From 2001-04, the Summit Institute of Development in Musa Tenggara Barat conducted the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT) involving 31,290 pregnant women, to determine if more micronutrients during pregnancy was key to long-term brain and cognitive development.
Half of the participants were given iron and folic acid supplementation (IFA) throughout their pregnancy until three months postpartum, while the other half were supplied with IFA incorporated with multiple micronutrients (MMN) such as iodine, zinc and vitamin B6.
The trial recorded 28,426 live births, with fewer low birth weight infants born to mothers from the MMN group, compared to those in IFA.
The long-term study revealed positive effects of MMN recorded in 487 children assessed at age 3·5 years for cognitive ability.
After 10 years, researchers decided to see how MMN supplementation, along with other socio-environmental factors affected children from the SUMMIT trial. Now aged 9-12 years, 2,879 children were tested. The IFA group included 1413 participants, while those from MMN group totalled 1466.
“The first objective was to follow up on school-age children (9–12 years) whose mothers had participated in SUMMIT, and assess the long-term effect of maternal MMN supplementation on child motor, cognitive, and socio-emotional development,” wrote the researchers. “The second was to assess, in the same context, the effect of biomedical and socio-environmental determinants on these outcomes.”
Findings significant
Socio-environmental determinants include assessment of the participants’ behaviour at home, social and thought problems along with multiple domains of child abilities.
The results were very promising, said the study. “We report significant effects of maternal MMN on procedural memory, on general intellectual ability in children of anaemic women, and positive shifts overall on cognitive, fine motor, and socio-emotional ability,” researchers wrote.
Children of mothers given MMN scored higher than children from the IFA in procedural memory. The score of 0.11 SD, said the study, is equivalent to cognitive development gained from half a year of schooling.
Children of anaemic mothers who also took MMN scored higher (0.18 SD) in general intellectual ability (compared to IFA children), similar to cognitive development gained from one year of schooling.
Overall, 18 of 21 tests showed a positive coefficient of MMN versus IFA (p=0·0431) with effect sizes from 0·00–0·18 SD.
While the study found that maternal MMN has long-term benefits for child cognitive development at 9–12 years of age, it also discovered that socio-environmental determinants are crucial to over-all enhancement of child cognition.
“The stronger association of socio-environmental determinants with improved cognition suggests that present reproductive, maternal, neonatal, and child health programmes focused on biomedical determinants might not sufficiently enhance child cognition – and that programmes addressing socio-environmental determinants are also essential to achieve thriving populations,” the study concluded.
Source: The Lancet Global Health
DOI: 10.1016/S2214-109X(16)30354-0
“Maternal multiple micronutrient supplementation and other biomedical and socio-environmental influences on children’s cognition at age 9–12 years in Indonesia: follow-up of the SUMMIT randomised trial”
Authors: Elizabeth L Prado, Susy K Sebayang, et al.