OBJECTIVES. To determine the association between maternal multivitamin supplementation and the mental and psychomotor development of children who are born to HIV-1-infected mothers in Tanzania, as secondary endpoints in a randomized trial that investigated the effect of maternal multivitamin supplementation on HIV-1 vertical transmission and progression.METHODS. The Bayley Scales of Infant Development, 2nd Edition, were administered at 6, 12, and 18 months of age to a subset of children (N ϭ 327). We assessed the effect of vitamin A and multivitamin (vitamins B, C, and E) supplementation using linear regression models and Cox proportional hazard models for the Mental Development Index, the Psychomotor Development Index, and raw scores separately.RESULTS. Multivitamin supplementation was associated significantly with a mean increase in Psychomotor Development Index score of 2.6 (95% confidence interval: 0.1-5.1). Multivitamins were also significantly protective against the risk for developmental delay on the motor scale (relative risk: 0.4; 95% confidence interval: 0.2-0.7) but not on the Mental Development Index. Vitamin A supplementation had no significant effect on these outcomes.CONCLUSIONS. Maternal multivitamin supplements provide a low-cost intervention to reduce the risk for developmental delays among infants who are born to HIVpositive mothers in developing countries. McGRATH, et al by guest on May 11, 2018 http://pediatrics.aappublications.org/ Downloaded from A LTHOUGH STUDIES HAVE sought to improve mental and psychomotor development in children through protein energy 1 and multivitamin child supplements, 2-4 few have examined the effect of maternal supplements on infant development. Nutritional deficiencies are common in children in developing countries. 5 In 1996, 43% of preschool Tanzanian children were stunted (low height for age). 6 Vitamin A, iodine, and iron deficiencies are also prevalent. 7-9 Pepping et al 8 found that vitamin A deficiency was a significant problem in Tanzania, with 1.5% of the preschool age children whom they surveyed having xerophthalmia and 1.6% having Bitot's spots. In addition, children are have HIV-1 infection; antenatal HIV-1 seroprevalence has been ϳ12% since 1995 in Dar es Salaam. 10 Because multivitamin deficiencies are associated with faster HIV disease progression in adults 11 and higher risk for infant morbidity, 12 they may have a negative impact on the mental and psychomotor development of the child.Daily consumption of multivitamin supplements by HIV-1-infected pregnant women has been shown to delay significantly the progression of HIV disease. 13 Multivitamin supplements also resulted in significant reductions in the risk for low birth weight (LBW), severe preterm birth, and fetal loss and improved the immunologic profile of the mothers and increased their hemoglobin concentrations. 14 Vitamin A supplementation during pregnancy has also been shown to reduce the risk for preterm delivery among HIV-infected women. 15 Baylin et al 16 demonstrated that vit...