Maternal Multiple Micronutrient Supplementation and Children's Cognition at Age 9‐12 Years in Indonesia

Abstract

Many micronutrients, including zinc, iodine, and B‐vitamins, are needed for the rapid brain development that occurs during gestation and infancy, laying a foundation for lifelong brain function. Few studies have examined the long‐term cognitive effects of maternal multiple micronutrient (MMN) supplements, compared to the current practice in many countries of iron and folic acid (IFA) supplementation. In 2001‐2004, in the SUMMIT trial, midwives in Indonesia were randomly assigned to distribute daily IFA or MMN from pregnancy through three months postpartum. We tested 3687 children of SUMMIT participants at 9‐12 years of age. Adjusting for midwife cluster, data collector, child age and gender, and home environment, children of mothers given MMN scored higher in visual attention (B=0.11, p < .01) and arithmetic (B=0.10, p=.05) compared to IFA. We observed positive effects on verbal ability (B=0.17, p=.02) in children of mothers who were undernourished at enrollment and on sustained attention (B=0.10, p=.04) and letter/word recognition (B=0.23, p=.04) in children of mothers who were anemic, consistent with previously observed effects on pre‐school cognition in these groups. We found positive effects on speed of sentence reading in children of well‐nourished mothers (B=0.11, p = .04), consistent with effects on birth weight in this group. No effects were found on fine motor ability, socio‐emotional scores, or several measures of executive function.Funded by Grand Challenges Canada