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FRIMED2-FRIPRO forskerprosjekt, medisin og helse

The importance of prenatal and postnatal nutrition on ADHD and cognitive functions in children

Alternative title: Betydningen av mors kosthold i svangerskapet for utvikling av ADHD symptomer og kognitive funksjoner hos barn

Awarded: NOK 8.8 mill.

Neurodevelopmental disorders, like ADHD, are prevalent mental disorders among children in Norway and worldwide. Because successful and lasting treatment of these disorders remains a challenge, the identification of preventable risk factors, like nutritional factors, should be a research priority. While nutritional factors have been studied in patients with ADHD, the effect of maternal nutrition during pregnancy and infancy on neurodevelopment in the child has hardly been studied. The main aim of this project is to investigate how nutritional factors in utero and early childhood are associated with neurodevelopment in the child; including cognitive functioning and symptoms of neurodevelopmental disorders. We focus on dietary patterns during pregnancy and infancy, as well as maternal iron status during pregnancy. The study population includes 1) participants in the Norwegian Mother and Child Cohort Study (MoBa) with parent-reported symptoms of neurodevelopmental disorders and other cognitive outcomes at 18 months to 8 years 2) a sub sample of MoBa participants with measured biomarkers (including iron status); and 3) children diagnosed with a mental health disorder in The Norwegian Patient Registry. Using the combination of questionnaire data and registry data as well as biological data simultaneously provides a unique opportunity to investigate the associations between pre and post-natal nutrition and neurodevelopment in the child. Results from this project can guide development of research-based advice on nutrition during pregnancy and infancy, in order to provide optimal conditions during critical periods of brain development, as well as being an important first step in the development of efficient and long-term preventive strategies for symptoms of neurodevelopmental disorders. In a systematic review of the research literature on the impact of maternal diet during pregnancy for child neurodevelopment published in 2017, we found a total of 18 relevant studies. Only four of these looked at dietary patterns, while the other studies investigated the impact of dietary factors like fish and fibre. A meta-analysis of the results from these studies showed a small, but significant, relationship between maternal diet and neurodevelopment in the child, with the strongest relationship seen for cognitive development relative to emotional development. Findings from this study substantiate the need for more research in this field. In 2019 we published a paper looking at the impact of maternal diet quality during pregnancy on cognitive, language and motor functions in the child, based on data from the Norwegian mother and child cohort study (MoBa). Here we developed a "healthy eating index" measuring adherence to the Norwegian food-based dietary guidelines. The paper was published in American Journal of Epidemiology. In two other papers we have investigated the importance of maternal iron status in pregnancy in relation to cognitive, language and motor functions in the child, as well as identifying important maternal factors associated with low iron status during pregnancy. Examples of groups with increased risk of low iron status was women with many previous pregnancies, particularly if last pregnancy was recent. We have also worked with methods for predicting levels of maternal iron during pregnancy based on information from the MoBa food frequency questionnaire. These papers are in the process of development for journal admission. We have also published a paper in Science of The Total Environment in 2019 where we investigated how low maternal iron status during pregnancy was associated with increased blood concentrations of other metals like manganese, cadmium and cobalt. These methods will be used to evaluate whether different maternal iron levels have differing influence on child development. We have recently finished the third manuscript in the PhD WP which have been sent for publication in a scientific journal. Here we investigated the association between maternal diet quality during pregnancy and child diet quality at three years and child ADHD symptoms at eight years and ADHD diagnosis from Norwegian Patient Registry. The PhD thesis was also completed and submitted in September 2020.

We have increased the scarce knowledge base on the influence of overall maternal diet on child developmental outcomes in Norwegian pregnant populations. We further provide new knowledge on iron status among pregnant women in Norway and its implications for child health. Based on this knowledge we can provide better recommendations on what directions future research within this field should focus on. Collaborators in our project are communicating directly with national and international Nutrition Councils to implement our findings into advice to women of fertile age. For instance, our results underline the need for continued focus on securing an adequate iron status among women of childbearing age. The results obtained from this project alone are not robust enough to provide solid basis for development of e.g. specific nutritional advice for pregnant women. The results do however provide more evidence to the scarce evidence pool of the topics addressed in this project.

Neurodevelopmental disorders, like ADHD, are prevalent mental disorders among children in Norway and worldwide. Knowledge about etiology is limited and it is of great public health importance, for the purpose of prevention, to identify risk factors for these debilitating disorders. While nutritional factors have been studied in patients with ADHD, the effect of maternal nutrition during pregnancy on neurodevelopment in the child is almost totally neglected. The main aim is to investigate how nutritional factors in utero and early childhood are associated with neurodevelopment in the child; including cognitive functioning and symptoms of neurodevelopmental disorders. The present project is designed to investigate the hypotheses that a healthy maternal dietary pattern may be beneficial to ensure a typical neurodevelopment, and that an unhealthy dietary pattern and/or low maternal iron status may be a risk factor for impaired neurodevelopment. We will focus on dietary patterns during pregnancy and early childhood, as well as maternal iron status before and during pregnancy. The study population will include 1) participants in the Norwegian Mother and Child Cohort Study (MoBa) with parent-reported symptoms of neurodevelopmental disorders at 18 months, 3, 5 and 8 years (max. n~76,000), including 3000 mothers with measured biomarkers; 2) children with clinically assessed psychiatric symptoms in the ADHD sub-study (n=1195); and 3) children diagnosed with a mental health disorder in The Norwegian Patient Registry (n~2000 cases). MoBa represent a unique opportunity to investigate exposure-outcome relationships in a large number of children. If all or parts of our hypotheses are confirmed, research based advice on nutrition during pregnancy in order to provide optimal conditions during critical periods of brain development may represent a new way to reduce the risk of neurodevelopmental disorders or deficits through relatively simple interventions.

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FRIMED2-FRIPRO forskerprosjekt, medisin og helse

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