Session/Event: Oh Baby! Gestational Stress and Social Determinants of Pre-conception, Pregnancy and Pediatrics (Oral 19)

(OR19-02-22) Association of Antenatal Micronutrient Supplementation With Adolescent Emotional and Behavioral Health: A 14-Year Follow-Up of a Double-Blind Randomized Controlled Trial

On Demand

Presenting Author(s)

Zhonghai Zhu, Ph.D

Assistant professor
Xi'an Jiaotong University
Boston, Massachusetts, United States

Disclosure: Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

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Co-Author(s)

YZ

Yingze Zhu

Xi'an Jiaotong University
LW

Liang Wang

Xi’an Jiaotong University
QQ

Qii Qi, MSc

Xi'an Jiaotong University
Xi'an, Shaanxi, China (People's Republic)
AA

Amanuel K. Andegiorgish

Xi’an Jiaotong University
ME

Mohamed Elhoumeda, MSc

Xi'an Jiaotong University
Xi'an, Shaanxi, China (People's Republic)
YC

Yue Cheng, Ph.D

Xi'an Jiaotong University
Xi'an, Shaanxi, China (People's Republic)
MD

Michael J. Dibley, MD, MPH

Professor of Global Public Health Nutrition
The University of Sydney
The University of Sydney, New South Wales, Australia
LZ

Lingxia Zeng, Ph.D

Xi'an Jiaotong University
Xi'an, Shaanxi, China (People's Republic)

Objectives: To examine the impact of antenatal micronutrient supplementation on adolescent emotional and behavioral health, and to identify the modifying effect of household wealth.

Methods: We conducted a double-blind cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2008. Pregnant women in every village were randomized to daily take one capsule of folic acid (as control), folic acid plus 60 mg iron (IFA), and multiple micronutrients (MMNs) including 30 mg iron. Singleton births were prospectively followed at early adolescence in 2016. Adolescents actively completed the localized and qualified Youth Self-Report. Scores of Internalizing Behavior Problems (constituting by Anxious/Depressed, Withdrawn and Somatic Complaints), Externalizing Behavior Problems (constituting by Delinquent/Rule-Breaking Behavior and Aggressive Behavior) and Total Behavior Problems, were derived. As priorly specified, we examined the modifying effect of household wealth on the response to antenatal IFA and MMNs vs. folic acid supplementation on adolescent emotional and behavioral health.

Results: Of 1920 adolescents included in the final analysis, 1130 (58.9%) were male, with a mean (SD) age of 11.8 (0.78) years. As compared to folic acid, adolescents born to mothers who consumed IFA had lower scores of total behavioral problems, externalizing, rule-breaking and aggressive behavior. The adjusted mean differences were -2.94 (95% CI -5.78, -0.11), -1.00 (95% CI -1.82, -0.18), -0.39 (95% CI -0.73, -0.05) and -0.61 (95% CI -1.15, -0.07), respectively. Similar associations were observed among medium-wealth households, while null associations in low-wealth households (all interaction P values < 0.05). Further, among high-wealth households, MMNs show benefits on reducing the risk of adolescent behavioral problems as compared to IFA or folic acid.

Conclusions: Sufficient iron intake in pregnancy has long-term benefits on reducing the risk of adolescent behavioral problems. Multiple micronutrients including 60 mg iron are recommended in rural areas with micronutrients deficiencies widely prevalent given the benefits of MMNs on improving birth outcomes.

Funding Sources: National Natural Science Foundation of China and China Postdoctoral Science Foundation