TABLE 2.
Associations of maternal intake of lutein and zeaxanthin (L/Z) during pregnancy with child cognitive and behavioral outcomes1
| Child outcome Trimester Model2 | Quartiles of maternal L/Z intake | |||
|---|---|---|---|---|
| Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | |
| (reference) | β (95% CI)3 | β (95% CI) | β (95% CI) | |
| Infancy | ||||
| VRM | ||||
| T1 (n = 1071) | ||||
| Model 0 | 0 | −1.30 (−4.20, 1.59) | −2.78 (−5.64, 0.09) | −3.34 (−6.20, −0.47)4 |
| Model 1 | 0 | −1.40 (−4.32, 1.52) | −2.33 (−5.27, 0.61) | −2.92 (−5.92, 0.08) |
| Model 2 | 0 | −1.49 (−4.44, 1.46) | −2.36 (−5.34, 0.63) | −3.22 (−6.39, −0.05)4 |
| T2 (n = 1049) | ||||
| Model 0 | 0 | −0.95 (−3.99, 2.09) | −2.87 (−5.80, 0.06) | −1.06 (−3.95, 1.83) |
| Model 1 | 0 | −0.41 (−3.49, 2.67) | −2.41 (−5.42, 0.61) | −0.30 (−3.33, 2.74) |
| Model 2 | 0 | −0.87 (−3.96, 2.22) | −3.35 (−6.44, −0.26)4 | −1.34 (−4.54, 1.85) |
| Early childhood | ||||
| PPVT-III | ||||
| T1 (n = 1206) | ||||
| Model 0 | 0 | 3.29 (0.90, 5.68)4 | 3.13 (0.74, 5.52)4 | 3.55 (1.18, 5.92)4 |
| Model 1 | 0 | 1.97 (−0.17, 4.11) | 1.12 (−1.04, 3.28) | 1.13 (−1.03, 3.30) |
| Model 2 | 0 | 1.69 (−0.46, 3.84) | 1.00 (−1.20, 3.19) | 0.91 (−1.38, 3.20) |
| T2 (n = 1177) | ||||
| Model 0 | 0 | 2.71 (0.31, 5.12)4 | 3.88 (1.45, 6.31)4 | 4.40 (2.00, 6.80)4 |
| Model 1 | 0 | 0.90 (−1.28, 3.09) | 1.34 (−0.90, 3.58) | 2.07 (−0.17, 4.31) |
| Model 2 | 0 | 0.90 (−1.31, 3.11) | 1.39 (−0.90, 3.68) | 2.17 (−0.23, 4.57) |
| WRAVMA total | ||||
| T1 (n = 1168) | ||||
| Model 0 | 0 | 0.71 (−1.15, 2.57) | 0.25 (−1.60, 2.10) | 0.10 (−1.73, 1.92) |
| Model 1 | 0 | 0.20 (−1.62, 2.03) | −0.77 (−2.60, 1.07) | −0.94 (−2.78, 0.89) |
| Model 2 | 0 | 0.06 (−1.78, 1.90) | −0.89 (−2.76, 0.99) | −1.14 (−3.07, 0.79) |
| T2 (n = 1137) | ||||
| Model 0 | 0 | 0.07 (−1.85, 1.99) | 0.72 (−1.19, 2.64) | 1.01 (−0.88, 2.89) |
| Model 1 | 0 | −0.42 (−2.32, 1.47) | −0.27 (−2.17, 1.63) | 0.02 (−1.90, 1.94) |
| Model 2 | 0 | −0.35 (−2.26, 1.57) | −0.12 (−2.07, 1.84) | 0.31 (−1.75, 2.37) |
| Mid-childhood | ||||
| KBIT-II nonverbal | ||||
| T1 (n = 1106) | ||||
| Model 0 | 0 | 1.96 (−1.05, 4.97) | 1.95 (−1.09, 4.99) | 4.79 (1.82, 7.76)4 |
| Model 1 | 0 | 1.01 (−1.99, 4.01) | 0.10 (−2.96, 3.16) | 3.09 (0.07, 6.12)4 |
| Model 2 | 0 | 0.86 (−2.16, 3.89) | −0.04 (−3.11, 3.04) | 2.87 (−0.31, 6.05) |
| T2 (n = 1064) | ||||
| Model 0 | 0 | 1.05 (−2.09, 4.19) | 3.75 (0.62, 6.87)4 | 3.38 (0.35, 6.42)4 |
| Model 1 | 0 | −0.20 (−3.32, 2.91) | 1.42 (−1.76, 4.60) | 1.00 (−2.17, 4.17) |
| Model 2 | 0 | −0.26 (−3.44, 2.91) | 1.28 (−1.96, 4.52) | 0.60 (−2.73, 3.94) |
| KBIT-II verbal | ||||
| T1 (n = 1093) | ||||
| Model 0 | 0 | 5.19 (2.47, 7.91)4 | 5.02 (2.33, 7.72)4 | 7.13 (4.50, 9.75)4 |
| Model 1 | 0 | 2.48 (0.08, 4.88)4 | 1.33 (−1.11, 3.76) | 3.23 (0.82, 5.65)4 |
| Model 2 | 0 | 2.21 (−0.21, 4.64) | 1.05 (−1.44, 3.53) | 2.67 (0.13, 5.20)4 |
| T2 (n = 1051) | ||||
| Model 0 | 0 | 3.49 (0.66, 6.32)4 | 5.78 (2.96, 8.61)4 | 7.56 (4.84, 10.27)4 |
| Model 1 | 0 | 1.34 (−1.22, 3.89) | 2.10 (−0.50, 4.71) | 3.70 (1.13, 6.28)4 |
| Model 2 | 0 | 1.30 (−1.30, 3.90) | 1.99 (−0.69, 4.66) | 3.55 (0.81, 6.28)4 |
| WRAVMA drawing | ||||
| T1 (n = 1099) | ||||
| Model 0 | 0 | −0.94 (−3.94, 2.05) | −0.40 (−3.41, 2.61) | −0.76 (−3.66, 2.13) |
| Model 1 | 0 | −1.46 (−4.54, 1.61) | −1.55 (−4.67, 1.58) | −1.87 (−4.93, 1.18) |
| Model 2 | 0 | −1.77 (−4.88, 1.33) | −1.87 (−5.03, 1.29) | −2.49 (−5.71, 0.73) |
| T2 (n = 1058) | ||||
| Model 0 | 0 | 0.45 (−2.63, 3.53) | 3.25 (0.21, 6.28) | 2.37 (−0.59, 5.32) |
| Model 1 | 0 | −0.17 (−3.30, 2.96) | 2.20 (−0.95, 5.35) | 1.31 (−1.86, 4.48) |
| Model 2 | 0 | 0.03 (−3.15, 3.21) | 2.38 (−0.85, 5.61) | 1.44 (−1.91, 4.79) |
| WRAML | ||||
| T1 (n = 1094) | ||||
| Model 0 | 0 | 0.83 (0.06, 1.61)4 | 0.72 (−0.07, 1.50) | 0.59 (−0.18, 1.36) |
| Model 1 | 0 | 0.75 (−0.04, 1.54) | 0.53 (−0.28, 1.33) | 0.40 (−0.41, 1.21) |
| Model 2 | 0 | 0.61 (−0.19, 1.41) | 0.40 (−0.42, 1.23) | 0.13 (−0.73, 0.98) |
| T2 (n = 1052) | ||||
| Model 0 | 0 | 0.33 (−0.49, 1.15) | 0.67 (−0.14, 1.49) | 0.08 (−0.72, 0.87) |
| Model 1 | 0 | 0.10 (−0.73, 0.93) | 0.39 (−0.45, 1.24) | −0.29 (−1.14, 0.56) |
| Model 2 | 0 | 0.14 (−0.71, 0.99) | 0.44 (−0.43, 1.31) | −0.27 (−1.18, 0.63) |
| BRIEF GEC | ||||
| T1 (n = 1174) | ||||
| Model 0 | 0 | −0.68 (−2.23, 0.86) | −1.99 (−3.55, −0.44)4 | −1.82 (−3.35, −0.29)4 |
| Model 1 | 0 | −0.46 (−2.01, 1.09) | −1.54 (−3.12, 0.03) | −1.52 (−3.09, 0.06) |
| Model 2 | 0 | −0.45 (−1.99, 1.10) | −1.42 (−3.01, 0.16) | −1.47 (−3.11, 0.17) |
| T2 (n = 1132) | ||||
| Model 0 | 0 | −0.59 (−2.23, 1.05) | −1.17 (−2.80, 0.46) | −1.92 (−3.50, −0.34)4 |
| Model 1 | 0 | −0.30 (−1.96, 1.36) | −0.69 (−2.36, 0.99) | −1.81 (−3.46, −0.15)4 |
| Model 2 | 0 | −0.07 (−1.72, 1.58) | −0.30 (−2.00, 1.40) | −1.35 (−3.08, 0.38) |
| SDQ total | ||||
| T1 (n = 1191) | ||||
| Model 0 | 0 | −0.71 (−1.54, 0.12) | −1.41 (−2.22, −0,59)4 | −1.33 (−2.13, −0.53)4 |
| Model 1 | 0 | −0.36 (−1.17, 0.45) | −0.84 (−1.65, −0.03) | −0.81 (−1.61, −0.01)4 |
| Model 2 | 0 | −0.31 (−1.12, 0.50) | −0.81 (−1.63, 0.00) | −0.75 (−1.59, 0.09) |
| T2 (n = 1148) | ||||
| Model 0 | 0 | −0.92 (−1.76, −0.08)4 | −1.33 (−2.17, −0.49)4 | −1.32 (−2.13, −0.50)4 |
| Model 1 | 0 | −0.51 (−1.34, 0.32) | −0.69 (−1.54, 0.16) | −0.78 (−1.61, 0.05) |
| Model 2 | 0 | −0.37 (−1.21, 0.46) | −0.50 (−1.37, 0.37) | −0.54 (−1.42, 0.34) |
Median maternal L/Z intake (range), in mg/d, for each quartile. First trimester: Q1 = 0.97 (0.09–1.433); Q2 = 1.78 (1.434–2.200); Q3 = 2.64 (2.201–3.251); Q4 = 4.51 (3.253–16.307). Second trimester: Q1 = 0.98 (0.05–1.426); Q2 = 1.82 (1.427–2.209); Q3 = 2.59 (2.210–3.187); Q4 = 4.48 (3.194–15.205). Nutrient values were adjusted for total energy intake using the residual model. BRIEF GEC, Behavioral Rating Inventory of Executive Function–Global Executive Composite; KBIT-II, Kaufman Brief Intelligence Test, Second Edition; PPVT-III, Peabody Picture Vocabulary Test, Third Edition; Q, quartile; SDQ, Strengths and Difficulties Questionnaire; VRM, visual recognition memory (percent novelty preference); WRAML, Wide Range Assessment of Memory and Learning, Second Edition; WRAVMA, Wide Range Assessment of Visual Motor Abilities.
Model 0 (crude): adjusted for child age and sex. Model 1 (multivariable): model 0 adjusted for maternal sociodemographic characteristics (age, race/ethnicity, marital status, parity, education, income, smoking history, prepregnancy BMI). Model 2 (multivariable): model 1 also adjusted for trimester-specific intake of total energy, DHA, folate, choline, vitamin B-12, and alcohol.
β (95% CI) represent the difference in mean cognitive/behavioral scores compared with the lowest quartile of maternal L/Z intake (reference).
95% CI for the difference in mean cognitive/behavioral scores excludes zero.