TABLE 1

Theoretical Rationale for the Neurodevelopmental Impact of MNCH&N Interventions Through a Reduction in Risk Factors

Intervention TargetsPotential Mechanisms for Impact
Improving maternal physical, mental health, and nutritional statusReduce inflammation and protect a developing fetus by preventing and treating infection.9,16,23
Protect a fetus from maternal hormonal imbalances and deleterious epigenetic changes by reducing chronic stress24 and preventing and treating depression.25
Prevent IUGR and support optimal gestational growth and development by ensuring adequate food and micronutrient intake, particularly iodine and iron.10
Improving birth outcomes and reducing incidence of newborn complications, neonatal infectionProtect against neurologic damage by reducing the risk of preterm birth and complications associated with prematurity.26
Ensure skilled birth attendance and hygienic delivery practices to prevent neurologic harm from sepsis.23
Reduce complications and neurologic damage from birth asphyxia and associated hypoxia23 by preventing obstructed labor, being large for gestational age, or postmature births and providing emergency cesarean deliveries and effective resuscitation when required.
Special care for preterm and SGA infantsEnhance lung adaptation and neuroprotection for vulnerable fetuses before imminent preterm birth with antenatal corticosteroids27 and magnesium sulfate.28
Provide appropriate thermal care and support prevention of neonatal infection, especially in preterm neonates who are vulnerable.29,30
Delay cord clamping to maximize umbilical transfusion and improve iron stores.31
Promoting optimal infant and child nutrition, care, and growthPromote optimal breastfeeding9 and complementary feeding practices to protect against malnutrition, infection, enteropathy,18 and linear growth stunting10 and optimize gut microbiome development.32
Ensure adequate psychosocial stimulation10 is provided during the period of rapid brain development.
Prevent and treat acute malnutrition and micronutrient deficiencies to prevent cognitive deficits.10
Infectious disease prevention and management in infancy and childhoodProvide routine childhood vaccinations and malaria prophylaxis,10 which can prevent and mitigate direct neurologic damage from infectious agents.
Support access to safe water, improve sanitation infrastructure, and promote hygienic practices to protect against environmental enteropathy and its sequelae.18
Reducing exposure to toxins and environmental contaminantsMinimize indoor air pollution to prevent placental pathology33 and neurodevelopmental deficits.34
Reduce lead and arsenic exposure10 at home and in the workplace to protect against cognitive deficits.
Support smoking cessation during pregnancy to prevent neurobehavioral deficits in children,35 and address maternal drug and alcohol exposure.