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5th January 2011: Iron and Folic Acid Directly Related to Improved Function in Children

Children whose mothers were given iron and folic acids while pregnant were found to have higher levels of intelligence, executive function and fine motor controls, researchers reveal in JAMA (Journal of the American Medical Association). Early iron deficiency has been shown to alter neuroanatomy and metabolism that in turn can stifle typical cognitive development patterns in children.

Iron-deficiency anemia affects about one-quarter of infants worldwide and many poor and minority children in the United States. During development, iron is needed in the brain for many purposes. For instance, iron is required to build myelin, which covers nerves and helps them share signals more efficiently. Iron is also needed for brain chemicals, such as the neurotransmitter dopamine, which sends signals within the brain. Recently, iron deficiency has been shown to affect the hippocampus, which plays an important role in certain kinds of memory.

Such a relation to iron and these increases in cognitive and motor function test scores was most prevalent in rural Nepal where deficiencies of iron and vital folic acid is rampant. In an area where iron deficiency is prevalent, children of mothers in rural Nepal who received prenatal iron, folic acid and vitamin A supplementation performed better on measures of intellectual and motor functioning compared to offspring of mothers who received vitamin A alone.

n general, the differences in test scores between the other intervention groups and controls were not statistically significant.

Nepal's gross domestic product (GDP) for 2008 was estimated at over $12 billion (adjusted to Nominal GDP), making it the 115th-largest economy in the world. Its workforce of about 10 million suffers from a severe shortage of skilled labor. About half of the population lives below the international poverty line of $1.25 USD a day.

Parul Christian, Dr. P.H., of Johns Hopkins University summarizes:

    "Micronutrient inadequacy is a critical concern among pregnant women and young children throughout the world. Gestation and the early postnatal period are considered sensitive periods for brain development, and nutritional deprivation during this period may lead to functional impairments. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects children's later functioning."

The study where this report was derived focused on a group of 676 Nepalese children, aged 7 to 9 years from June 2007 to April 2009, who had been born to women in groups of a community-based randomized controlled trial of prenatal micronutrient supplementation conducted between 1999 and 2001. Intellectual memory and reasoning examinations, executive processing tests and motor function, such as manual dexterity and balance observations, were assessed.

A number of children were also placed in the placebo group of an iron and zinc supplementation trial while in preschool. A random selection of mothers and children received daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A. These were compared with a vitamin A alone group that ingested the supplements from early pregnancy through 3 months after birth.

In conclusion, the researchers recommend an increase in provision guidelines to mothers and children that live under less fortunate conditions.

The study finally states:

    "Antenatal iron/folic acid use per international guidelines should be expanded in many low and middle income settings where program coverage continues to be poor. Further follow-up studies are required to examine whether the observed benefits in early school age persist into adolescence and adulthood."

"Prenatal Micronutrient Supplementation and Intellectual and Motor Function in Early School-aged Children in Nepal"
Parul Christian, DrPH; Laura E. Murray-Kolb, PhD; Subarna K. Khatry, MBBS, FRCS; Joanne Katz, ScD; Barbara A. Schaefer, PhD; Pamela M. Cole, PhD; Steven C. LeClerq, MPH; James M. Tielsch, PhD
JAMA. 2010;304(24):2716-2723. doi: 10.1001/jama.2010.1861

Article reproduced from medicaLexicon

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