No association between maternal B12 intake and child’s IQ. Confounders adjusted for: The child’s sex, GA, BWT, BF, current age, MA, parity, ME, social class, MS, alcohol, maternal energy intake and infections in pregnancy, folate supplementation | 14 Medium |
Author, Year, Sample size, Age, Country, Study design | Nutrient | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
31Wehby GL; 2008
N = 6774 Age 3 years USA Population based longitudinal | Prenatal iron supplements (3 months prior to pregnancy and/or during the following 3 months) 36.2 % used supplement | Denver developmental screening-language, personal-social, gross motor and fine motor | Iron use was associated with improved performance in personal-social development (OR = 0.5) but not with language and motor domains Confounders adjusted for: The child’s sex, age, ethnicity, MA, ME, MS, alcohol, drug abuse, income, maternal health status | 11 High |
38Rioux FM; 2011
N = 63 Age 6 Months Canada Observational | Hb, serum ferritin at 28-32 weeks gestation 90 % mothers took iron supplements (27 mg of iron) | Brunet-Lezine Scale of Psychomotor Development of Early Childhood. Bayley Scales of Infant Development | No association between maternal gestational Iron status with mental and psychomotor development. Confounders adjusted for: ME, PE, MIQ, income, BF, GA, BWT, birth head circumference, infants’ current weight and Hb | 16 Medium |
39Ferarouei. M; 2010
N = 9983 14 years
N = 10474 16 years Finland Prospective Birth cohort study | Hb concentrations at 3rd 7th and 9th gestational months Anaemia | School performance 14 years- Self report 16 years- School report | ↑maternal HB at 9 months-↑ total school performance score (β = 0.03) and theory score at 14 years and total score at 16 years Offspring of mothers with anaemia –low school scores (OR = -0.05 at 14 years and (OR = -0.06) at 16 years Confounders adjusted for: The child’s sex, BWT, pregnancy wanted or not, ME, social class, parity, marital status, MS, maternal mental health status | 18 Low |
40Davidson PW; 2008
N = 229 Age 5, 9, 25and 30 months Republic of Seychelles Longitudinal cohort study | Iron- total body stores at 14-24 weeks of gestation assessed before the start of iron supplementation | Bayley Scales of Infant Development: Mental Development Index (MDI) and Psychomotor Development Index (PDI) (9 and 30 months) Infant cognition (Fagan Infantest-novelty preference) and Visual Expectation Paradigm –visual recognition memory (9 and 25 months) A-not-B and Delayed Spatial Alternation: inhibition, working memory, planning and attention (25 months) | No association between maternal iron stores and cognitive function at any age. Confounders adjusted for: The child’s sex, BWT, MA, SES, HE, MIQ and both parents living with the child (yes/no) | 19 Low |
41Lewis SJ; 2013
N = ~3,500 Age 8 years UK Population based prospective birth cohort | Hb concentrations Before 18 weeks Hb <11.0 g/dl -8 % After 28 weeks Hb <11.0 g/dl -30 % | Wechsler Intelligence Scale for Children-III- Full- scale IQ | No association between maternal Hb and child’s IQ Confounders adjusted for: GA, ME, the child’s genotype, iron supplementation, population stratification | 15 Medium |
42Tran TD; 2013
N = 378 Age 6 months Vietnam Population based prospective cohort study | Iron deficiency anaemia (Hb <11.0 g/dl and serum ferritin <15 ng/ml) during 12-28 weeks of gestation-16 % | Bayley Scales of Infant and Toddler Development-III edition-cognitive score | Infants of anaemic mothers scored 11.6 points (0.77SD) lower in BSID cognitive scores compared to infants of non-anaemic mothers. Confounders adjusted for: parity, MA, ME, wealth index, the child’s birth and current weight, family support, BF. | 18 Low |
43Zhou SJ; 2006
N = 302 Age 4 years; Australia Double blind randomized controlled trial | Iron supplements (20 mg/day) or placebo from 20 weeks gestation until delivery Compliance-86 % | Stanford Binet Intelligence Scale – IQ (verbal reasoning, visual reasoning, quantitative reasoning and short-term memory) | No difference between the children of supplement group and placebo group in the mean score of composite IQ or any subscales IQ or in the proportion of children whose IQ fell 1 or 2 SD below the mean. Confounders adjusted for: sex, birth order, gestational age, MA, ME, PE, HE, BF | 20 Low |
44Li Q; 2009
N = 1305 Age 3, 6 and 12 months Double blind cluster randomized controlled trial China | 3 intervention groups (All received folic acid) Folic acid alone 400 μg (n = 471)-control Iron 60 mg + folic acid 400 μg (n = 438) Multiple micronutrients ((b vitamins (1,2,3 6 AND 12), vitamin A, D, C, E and minerals (zinc, iodine, copper, selenium) + Iron 30 mg + 400 μg folic acid)) (n = 396) Daily supplementation from enrolment until delivery; inadequate information about compliance | Bayley Scales of Infant Development :Mental (MD) and Psychomotor development (PD) | No significant difference in infants MD and PD score at 3 and 6 months and PD score at 12 months between supplement groups Mean MD score among children of multiple micronutrient group increased by 1 to 1.22 points compared to children of folic acid alone, or folic acid + iron group at 12 months Confounders adjusted for: Infants age, sex, gestational age, apgar score, BWT, infant health, maternal age and BMI, parental education, occupation, SES, number of tablets consumed | 19 Low |
Author, Year, Sample size, Age, Country, Study design | Nutrient | Cognitive function | Results after adjustment for confounders | QS and RB |
---|---|---|---|---|
45Alderman H; 2014
N = 6774 Age 16-22 years Double blind cluster randomized controlled trial Gambia | Carbohydrate/protein supplements Intervention Group: 2 biscuits daily (1015 kcal carbohydrate and 22 g protein) from 20 weeks of gestation to delivery Control group: same supplements for 20 weeks during postpartum but not during pregnancy No information about compliance | Raven’s progressive matrices- nonverbal reasoning ability The Mill Hill vocabulary test The backward and forward digit-span test Schooling achievement (questionnaire) | No difference in any of the cognitive test scores or schooling achievement between children whose mothers received the supplements during pregnancy and children whose mothers received supplements during postpartum. Confounders adjusted for: The child’s sex, age, GA, ME, PE, maternal height, parity, season of birth, language and village allocation | 19 Low |