Further Considerations on Adverse Childhood Experiences and Neurocognitive Development—Reply

Abstract

In Reply We are privileged to address questions raised regarding our article. 1 Chen and Chen had questions on maternal anemia. Indeed, we did not collect these data, and iron deficiency anemia in pregnancy was not an exclusion criterion for the trial. We agree that gestational anemia is a global challenge and prevention is strongly advocated. 2 However, even though iron supplementation is beneficial for mothers, it has been shown to not improve the neonatal outcomes of low birthweight, preterm delivery, or infant mortality. 3 Similarly, no significant benefit of routine antenatal iron supplementation was seen in terms of offspring neurodevelopment. 4 These results should be interpreted in the context of baseline risk for gestational anemia in a population (the higher the rate of gestational anemia, the better effect of iron supplementation). 5 As suggested, it would rather be of value to plan trials to study the effects of antenatal supplementation based on the regional differences in rates of anemia, rather than anemia in individual pregnant women.Jiang and Cui had questions on the lack of effect of iron supplementation on risk of iron deficiency at 12 months. In this case, it is important to interpret the findings in the context of the low baseline risk in the study population. The cited systematic review by Pasricha et al 6 concluded that daily iron supplementation in children aged 4 to 24 months reduced the risk of anemia, but it included populations with high risk of anemia. We agree that it would have been optimal to obtain blood samples directly after the intervention period. However, even if we were not able to observe the transient difference in iron status between the groups, the effect of iron supplementation on psychomotor development was still absent, and the conclusions of our article are still valid.