Effects of Nutritional Interventions during Pregnancy on Infant and Child Cognitive Outcomes: A Systematic Review and Meta-Analysis

Rachael M Taylor, Shanna M Fealy, Alessandra Bisquera, Roger Smith, Clare E Collins, Tiffany-Jane Evans, Alexis J Hure, Rachael M Taylor, Shanna M Fealy, Alessandra Bisquera, Roger Smith, Clare E Collins, Tiffany-Jane Evans, Alexis J Hure

Abstract

Background: Epidemiological studies have demonstrated that folate, iodine and iron intake during pregnancy impacts on foetal brain development and cognitive function. However, in human studies, the relationship with other dietary nutrients is less clear.

Objective: This systematic review aims to critically appraise the current literature and meta-analyses results from nutritional interventions during pregnancy that aimed to optimise infant and child cognitive outcomes.

Design: Ten electronic databases were searched for articles published up to August 2017. The search was limited to articles published in English. Randomised controlled trials (RCTs) testing the impact of any nutritional intervention (dietary counselling, education, nutrient supplementation, fortified foods and/or foods) during pregnancy on cognitive outcomes of children (<10 years old). Two independent reviewers assessed study eligibility and quality using the American Dietetic Association quality criteria checklist for primary research. Standardised mean differences were used for nine cognitive domains to measure effects for meta-analyses.

Results: A total of 34 RCTs were included (21 studies included children aged less than 35 months, 10 studies included children aged 36-60 months and 3 studies included children aged 61-119 months). The types of nutritional interventions included nutrient supplements, whole foods, fortified foods and nutrition education. The following nine cognition outcomes: attention, behaviour, crystallised intelligence, fluid intelligence, global cognition, memory, motor skills, visual processing, and problem solving were not significantly impacted by nutritional interventions, although 65% of studies conducted post-hoc data analyses and were likely to be underpowered. Although, long chain polyunsaturated fatty acids (LCPUFA) supplementation was associated with a marginal increase in crystallised intelligence (Effect size (ES): 0.25; 95% confidence interval (95% CI): -0.04, 0.53), the effect was not statistically significant (p = 0.09), with significant study heterogeneity (p = 0.00).

Conclusions: LCPUFA supplementation may be associated with an improvement in child crystallised intelligence, however further research is warranted. The remaining eight cognition domains were not significantly impacted by maternal nutritional interventions.

Keywords: behaviour; child; cognition; cognitive function; infant; nutrition; pregnancy; supplement.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for study selection process.
Figure 2
Figure 2
Forest plot for child behaviour outcomes. The overall effect size was estimated by standardised mean difference (SMD). LCPUFA, long chain polyunsaturated fatty acids. D+L, random-effects estimate (Der Simonian and Laird method) and I-V, fixed-effects estimate (inverse variance method).
Figure 3
Figure 3
Forest plot for child motor skills outcomes. The overall effect size was estimated by standardised mean difference (SMD). LCPUFA, long chain polyunsaturated fatty acids; MMN, multiple micronutrient. D+L, random-effects estimate (Der Simonian and Laird method) and I-V, fixed-effects estimate (inverse variance method).
Figure 4
Figure 4
Forest plot for child fluid intelligence outcomes. The overall effect size was estimated by standardised mean difference (SMD). LCPUFA, long chain polyunsaturated fatty acids; MMN, multiple micronutrient. D+L, random-effects estimate (Der Simonian and Laird method) and I-V, fixed-effects estimate (inverse variance method).
Figure 5
Figure 5
Forest plot for child global cognition outcomes. The overall effect size was estimated by standardised mean difference (SMD). LCPUFA, long chain polyunsaturated fatty acids; MMN, multiple micronutrient. D+L, random-effects estimate (Der Simonian and Laird method) and I-V, fixed-effects estimate (inverse variance method).
Figure 6
Figure 6
Forest plot for child crystallised intelligence outcomes. The overall effect size was estimated by standardised mean difference (SMD). LCPUFA, long chain polyunsaturated fatty acids; MMN, multiple micronutrient. D+L, random-effects estimate (Der Simonian and Laird method) and I-V, fixed-effects estimate (inverse variance method).
Figure 7
Figure 7
Funnel plot for child crystallized intelligence outcomes with 95% confidence limits. meanSE, mean standard error.

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