Child neurodevelopment after multidomain interventions from preconception through early childhood

Ravi Prakash Upadhyay; Sunita Taneja; Ranadip Chowdhury; Neeta Dhabhai; Savita Sapra; Sarmila Mazumder; Sitanshi Sharma; Mark Tomlinson; Tarun Dua; Harish Chellani; Rupali Dewan; Pratima Mittal; M. K. Bhan; Nita Bhandari; Ratan Shekhawat; Sabreen Siraj; Sugandhi Nagpal; Farah Abbasi; Heena Chaudhary; Karishma Sharma; Farhana Rafiqui; Kiran Bhatia; Jasmine Kaur; Medha Shekhar; Anita Kate; Gunjan Aggarwal; Runa Ghosh; Kunal Kishore; Navneet Mehra; Nikita Arya; Ritu Chaudhary; Anuradha Tamaria; Tivendra Kumar; Sowmya Karantha C; Purnima Modi; Neelam Kaur; Neha Tyagi; Geeta Mehto; Afifa Khatun; Sayeed Ahmed; Aparna Singh; Gulafshan Ansari; Ramanjeet Kaur; Manisha Gupta; Girish Chand Pant; Ankita Dutta; Deepak More; Mukesh Kumar; Sonia Kuruvilla; Anjali Chandra; Pradeep Debata; Anita Yadav; Abhinav Jain; Rahul Sachdev; Omprakash Bansal; Raghav Agarwal

doi:10.1001/jama.2023.23727

Child neurodevelopment after multidomain interventions from preconception through early childhood

Ravi Prakash Upadhyay, Sunita Taneja, Ranadip Chowdhury, Neeta Dhabhai, Savita Sapra, Sarmila Mazumder, Sitanshi Sharma, Mark Tomlinson, Tarun Dua, Harish Chellani, Rupali Dewan, Pratima Mittal, M. K. Bhan, Nita Bhandari, Ratan Shekhawat, Sabreen Siraj, Sugandhi Nagpal, Farah Abbasi, Heena Chaudhary, Karishma SharmaFarhana Rafiqui, Kiran Bhatia, Jasmine Kaur, Medha Shekhar, Anita Kate, Gunjan Aggarwal, Runa Ghosh, Kunal Kishore, Navneet Mehra, Nikita Arya, Ritu Chaudhary, Anuradha Tamaria, Tivendra Kumar, Sowmya Karantha C, Purnima Modi, Neelam Kaur, Neha Tyagi, Geeta Mehto, Afifa Khatun, Sayeed Ahmed, Aparna Singh, Gulafshan Ansari, Ramanjeet Kaur, Manisha Gupta, Girish Chand Pant, Ankita Dutta, Deepak More, Mukesh Kumar, Sonia Kuruvilla, Anjali Chandra, Pradeep Debata, Anita Yadav, Abhinav Jain, Rahul Sachdev, Omprakash Bansal, Raghav Agarwal

School of Nursing and Midwifery

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Importance
Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.

Objective
To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.

Design, Setting, and Participants
In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial’s secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2020, through February 25, 2022.

Interventions
Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.

Main Outcomes and Measures
Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.

Results
The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.

Conclusions and Relevance
Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children’s development warrant further evaluation.

Original language	English
Pages (from-to)	28-37
Journal	JAMA
Volume	331
Issue number	1
DOIs	https://doi.org/10.1001/jama.2023.23727
Publication status	Published - 02 Jan 2024

Keywords

General Medicine

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Upadhyay, R. P., Taneja, S., Chowdhury, R., Dhabhai, N., Sapra, S., Mazumder, S., Sharma, S., Tomlinson, M., Dua, T., Chellani, H., Dewan, R., Mittal, P., Bhan, M. K., Bhandari, N., Shekhawat, R., Siraj, S., Nagpal, S., Abbasi, F., Chaudhary, H., ... Agarwal, R. (2024). Child neurodevelopment after multidomain interventions from preconception through early childhood. JAMA, 331(1), 28-37. https://doi.org/10.1001/jama.2023.23727

@article{6c1309e523984bd290ef91ee6dc5ad18,

title = "Child neurodevelopment after multidomain interventions from preconception through early childhood",

abstract = "ImportanceMultidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.ObjectiveTo evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.Design, Setting, and ParticipantsIn this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial{\textquoteright}s secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2020, through February 25, 2022.InterventionsHealth, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.Main Outcomes and MeasuresCognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.ResultsThe mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.Conclusions and RelevanceMultidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children{\textquoteright}s development warrant further evaluation.",

keywords = "General Medicine",

author = "Upadhyay, {Ravi Prakash} and Sunita Taneja and Ranadip Chowdhury and Neeta Dhabhai and Savita Sapra and Sarmila Mazumder and Sitanshi Sharma and Mark Tomlinson and Tarun Dua and Harish Chellani and Rupali Dewan and Pratima Mittal and Bhan, {M. K.} and Nita Bhandari and Ratan Shekhawat and Sabreen Siraj and Sugandhi Nagpal and Farah Abbasi and Heena Chaudhary and Karishma Sharma and Farhana Rafiqui and Kiran Bhatia and Jasmine Kaur and Medha Shekhar and Anita Kate and Gunjan Aggarwal and Runa Ghosh and Kunal Kishore and Navneet Mehra and Nikita Arya and Ritu Chaudhary and Anuradha Tamaria and Tivendra Kumar and {Karantha C}, Sowmya and Purnima Modi and Neelam Kaur and Neha Tyagi and Geeta Mehto and Afifa Khatun and Sayeed Ahmed and Aparna Singh and Gulafshan Ansari and Ramanjeet Kaur and Manisha Gupta and Pant, {Girish Chand} and Ankita Dutta and Deepak More and Mukesh Kumar and Sonia Kuruvilla and Anjali Chandra and Pradeep Debata and Anita Yadav and Abhinav Jain and Rahul Sachdev and Omprakash Bansal and Raghav Agarwal",

year = "2024",

month = jan,

day = "2",

doi = "10.1001/jama.2023.23727",

language = "English",

volume = "331",

pages = "28--37",

journal = "JAMA",

issn = "0098-7484",

publisher = "American Medical Association",

number = "1",

}

Upadhyay, RP, Taneja, S, Chowdhury, R, Dhabhai, N, Sapra, S, Mazumder, S, Sharma, S, Tomlinson, M, Dua, T, Chellani, H, Dewan, R, Mittal, P, Bhan, MK, Bhandari, N, Shekhawat, R, Siraj, S, Nagpal, S, Abbasi, F, Chaudhary, H, Sharma, K, Rafiqui, F, Bhatia, K, Kaur, J, Shekhar, M, Kate, A, Aggarwal, G, Ghosh, R, Kishore, K, Mehra, N, Arya, N, Chaudhary, R, Tamaria, A, Kumar, T, Karantha C, S, Modi, P, Kaur, N, Tyagi, N, Mehto, G, Khatun, A, Ahmed, S, Singh, A, Ansari, G, Kaur, R, Gupta, M, Pant, GC, Dutta, A, More, D, Kumar, M, Kuruvilla, S, Chandra, A, Debata, P, Yadav, A, Jain, A, Sachdev, R, Bansal, O & Agarwal, R 2024, 'Child neurodevelopment after multidomain interventions from preconception through early childhood', JAMA, vol. 331, no. 1, pp. 28-37. https://doi.org/10.1001/jama.2023.23727

TY - JOUR

T1 - Child neurodevelopment after multidomain interventions from preconception through early childhood

AU - Upadhyay, Ravi Prakash

AU - Taneja, Sunita

AU - Chowdhury, Ranadip

AU - Dhabhai, Neeta

AU - Sapra, Savita

AU - Mazumder, Sarmila

AU - Sharma, Sitanshi

AU - Tomlinson, Mark

AU - Dua, Tarun

AU - Chellani, Harish

AU - Dewan, Rupali

AU - Mittal, Pratima

AU - Bhan, M. K.

AU - Bhandari, Nita

AU - Shekhawat, Ratan

AU - Siraj, Sabreen

AU - Nagpal, Sugandhi

AU - Abbasi, Farah

AU - Chaudhary, Heena

AU - Sharma, Karishma

AU - Rafiqui, Farhana

AU - Bhatia, Kiran

AU - Kaur, Jasmine

AU - Shekhar, Medha

AU - Kate, Anita

AU - Aggarwal, Gunjan

AU - Ghosh, Runa

AU - Kishore, Kunal

AU - Mehra, Navneet

AU - Arya, Nikita

AU - Chaudhary, Ritu

AU - Tamaria, Anuradha

AU - Kumar, Tivendra

AU - Karantha C, Sowmya

AU - Modi, Purnima

AU - Kaur, Neelam

AU - Tyagi, Neha

AU - Mehto, Geeta

AU - Khatun, Afifa

AU - Ahmed, Sayeed

AU - Singh, Aparna

AU - Ansari, Gulafshan

AU - Kaur, Ramanjeet

AU - Gupta, Manisha

AU - Pant, Girish Chand

AU - Dutta, Ankita

AU - More, Deepak

AU - Kumar, Mukesh

AU - Kuruvilla, Sonia

AU - Chandra, Anjali

AU - Debata, Pradeep

AU - Yadav, Anita

AU - Jain, Abhinav

AU - Sachdev, Rahul

AU - Bansal, Omprakash

AU - Agarwal, Raghav

PY - 2024/1/2

Y1 - 2024/1/2

N2 - ImportanceMultidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.ObjectiveTo evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.Design, Setting, and ParticipantsIn this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial’s secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2020, through February 25, 2022.InterventionsHealth, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.Main Outcomes and MeasuresCognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.ResultsThe mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.Conclusions and RelevanceMultidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children’s development warrant further evaluation.

AB - ImportanceMultidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.ObjectiveTo evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.Design, Setting, and ParticipantsIn this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial’s secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2020, through February 25, 2022.InterventionsHealth, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.Main Outcomes and MeasuresCognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.ResultsThe mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.Conclusions and RelevanceMultidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children’s development warrant further evaluation.

KW - General Medicine

U2 - 10.1001/jama.2023.23727

DO - 10.1001/jama.2023.23727

M3 - Article

SN - 0098-7484

VL - 331

SP - 28

EP - 37

JO - JAMA

JF - JAMA

IS - 1

ER -

Child neurodevelopment after multidomain interventions from preconception through early childhood

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