Effects of Micronutrients during Pregnancy and Early Infancy on Mental and Psychomotor Development
Spectacular progress has been made in the last decades in the global fight against deficiencies of iodine and vitamin A . As a result, the number of people suffering from iodine deficiency has been reduced from about 1.5 billion in 1990 to about 0.5 billion now, almost entirely due to the introduction in many countries of what has been termed ‘universal salt iodization’. In addition, approximately one million child deaths may have been prevented between 1998 and 2000 by vitamin A supplementation . The political and financial commitment that has allowed these achievements has been generated to a large extent by scientific studies that have shown the extent of human suffering caused by these deficiencies, and that have determined the potential health gains of interventions. Progress in eliminating deficiencies of other micronutrients, notably iron, has been much slower. About two billion people, or about one third of the human population, continue to suffer from iron deficiency. Iron supplementation programs have been advocated for infants and preschool children, largely because of concerns of possible adverse effects of iron deficiency on mental and motor development. Similar concerns were instrumental in establishing salt iodization programs. The questions that will be addressed in this chapter concern the extent to which a shortage of iodine and iron during fetal and infant development impairs mental development, and the extent to which this impairment can be redressed by increasing the intake of these micronutrients. First, the stages of brain development in the fetus and infant will be addressed, followed by an assessment of the timing of vulnerable periods when the brain of the fetus and infant is at high risk of exposure to an inadequate supply of iodine or iron. Where possible, the mechanisms involved will be discussed. Then, observational and intervention studies will be reviewed that have examined the effect of deficiencies of iodine or iron on mental development. Approximately half of the world’s population may be at risk of low zinc intake . Given this high prevalence, inconclusive but mounting evidence that zinc deficiency during pregnancy may possibly impair the infant’s neurobehavioral development and immune function should also raise great concern [4–10]. However, because of space limitations, such effects and those of other micronutrients  will not be reviewed in the present report.