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American Academy of Pediatrics
Article

Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China

Suying Chang, Lingxia Zeng, Inge D. Brouwer, Frans J. Kok and Hong Yan
Pediatrics March 2013, 131 (3) e755-e763; DOI: https://doi.org/10.1542/peds.2011-3513
Suying Chang
aUnited Nations Children’s Fund Office for China, Beijing, China;
bDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands; and
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Lingxia Zeng
cSchool of Public Health, Xi’an Jiaotong University College of Medicine, Shaanxi, China
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Inge D. Brouwer
bDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands; and
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Frans J. Kok
bDivision of Human Nutrition, Wageningen University, Wageningen, Netherlands; and
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Hong Yan
cSchool of Public Health, Xi’an Jiaotong University College of Medicine, Shaanxi, China
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Abstract

OBJECTIVE: To determine the impact of iron deficiency anemia (IDA) in pregnancy on young child development.

METHODS: A 2-year follow-up of 850 children born to women who participated in a double-blind cluster randomized controlled trial of prenatal micronutrient supplementation in western rural China. These women were randomly assigned to receive either daily folic acid, iron/folic acid (60 mg iron), or multiple micronutrients (with 30 mg iron) during pregnancy. Children were categorized into the prenatal-IDA and prenatal–non-IDA groups based on the mother’s hemoglobin in the third trimester. Each group contained 3 subgroups based on mother’s treatment: folic acid, iron/folic acid, and multiple micronutrients. Bayley scales of infant development were administered to the children to assess their development at 3, 6, 12, 18, and 24 months of age.

RESULTS: Compared with the prenatal–non-IDA group, the prenatal-IDA group showed a significantly lower mental development index at 12, 18, and 24 months of age. The adjusted mean difference was 5.8 (95% confidence interval [CI], 1.1–10.5), 5.1 (95% CI, 1.2–9.0), and 5.3 (95% CI, 0.9–9.7), respectively. Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal–non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients.

CONCLUSIONS: Prenatal IDA in the third trimester is associated with mental development of the child. However, prenatal supplementation with sufficient iron protects child development even when the woman’s IDA was not properly corrected in pregnancy.

KEY WORDS
  • follow-up
  • iron deficiency anemia in pregnancy
  • child development
  • Abbreviations:
    BSID —
    Bayley scale of infant development
    CI —
    confidence interval
    GLM —
    general linear model
    Hb —
    hemoglobin
    ID —
    iron deficiency
    IDA —
    iron deficiency anemia
    MD —
    mental development crude score
    MDI —
    mental development index
    MMN —
    multiple micronutrient supplementation
    PD —
    psychomotor development crude score
    PDI —
    psychomotor development index
    • Accepted November 14, 2012.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 3
    1 Mar 2013
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    Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China
    Suying Chang, Lingxia Zeng, Inge D. Brouwer, Frans J. Kok, Hong Yan
    Pediatrics Mar 2013, 131 (3) e755-e763; DOI: 10.1542/peds.2011-3513

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    Effect of Iron Deficiency Anemia in Pregnancy on Child Mental Development in Rural China
    Suying Chang, Lingxia Zeng, Inge D. Brouwer, Frans J. Kok, Hong Yan
    Pediatrics Mar 2013, 131 (3) e755-e763; DOI: 10.1542/peds.2011-3513
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    Keywords

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