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Child Neurodevelopment After Multidomain Interventions From Preconception Through Early Childhood: The WINGS
Ravi Prakash Upadhyay1, Sunita Taneja1, Ranadip Chowdhury1
1Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
Insights
Multidomain interventions before and during pregnancy improved child neurodevelopment. These interventions show promise for enhancing early childhood development outcomes.
Area of Science:
- Global Health
- Developmental Pediatrics
- Public Health Interventions
Background:
- Multidomain interventions during pregnancy and early childhood have shown benefits for child neurodevelopment.
- The impact of preconception interventions, in addition to pregnancy and early childhood interventions, remains less understood.
Purpose of the Study:
- To assess the effect of a comprehensive intervention program on child neurodevelopment.
- The program included health, nutrition, water, sanitation, and hygiene (WASH), and psychosocial support.
- Interventions were delivered during preconception, pregnancy, and early childhood periods.
Main Methods:
- A randomized trial was conducted in low- and middle-income neighborhoods in Delhi, India.
- 13,500 participants were initially assigned to preconception interventions or routine care.
- Neurodevelopmental assessments were performed at 24 months in a subsample of children across intervention and control groups.
Main Results:
- Children receiving preconception interventions showed improved cognitive scores compared to controls.
- Interventions during pregnancy and early childhood led to significant improvements in cognitive, language, motor, and socioemotional scores.
- The combined preconception, pregnancy, and early childhood intervention group demonstrated the most substantial gains in all neurodevelopmental domains.
Conclusions:
- Multidomain interventions spanning preconception, pregnancy, and early childhood result in modest but significant improvements in child neurodevelopment at 24 months.
- These comprehensive interventions are valuable for enhancing early childhood development and warrant further investigation.
- Integrating health, nutrition, WASH, and psychosocial support from preconception onwards can positively impact developmental trajectories.
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, 2000, 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.
Trial Registration:
Clinical Trials Registry-India CTRI/2017/06/008908.
