human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To determine the impact of iron deficiency anemia ( IDA ) in pregnancy on young child development . METHODS : A 2-year follow-up of 850 children born to women who participated in a double-blind cluster r and omized controlled trial of prenatal micronutrient supplementation in western rural China . These women were r and omly assigned to receive either daily folic acid , iron/folic acid ( 60 mg iron ) , or multiple micronutrients ( with 30 mg iron ) during pregnancy . Children were categorized into the prenatal-IDA and prenatal – non-IDA groups based on the mother ’s hemoglobin in the third trimester . Each group contained 3 subgroups based on mother ’s treatment : folic acid , iron/folic acid , and multiple micronutrients .  Bayley scales of infant development were administered to the children to assess their development at 3 , 6 , 12 , 18 , and 24 months of age . RESULTS : Compared with the prenatal – non-IDA group , the prenatal-IDA group showed a significantly lower mental development index at 12 , 18 , and 24 months of age . The adjusted mean difference was 5.8 ( 95 % confidence interval [ CI ] , 1.1–10.5 ) , 5.1 ( 95 % CI , 1.2–9.0 ) , and 5.3 ( 95 % CI , 0.9–9.7 ) , respectively . Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal – non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients . CONCLUSIONS : Prenatal IDA in the third trimester is associated with mental development of the child . However , prenatal supplementation with sufficient iron protects child development even when the woman ’s IDA was not properly corrected in pregnancy Background Antenatal anaemia , iron deficiency and common mental disorders ( CMD ) are prevalent in low- and middle-income countries . The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development . Methods A cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 r and omly-selected rural communes in Ha Nam province was recruited . Participants provided data twice during pregnancy ( early and late gestation ) and twice after giving birth ( 8 weeks and 6 months postpartum ) . The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD ( score ≥ 4 ) . Maternal anaemia ( Hb < 11 g/dL ) and iron deficiency ( ferritin < 15 ng/mL ) were evaluated at early and late gestation . Infants ’ motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales ( BSID-M ) at the age of six months . Direct and indirect effects of the exposures on the outcome were examined with Path analysis . Results In total , 497 of 523 ( 97 % ) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses . The prevalence of anaemia was 21.5 % in early pregnancy and 24.4 % in late pregnancy . There was 4.1 % iron deficiency at early pregnancy and 48.2 % at late pregnancy . Clinical ly significant symptoms of CMD were apparent among 40 % women in early pregnancy and 28 % in late pregnancy . There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy ( an estimated mean reduction of 2.61 points , 95 % Confidence Interval , CI , 0.57 to 4.65 ) and CMD in early pregnancy ( 7.13 points , 95 % CI 3.13 to 11.13 ) . Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy . Conclusions Antenatal anaemia , iron deficiency , and CMD have a negative impact on subsequent infant motor development . These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries BACKGROUND Iron supplements are often prescribed during pregnancy despite the lack of intervention trials that have assessed the effects of supplementation in pregnancy on childhood development . OBJECTIVE The objective was to determine whether iron supplementation during pregnancy influences  childhood intelligence quotient ( IQ )  in an industrialized country . DESIGN Pregnant women ( n = 430 ) were r and omly allocated to receive iron ( 20 mg/d ) or placebo from 20 wk gestation until delivery , and the women and their children were followed up over the long term ( 4 y ) . Seventy percent of these families participated in the follow-up . The proportion of women with iron deficiency anemia at the end of pregnancy was 1 % ( 2 of 146 ) in the iron group and 11 % ( 15 of 141 ) in the placebo group . The primary outcome was the IQ of the children at 4 y of age , as assessed by the Stanford-Binet Intelligence Scale . Secondary outcomes included child behavior and the general health of the mothers . RESULTS The mean IQ was not significantly different ( P = 0.980 ) between the children of the iron-supplemented mothers ( 109 + /- 11 ; n = 153 ) and the children of the mothers in the placebo group ( 109 + /- 11 ; n = 149 ) . However , the percentage of children with an abnormal behavior score was higher in the iron group ( 24 of 151 , or 16 % ) than in the placebo group ( 12 of 149 , or 8 % ) ; the relative risk was 1.97 ( 95 % CI : 1.03 , 3.80 ; P = 0.037 ) . There was no significant difference in the health of the mothers between groups , as assessed by the SF-36 Health Survey . CONCLUSIONS Prenatal iron supplementation that reduces the incidence of iron deficiency anemia from 11 % to 1 % has no effect on the IQ of the offspring at 4 y of age BACKGROUND Iron deficiency anemia ( IDA ) is common in pregnant women , but previous trials aim ed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects . OBJECTIVE The objective was to assess the effect on  maternal IDA and iron deficiency ( ID , without anemia ) of supplementing pregnant women with a low dosage ( 20 mg/d ) of iron . Effects on iron status were assessed at the time of delivery and at 6 mo postpartum . Gastrointestinal side effects were assessed at 24 and 36 wk of gestation . DESIGN This was a r and omized , double-blind , placebo-controlled trial of a 20-mg daily iron supplement ( ferrous sulfate ) given from 20 wk of gestation until delivery . RESULTS A total of 430 women were enrolled , and 386 ( 89.7 % ) completed the follow-up to 6 mo postpartum . At delivery , fewer women from the iron-supplemented group than from the placebo group had IDA [ 6/198 , or 3 % , compared with 20/185 , or 11 % ; relative risk ( RR ) : 0.28 ; 95 % CI : 0.12 , 0.68 ; P < 0.005 ] , and fewer women from the iron-supplemented group had ID ( 65/186 , or 35 % , compared with 102/176 , or 58 % ; RR : 0.60 ; 95 % CI : 0.48 , 0.76 ; P < 0.001 ) . There was no significant difference in gastrointestinal side effects between groups . At 6 mo postpartum , fewer women from the iron-supplemented group had ID ( 31/190 , or 16 % , compared with 51/177 , or 29 % ; RR : 0.57 ; 95 % CI : 0.38 , 0.84 ; P < 0.005 ) . The rate of IDA between the groups did not differ significantly at 6 mo postpartum . CONCLUSION Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects BACKGROUND Few data exist for the effects of multiple micronutrient ( MM ) or food supplementation to undernourished pregnant women on their offsprings ' development . OBJECTIVE We aim ed to compare the effects on infant development of early ( 8 - 10 wk gestation ) or usual ( approximately 17 wk gestation ) supplementation with food and MM , 30 mg Fe + 400 microg folate , or 60 mg Fe + 400 microg folate . DESIGN A large , r and omized , controlled trial of pregnancy supplementation was conducted in Bangladesh . A sub sample of infants ( n = 2853 ) were assessed on 2 problem-solving tests ( support and cover tests ) , the motor index of the Bayley Scales of Infant Development , and Wolke 's behavior ratings at 7 mo of age . RESULTS There were no significant effects of any intervention in the group as a whole . However , infants of undernourished mothers [ body mass index ( BMI ; in kg/m2 ) < 18.5 ] who received early food supplementation performed slightly but significantly ( P = 0.035 ) better on the support test than did infants of mothers who received usual food supplementation ( z score : 0.17 ; 95 % CI : 0.01 , 0.33 ) . There were no benefits in infants of higher- BMI mothers ( P = 0.024 for BMI x food interaction ) . Children of low- BMI mothers who received MMs had slightly better motor scores ( z score : 0.28 ; 95 % CI : 0.08 , 0.48 ) and activity ratings ( z score : 0.24 ; 95 % CI : 0.037 , 0.45 ) than did those who received 30 mg Fe + 400 microg folate , whereas other children did not benefit ( P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients ) . CONCLUSIONS Small benefits from early food and MM supplementation were found in infants of low- BMI but not of high- BMI mothers . However , the benefits were of doubtful functional importance , and longer follow-up is required to determine programmatic implication Maternal nutrition is important for fetal development , but its impact on the functional outcome of infants is still unclear . The present study investigated the effects of vitamin A and Fe supplementation during gestation on  infant mental and psychomotor development . Mothers of infants from five villages in Indonesia were r and omly assigned to supervised , double-blind supplementation once per week from approximately 18 weeks of pregnancy until delivery . Supplementation comprised 120 mg Fe+500 microg folic acid with ( n 94 ) or without ( n 94 ) 4800 microg retinol in the form of retinyl acetate .  Mothers of infants who participated in the national Fe+folic acid supplementation programme , but whose intake of supplements was not supervised , were recruited from four other villages ( n 88 ) . The mental and psychomotor development of infants was assessed , either at 6 or 12 months of age , using the Bayley Scales of Infant Development ( BSID ) . We found no impact of vitamin A supplementation on mental or psychomotor development of infants . In addition , infants whose mothers had received weekly Fe supplementation had similar mental and psychomotor indices as those whose mothers had participated in the governmental Fe supplementation programme . The study population was moderately Fe and vitamin A deficient . The size of the treatment groups was large enough to detect a mean difference of 10 points on the BSID , which is less than 1 sd ( 15 points ) of the average performance of an infant on the BSID . In conclusion , the present study did not find an impact of weekly supplementation of 4800 RE vitamin A in addition to Fe during gestation on functional development  of Indonesian infants . However , smaller improvements in development may be seen if studied in a larger and /or more deficient population Beverley-Anne Biggs and colleagues conduct a community-based cluster r and omized trial in rural Viet Nam to compare the effect of antenatal iron-folic acid supplementation taken daily or twice weekly on  maternal and infant outcomes . Please see later in the article for the Editors ' OBJECTIVES : We investigated the relative benefit of maternal multiple micronutrient ( MMN ) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age ( 42 months ) . METHODS : We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial , a cluster-r and omized trial in Indonesia , on tests adapted and vali date d in the local context measuring motor , language , visual attention/spatial , executive , and socioemotional abilities . Analysis was according to intention to treat . RESULTS : In children of undernourished mothers ( mid-upper arm circumference < 2 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To determine the impact of iron deficiency anemia ( IDA ) in pregnancy on young child development . METHODS : A 2-year follow-up of 850 children born to women who participated in a double-blind cluster r and omized controlled trial of prenatal micronutrient supplementation in western rural China . These women were r and omly assigned to receive either daily folic acid , iron/folic acid ( 60 mg iron ) , or multiple micronutrients ( with 30 mg iron ) during pregnancy . Children were categorized into the prenatal-IDA and prenatal – non-IDA groups based on the mother ’s hemoglobin in the third trimester . Each group contained 3 subgroups based on mother ’s treatment : folic acid , iron/folic acid , and multiple micronutrients .  Bayley scales of infant development were administered to the children to assess their development at 3 , 6 , 12 , 18 , and 24 months of age . RESULTS : Compared with the prenatal – non-IDA group , the prenatal-IDA group showed a significantly lower mental development index at 12 , 18 , and 24 months of age . The adjusted mean difference was 5.8 ( 95 % confidence interval [ CI ] , 1.1–10.5 ) , 5.1 ( 95 % CI , 1.2–9.0 ) , and 5.3 ( 95 % CI , 0.9–9.7 ) , respectively . Further analysis showed that the mental development indexes in the prenatal-IDA group and prenatal – non-IDA group were similar with supplementation of iron/folic acid but were significantly lower in the prenatal-IDA group with supplementation of folic acid or multiple micronutrients . CONCLUSIONS : Prenatal IDA in the third trimester is associated with mental development of the child . However , prenatal supplementation with sufficient iron protects child development even when the woman ’s IDA was not properly corrected in pregnancy Background Antenatal anaemia , iron deficiency and common mental disorders ( CMD ) are prevalent in low- and middle-income countries . The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development . Methods A cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 r and omly-selected rural communes in Ha Nam province was recruited . Participants provided data twice during pregnancy ( early and late gestation ) and twice after giving birth ( 8 weeks and 6 months postpartum ) . The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD ( score ≥ 4 ) . Maternal anaemia ( Hb < 11 g/dL ) and iron deficiency ( ferritin < 15 ng/mL ) were evaluated at early and late gestation . Infants ’ motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales ( BSID-M ) at the age of six months . Direct and indirect effects of the exposures on the outcome were examined with Path analysis . Results In total , 497 of 523 ( 97 % ) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses . The prevalence of anaemia was 21.5 % in early pregnancy and 24.4 % in late pregnancy . There was 4.1 % iron deficiency at early pregnancy and 48.2 % at late pregnancy . Clinical ly significant symptoms of CMD were apparent among 40 % women in early pregnancy and 28 % in late pregnancy . There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy ( an estimated mean reduction of 2.61 points , 95 % Confidence Interval , CI , 0.57 to 4.65 ) and CMD in early pregnancy ( 7.13 points , 95 % CI 3.13 to 11.13 ) . Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy . Conclusions Antenatal anaemia , iron deficiency , and CMD have a negative impact on subsequent infant motor development . These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries BACKGROUND Iron supplements are often prescribed during pregnancy despite the lack of intervention trials that have assessed the effects of supplementation in pregnancy on childhood development . OBJECTIVE The objective was to determine whether iron supplementation during pregnancy influences  childhood intelligence quotient ( IQ )  in an industrialized country . DESIGN Pregnant women ( n = 430 ) were r and omly allocated to receive iron ( 20 mg/d ) or placebo from 20 wk gestation until delivery , and the women and their children were followed up over the long term ( 4 y ) . Seventy percent of these families participated in the follow-up . The proportion of women with iron deficiency anemia at the end of pregnancy was 1 % ( 2 of 146 ) in the iron group and 11 % ( 15 of 141 ) in the placebo group . The primary outcome was the IQ of the children at 4 y of age , as assessed by the Stanford-Binet Intelligence Scale . Secondary outcomes included child behavior and the general health of the mothers . RESULTS The mean IQ was not significantly different ( P = 0.980 ) between the children of the iron-supplemented mothers ( 109 + /- 11 ; n = 153 ) and the children of the mothers in the placebo group ( 109 + /- 11 ; n = 149 ) . However , the percentage of children with an abnormal behavior score was higher in the iron group ( 24 of 151 , or 16 % ) than in the placebo group ( 12 of 149 , or 8 % ) ; the relative risk was 1.97 ( 95 % CI : 1.03 , 3.80 ; P = 0.037 ) . There was no significant difference in the health of the mothers between groups , as assessed by the SF-36 Health Survey . CONCLUSIONS Prenatal iron supplementation that reduces the incidence of iron deficiency anemia from 11 % to 1 % has no effect on the IQ of the offspring at 4 y of age BACKGROUND Iron deficiency anemia ( IDA ) is common in pregnant women , but previous trials aim ed at preventing IDA used high-dose iron supplements that are known to cause gastrointestinal side effects . OBJECTIVE The objective was to assess the effect on  maternal IDA and iron deficiency ( ID , without anemia ) of supplementing pregnant women with a low dosage ( 20 mg/d ) of iron . Effects on iron status were assessed at the time of delivery and at 6 mo postpartum . Gastrointestinal side effects were assessed at 24 and 36 wk of gestation . DESIGN This was a r and omized , double-blind , placebo-controlled trial of a 20-mg daily iron supplement ( ferrous sulfate ) given from 20 wk of gestation until delivery . RESULTS A total of 430 women were enrolled , and 386 ( 89.7 % ) completed the follow-up to 6 mo postpartum . At delivery , fewer women from the iron-supplemented group than from the placebo group had IDA [ 6/198 , or 3 % , compared with 20/185 , or 11 % ; relative risk ( RR ) : 0.28 ; 95 % CI : 0.12 , 0.68 ; P < 0.005 ] , and fewer women from the iron-supplemented group had ID ( 65/186 , or 35 % , compared with 102/176 , or 58 % ; RR : 0.60 ; 95 % CI : 0.48 , 0.76 ; P < 0.001 ) . There was no significant difference in gastrointestinal side effects between groups . At 6 mo postpartum , fewer women from the iron-supplemented group had ID ( 31/190 , or 16 % , compared with 51/177 , or 29 % ; RR : 0.57 ; 95 % CI : 0.38 , 0.84 ; P < 0.005 ) . The rate of IDA between the groups did not differ significantly at 6 mo postpartum . CONCLUSION Supplementing the diet of women with 20 mg Fe/d from week 20 of pregnancy until delivery is an effective strategy for preventing IDA and ID without side effects BACKGROUND Few data exist for the effects of multiple micronutrient ( MM ) or food supplementation to undernourished pregnant women on their offsprings ' development . OBJECTIVE We aim ed to compare the effects on infant development of early ( 8 - 10 wk gestation ) or usual ( approximately 17 wk gestation ) supplementation with food and MM , 30 mg Fe + 400 microg folate , or 60 mg Fe + 400 microg folate . DESIGN A large , r and omized , controlled trial of pregnancy supplementation was conducted in Bangladesh . A sub sample of infants ( n = 2853 ) were assessed on 2 problem-solving tests ( support and cover tests ) , the motor index of the Bayley Scales of Infant Development , and Wolke 's behavior ratings at 7 mo of age . RESULTS There were no significant effects of any intervention in the group as a whole . However , infants of undernourished mothers [ body mass index ( BMI ; in kg/m2 ) < 18.5 ] who received early food supplementation performed slightly but significantly ( P = 0.035 ) better on the support test than did infants of mothers who received usual food supplementation ( z score : 0.17 ; 95 % CI : 0.01 , 0.33 ) . There were no benefits in infants of higher- BMI mothers ( P = 0.024 for BMI x food interaction ) . Children of low- BMI mothers who received MMs had slightly better motor scores ( z score : 0.28 ; 95 % CI : 0.08 , 0.48 ) and activity ratings ( z score : 0.24 ; 95 % CI : 0.037 , 0.45 ) than did those who received 30 mg Fe + 400 microg folate , whereas other children did not benefit ( P = 0.05 for both motor scores and BMI x micronutrients and for activity and BMI x micronutrients ) . CONCLUSIONS Small benefits from early food and MM supplementation were found in infants of low- BMI but not of high- BMI mothers . However , the benefits were of doubtful functional importance , and longer follow-up is required to determine programmatic implication Maternal nutrition is important for fetal development , but its impact on the functional outcome of infants is still unclear . The present study investigated the effects of vitamin A and Fe supplementation during gestation on  infant mental and psychomotor development . Mothers of infants from five villages in Indonesia were r and omly assigned to supervised , double-blind supplementation once per week from approximately 18 weeks of pregnancy until delivery . Supplementation comprised 120 mg Fe+500 microg folic acid with ( n 94 ) or without ( n 94 ) 4800 microg retinol in the form of retinyl acetate .  Mothers of infants who participated in the national Fe+folic acid supplementation programme , but whose intake of supplements was not supervised , were recruited from four other villages ( n 88 ) . The mental and psychomotor development of infants was assessed , either at 6 or 12 months of age , using the Bayley Scales of Infant Development ( BSID ) . We found no impact of vitamin A supplementation on mental or psychomotor development of infants . In addition , infants whose mothers had received weekly Fe supplementation had similar mental and psychomotor indices as those whose mothers had participated in the governmental Fe supplementation programme . The study population was moderately Fe and vitamin A deficient . The size of the treatment groups was large enough to detect a mean difference of 10 points on the BSID , which is less than 1 sd ( 15 points ) of the average performance of an infant on the BSID . In conclusion , the present study did not find an impact of weekly supplementation of 4800 RE vitamin A in addition to Fe during gestation on functional development  of Indonesian infants . However , smaller improvements in development may be seen if studied in a larger and /or more deficient population Beverley-Anne Biggs and colleagues conduct a community-based cluster r and omized trial in rural Viet Nam to compare the effect of antenatal iron-folic acid supplementation taken daily or twice weekly on  maternal and infant outcomes . Please see later in the article for the Editors ' OBJECTIVES : We investigated the relative benefit of maternal multiple micronutrient ( MMN ) supplementation during pregnancy and until 3 months postpartum compared with iron/folic acid supplementation on child development at preschool age ( 42 months ) . METHODS : We assessed 487 children of mothers who participated in the Supplementation with Multiple Micronutrients Intervention Trial , a cluster-r and omized trial in Indonesia , on tests adapted and vali date d in the local context measuring motor , language , visual attention/spatial , executive , and socioemotional abilities . Analysis was according to intention to treat . RESULTS : In children of undernourished mothers ( mid-upper arm circumference < 2 
    Output:
    