As part of comprehensive maternal and fetal care, prenatal micronutrient supplements should be considered as “uniquely effective first steps in decreasing risk for future psychiatric and other illnesses in newborn children,” conclude the authors of a systematic review of relevant research.
“This paper is the only comprehensive review of the major micronutrients supplements that affect behavioral outcomes from pregnancies,” first author Robert Freedman, MD, from the Department of Psychiatry, University of Colorado School of Medicine in Aurora, told Medscape Medical News.
“The prenatal period is a unique opportunity for safe and effective prevention of brain developmental problems that are associated with later severe mental illnesses. Just as folic acid is effective for preventing neural tube defects only before birth, once the baby is born, this opportunity is past,” said Freedman.
The review was published online March 21 in the American Journal of Psychiatry.
Emotional Development, Mental Illness
Fetal brain development — which is influenced by genotype, by the environment in the womb, and by the mother’s nutrition, her history of infection, and her status with respect to psychiatric disorders and substance use — is the earliest developmental step relating to risk for mental illness, the authors note.
Prenatal interventions to reduce the risk for later mental illness, including schizophrenia, bipolar disorder, and autism, have yet to be firmly established for clinical use.
In the literature review, Freedman and colleagues focused on 45 studies that assessed the effects of prenatal micronutrient supplementation on childhood emotional development and later mental illness. These included four studies on folic acid, 17 on omega-3 fatty acids, nine on phosphatidylcholine, and 15 on vitamins A and D supplementation.
Key findings include the following:
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Folic acid has benefits for the development of the fetal brain and subsequent child behavior and cognition, but it has not been shown specifically to prevent schizophrenia.
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Omega-3 fatty acids increase the risk for later schizophrenia and modestly increase childhood symptoms of attention deficit/hyperactivity disorder, but they also substantively decrease the risk for both premature birth and childhood wheezing.
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Phosphatidylcholine supplements have been studied prospectively and have generally been found to promote the development of the fetal brain and to subsequently affect childhood behavior, but no retrospective epidemiologic studies have been conducted.
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Higher serum levels of vitamins A and D appear to promote brain development and to decrease risk for schizophrenia, but their potential toxicity limits their use to currently recommended amounts.
Research Dilemma
The investigators note that it is unlikely that any single prenatal intervention will prevent mental illnesses in all individuals. To obtain evidence-based data for any nutrient will require new research agendas that emphasize prenatal clinical trials of interventions; early biomarkers of their effectiveness, as developed in translational models; and longer-term follow-up through developmental stages of childhood into adulthood, they add.
“Unlike neural tube defects that present at birth, mental illnesses such as schizophrenia may not appear before early adulthood,” said Freedman.
“To determine if a micronutrient supplement decreases the incidence of adult mental illness would require large groups of women and children treated and then observed for decades. The dilemma, therefore, is how the current research, which can track the early development of behavior in children for only a few years, should guide women who are pregnant now,” he added.
Without definitive evidence, parents currently planning pregnancy have difficult decisions to make about nutrient supplements.
“The mother is unlikely to receive fully effective levels of the currently studied nutrients from diet alone. Adverse effects of supplements are few at the doses studied, but it would be premature to conclude that they are nonexistent,” the investigators write. “Conversely, there is only one opportunity in each child’s life for intervention to enhance fetal brain development and protect the child against developmental risks that arise in this period.”
The review had no commercial funding. Dr Freedman is editor-in-chief of the American Journal of Psychiatry.
Am J Psychiatry. Published online March 21, 2018. Abstract
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