Diabetes Unit, KEM Hospital Research Center, Pune, India.
Department of Economics & Finance, Nistler College of Business and Public Administration, University of North Dakota, Grand Forks, ND, USA.
J Dev Orig Health Dis. 2023 Feb;14(1):110-121. doi: 10.1017/S2040174422000356. Epub 2022 Jun 28.
Neurocognitive development is a dynamic process over the life course and is influenced by intrauterine factors as well as later life environment. Using data from the Pune Maternal Nutrition Study from 1994 to 2008, we investigate the association of in utero, birth, and childhood conditions with offspring neurocognitive development in 686 participants of the cohort, at age 12 years. The life course exposure variables in the analysis include maternal pre-pregnancy size and nutrition during pregnancy, offspring birth measurements, nutrition and physical growth at age 12 years along with parental education and socio-economic status. We used the novel Bayesian Model Averaging (BMA) approach; which has been shown to have better predictive performance over traditional tests of associations. Our study employs eight standard neurocognitive tests that measure intelligence, working memory, visuo-conceptual and verbal learning, and decision-making/attention at 12 years of age. We control for nutritional-metabolic information based on blood measurements from the pregnant mothers and the children at 12 years of age. Our findings highlight the critical role of parental education and socio-economic background in determining child neurocognitive performance. Maternal characteristics (pre-pregnancy BMI, fasting insulin during pregnancy) and child height at 12 years were also robust predictors on the BMA. A range of early factors - such as maternal folate and ferritin concentrations during pregnancy, and child's head circumference at birth - remained important determinants of some dimensions of child's neurocognitive development, but their associations were not robust once we account for model uncertainty. Our results suggest that intrauterine influences on long- term neurocognitive outcomes may be potentially reversible by post-birth remediation. In addition to the current nutritional interventions, public health policy should also consider social interventions in children born into families with low socio-economic status to improve human capital.
神经认知发展是一个贯穿生命全程的动态过程，受到宫内因素以及后期生活环境的影响。本研究利用 1994 年至 2008 年普纳母婴营养研究的数据，在队列的 686 名参与者中，调查了宫内、出生和儿童时期的条件与 12 岁后代神经认知发展的关系。分析中的生命全程暴露变量包括母亲孕前体重和孕期营养、后代出生测量值、12 岁时的营养和身体生长情况以及父母的教育和社会经济地位。我们使用了新颖的贝叶斯模型平均（BMA）方法；该方法已被证明在关联的传统测试中具有更好的预测性能。我们的研究采用了八项标准神经认知测试，用于测量 12 岁时的智力、工作记忆、视觉概念和言语学习以及决策/注意力。我们根据孕妇和 12 岁儿童的血液测量值控制营养代谢信息。我们的研究结果强调了父母教育和社会经济背景在决定儿童神经认知表现方面的关键作用。母亲特征（孕前 BMI、孕期空腹胰岛素）和 12 岁时的儿童身高也是 BMA 的可靠预测指标。一系列早期因素，如孕期母亲叶酸和铁蛋白浓度以及儿童出生时的头围，仍然是儿童神经认知发展某些方面的重要决定因素，但在考虑模型不确定性后，这些因素的相关性并不稳定。我们的研究结果表明，宫内因素对长期神经认知结果的影响可能通过出生后补救措施而具有潜在的可逆转性。除了目前的营养干预措施外，公共卫生政策还应考虑在社会经济地位较低的家庭中出生的儿童的社会干预措施，以提高人力资本。
