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      Effect of maternal pre-pregnancy underweight and average gestational weight gain on physical growth and intellectual development of early school-aged children

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          Abstract

          The aim of this study was to assess the effect of low maternal weight at pre-pregnancy and the average gestational weight gain on undernourished children and their intellectual development. From October 2012 to September 2013, we followed 1744 offspring of women who participated in a trial conducted from 2002 to 2006. Pregnant women recruited in the original trial could receive three prenatal health checks for free, at which maternal weight and height were measured. WISC-IV was used to estimate the intellectual development of children. Weight and height of both pregnant women and children were measured by trained anthropometrists using standard procedures. Having low maternal weight at pre-pregnancy was associated with an increased risk of undernutrition amongst children (underweight: OR = 2.02, 95%CI: 1.14–3.56, thinness: OR = 2.79, 95%CI: 1.50–5.17) and a decrease in verbal comprehension index (−2.70 points, 95%CI: −4.95–0.44) of children. The effect of average gestational weight gain on occurrences of underweight children (OR = 0.08, 95%CI: 0.01–0.55) was also found. We identified the effect of maternal pre-pregnancy underweight on impairment of the separate intellectual domains (verbal comprehension index) and increasing occurrence of undernourished children. Average gestational weight gain was positively associated with a decreased prevalence of underweight children but not with the intellectual development of children in rural China.

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          Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India.

          Using data from India, we estimate the relationship between household wealth and children's school enrollment. We proxy wealth by constructing a linear index from asset ownership indicators, using principal-components analysis to derive weights. In Indian data this index is robust to the assets included, and produces internally coherent results. State-level results correspond well to independent data on per capita output and poverty. To validate the method and to show that the asset index predicts enrollments as accurately as expenditures, or more so, we use data sets from Indonesia, Pakistan, and Nepal that contain information on both expenditures and assets. The results show large, variable wealth gaps in children's enrollment across Indian states. On average a "rich" child is 31 percentage points more likely to be enrolled than a "poor" child, but this gap varies from only 4.6 percentage points in Kerala to 38.2 in Uttar Pradesh and 42.6 in Bihar.
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            Brain development of very preterm and very low-birthweight children in childhood and adolescence: a meta-analysis.

            The aim of this article was to clarify the impact and consequences of very preterm birth (born <32wks of gestation) and/or very low birthweight ([VLBW], weighing <1500g) on brain volume development throughout childhood and adolescence. The computerized databases PubMed, Web of Knowledge, and EMBASE were searched for studies that reported volumetric outcomes during childhood or adolescence using magnetic resonance imaging and included a term-born comparison group. Fifteen studies were identified, encompassing 818 very preterm/VLBW children and 450 term-born peers. Average reductions in the total brain volume, white matter volume, grey matter volume, and in the size of the cerebellum, hippocampus, and corpus callosum were investigated using meta-analytic methods. Very preterm/VLBW children were found to have a significantly smaller total brain volume than the comparison group (d=-0.58; 95% confidence interval [CI] -0.43 to -0.73; p<0.001), smaller white matter volume (d=-0.53; CI -0.40 to -0.67; p<0.001), smaller grey matter volume (d=-0.62; CI -0.48 to -0.76; p<0.001), smaller cerebellum (d=-0.74; CI -0.56 to -0.92; p<0.001), smaller hippocampus (d=-0.47; CI -0.26 to -0.69; p<0.001), and smaller corpus callosum (d=-0.71; CI -0.34 to -1.07; p<0.001). Reductions have been associated with decreased general cognitive functioning, and no relations with age at assessment were found.   Very preterm/VLBW birth is associated with an overall reduction in brain volume, which becomes evident in equally sized reductions in white and grey matter volumes, as well as in volumes of diverse brain structures throughout childhood and adolescence. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.
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              Impact of micronutrient supplementation during pregnancy on birth weight, duration of gestation, and perinatal mortality in rural western China: double blind cluster randomised controlled trial

              Objective To examine the impact of antenatal supplementation with multiple micronutrients or iron and folic acid compared with folic acid alone on birth weight, duration of gestation, and maternal haemoglobin concentration in the third trimester. Design Cluster randomised double blind controlled trial. Setting Two rural counties in north west China. Participants 5828 pregnant women and 4697 live births. Interventions Villages were randomised for all pregnant women to take either daily folic acid (control), iron with folic acid, or multiple micronutrients with a recommended allowance of 15 vitamins and minerals. Main outcome measures Birth weight, length, and head circumference measured within 72 hours after delivery. Neonatal survival assessed at the six week follow-up visit. Results Birth weight was 42 g (95% confidence interval 7 to 78 g) higher in the multiple micronutrients group compared with the folic acid group. Duration of gestation was 0.23 weeks (0.10 to 0.36 weeks) longer in the iron-folic acid group and 0.19 weeks (0.06 to 0.32 weeks) longer in the multiple micronutrients group. Iron-folic acid was associated with a significantly reduced risk of early preterm delivery (<34 weeks) (relative risk 0.50, 0.27 to 0.94, P=0.031). There was a significant increase in haemoglobin concentration in both iron-folic acid (5.0 g/l, 2.0 to 8.0 g/l, P=0.001) and multiple micronutrients (6.9 g/l, 4.1 to 9.6 g/l, P<0.001) groups compared with folic acid alone. In post hoc analyses there were no significant differences for perinatal mortality, but iron-folic acid was associated with a significantly reduced early neonatal mortality by 54% (relative risk 0.46, 0.21 to 0.98). Conclusion In rural populations in China antenatal supplementation with iron-folic acid was associated with longer gestation and a reduction in early neonatal mortality compared with folic acid. Multiple micronutrients were associated with modestly increased birth weight compared with folic acid, but, despite this weight gain, there was no significant reduction in early neonatal mortality. Pregnant women in developing countries need sufficient doses of iron in nutrient supplements to maximise reductions in neonatal mortality. Trial registration ISRCTN08850194.
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                Author and article information

                Contributors
                yh.paper_xjtu@aliyun.com
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                13 August 2018
                13 August 2018
                2018
                : 8
                : 12014
                Affiliations
                [1 ]ISNI 0000 0001 0599 1243, GRID grid.43169.39, Department of Epidemiology and Biostatistics, School of Public Health, , Xi’an Jiaotong University Health Science Center, ; Xi’an, China
                [2 ]Department of Health Information, Shaanxi Provincial Center for Disease Control and Prevention, Xi’an, China
                [3 ]ISNI 0000 0004 1936 9764, GRID grid.48004.38, Department of Clinical Sciences, , Liverpool School of Tropical Medicine, Pembroke Place, ; Liverpool, United Kingdom
                [4 ]Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi’an, China
                [5 ]ISNI 0000 0001 0599 1243, GRID grid.43169.39, Key Laboratory of Environment and Genes Related to Diseases, , Xi’an Jiaotong University, ; Xi’an, China
                Article
                30514
                10.1038/s41598-018-30514-6
                6089877
                30104682
                f7e44872-a21b-4ea9-b9b0-48de53857206
                © The Author(s) 2018

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 September 2017
                : 23 July 2018
                Funding
                Funded by: FundRef https://doi.org/10.13039/501100001809, National Natural Science Foundation of China (National Science Foundation of China);
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award ID: 81230016
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/501100002858, China Postdoctoral Science Foundation;
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award ID: 2016M592804
                Award Recipient :
                Funded by: FundRef https://doi.org/10.13039/501100004602, Program for New Century Excellent Talents in University (Program for New Century Excellent Talents);
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award ID: NCET-11-0417
                Award Recipient :
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