Evaluating the Effect of Docosahexaenoic Acid (DHA) Supplementation during Pregnancy on Child Cognitive Development at 5 Years of Age in Morelos, Mexico. Public

Abstract

Maternal nutritional status is an important determinant of child growth and cognitive development outcomes. Recently there has been increased attention on maternal nutrition requirements of dietary lipids, especially essential fatty acids (EFAs).

Docosahexaenoic acid (DHA), a long-chain polyunsaturated fatty acid (LCPUFA) derived from the n-3 EFA family, is found predominately in the metabolically active neural membranes of the brain and retina and is known to influence cognitive ability and visual acuity. The significance of maternal n-3 LCPUFAs status is of interest to researchers since fetal accretion is highest during the last trimester of pregnancy.

Since 2007, a large double-blind, randomized placebo-controlled trial of DHA supplementation has followed a cohort of Mexican women (n=1,094) and the offspring (n=978) born to them from birth to early childhood. Secondary data analysis was carried out to evaluate the impact of the intervention on child cognitive development for 802 children (88% of the birth cohort) as measured by the Spanish version of the McCarthy Scales of Children's Abilities (MSCA) for Global Development at 5 years of age. Outcome measures calculated were the raw and standardized scores of the MSCA six scales: verbal, perceptual-performance, quantitative, memory, motor and general cognitive.

Intent-to-treat analysis determined that DHA supplementation (400mg/day) mid-pregnancy until delivery did not significantly improve child cognitive development at 5 years of age (p>0.05). A significant treatment by home environment at 12 months of age interaction was detected for verbal, perceptual-performance, memory, and general cognitive raw and standardized scores (p≤0.10), indicating that offspring from poor home environments benefited from prenatal DHA supplementation.

There were no main effects of prenatal DHA supplementation on offspring development at 5 years of age. However, verbal, perceptual-performance, memory, and general cognitive raw and standardized scores were higher among children from poor home environments at 12 months of age who were exposed to DHA in utero compared to those from similar home environments that received the placebo.

Table of Contents

Table of Contents

List of Tables...............................................................................p. 1

List of Figures...............................................................................p. 1

List of Acronyms............................................................................p. 2

Chapter 1: INTRODUCTION...............................................................p. 3

Chapter 2: REVIEW OF THE LITERATURE..............................................p. 7

Neurodevelopment

Risks Factors Influencing Cognitive Development

Protective Factors Influencing Cognitive Development

Cognitive Development

Chapter 3: METHODS.........................................................................p. 22

Overview

Study Population, Setting, and Eligibility Criteria

Intervention

Randomization and Blinding

Outcome Measures

Statistical Analysis

Chapter 4: RESULTS............................................................................p. 38

Primary Analysis

Sub Analyses

Chapter 5: DISCUSSION........................................................................p. 42

Overview

Bias

Strengths

Limitations

Future Directions

REFERENCES....................................................................................... p. 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Mexico pregnancy cognitive development docosahexaenoic acid
Committee Chair / Thesis Advisor	Ramakrishnan, Usha, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) Hospital or other health care provider

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