TABLE 3.
Associations of maternal intake of lutein and zeaxanthin-rich (L/Z-rich) foods during pregnancy with child cognitive and behavioral outcomes1
| Child outcome Trimester Model3 | Quartiles of maternal L/Z-rich foods intake2 | |||
|---|---|---|---|---|
| Quartile 1 | Quartile 2 | Quartile 3 | Quartiles 4 | |
| (reference) | β (95% CI)4 | β (95% CI) | β (95% CI) | |
| Infancy | ||||
| VRM | ||||
| T1 (n = 1071) | ||||
| Model 0 | 0 | −1.01 (−3.92, 1.91) | −0.50 (−3.36, 2.36) | −1.48 (−4.33, 1.37) |
| Model 1 | 0 | −0.95 (−3.88, 1.97) | −0.06 (−2.93, 2.81) | −1.06 (−3.93, 1.81) |
| Model 2 | 0 | −0.91 (−3.89, 2.07) | −0.47 (−3.55, 2.60) | −1.72 (−5.11, 1.67) |
| T2 (n = 1049) | ||||
| Model 0 | 0 | −1.36 (−4.28, 1.57) | −0.89 (−3.81, 2.04) | −1.26 (−4.11, 1.59) |
| Model 1 | 0 | −0.63 (−3.57, 2.31) | −0.65 (−3.52, 2.22) | 0.66 (−1.34, 2.66) |
| Model 2 | 0 | −1.86 (−4.88, 1.17) | −1.55 (−4.63, 1.54) | −2.08 (−5.48, 1.33) |
| Early childhood | ||||
| PPVT-III | ||||
| T1 (n = 1206) | ||||
| Model 0 | 0 | 0.50 (−1.88, 2.87) | −0.47 (−2.85, 1.92) | 1.26 (−1.11, 3.62) |
| Model 1 | 0 | −0.26 (−2.34, 1.82) | −1.01 (−3.10, 1.09) | 0.58 (−1.50, 2.67) |
| Model 2 | 0 | −0.05 (−2.17, 2.07) | −0.75 (−2.98, 1.48) | 1.15 (−1.31, 3.61) |
| T2 (n = 1177) | ||||
| Model 0 | 0 | −1.07 (−3.50, 1.36) | −0.11 (−2.52, 2.30) | 0.49 (−1.90, 2.87) |
| Model 1 | 0 | −0.97 (−3.13, 1.18) | −1.13 (−3.27, 1.01) | −0.03 (−2.16, 2.11) |
| Model 2 | 0 | −1.09 (−3.28, 1.11) | −1.03 (−3.29, 1.23) | −0.23 (−2.74, 2.28) |
| WRAVMA total | ||||
| T1 (n = 1168) | ||||
| Model 0 | 0 | −0.43 (−2.27, 1.42) | −1.40 (−3.25, 0.45) | −0.67 (−2.48, 1.15) |
| Model 1 | 0 | −0.93 (−2.72, 0.87) | −1.89 (−3.70, −0.09)5 | −1.00 (−2.77, 0.76) |
| Model 2 | 0 | −0.76 (−2.59, 1.06) | −1.62 (−3.54, 0.31) | −0.40 (−2.46, 1.66) |
| T2 (n = 1137) | ||||
| Model 0 | 0 | −0.44 (−2.33, 1.46) | 0.56 (−1.31, 2.43) | −0.31 (−2.18, 1.56) |
| Model 1 | 0 | −0.65 (−2.50, 1.21) | −0.01 (−1.85, 1.83) | −0.66 (−2.50, 1.18) |
| Model 2 | 0 | −0.22 (−2.12, 1.68) | 0.69 (−1.25, 2.63) | 0.64 (−1.53, 2.81) |
| Mid-childhood | ||||
| KBIT-II nonverbal | ||||
| T1 (n = 1106) | ||||
| Model 0 | 0 | 1.50 (−1.54, 4.54) | 0.57 (−2.44, 3.59) | 2.48 (−0.46, 5.41) |
| Model 1 | 0 | 1.56 (−1.37, 4.48) | 0.29 (−2.61, 3.20) | 2.02 (−0.86, 4.89) |
| Model 2 | 0 | 1.67 (−1.32, 4.65) | 0.64 (−2.46, 3.75) | 2.64 (−0.69, 5.96) |
| T2 (n = 1064) | ||||
| Model 0 | 0 | −1.25 (−4.37, 1.86) | 1.31 (−1.84, 4.45) | 0.53 (−2.56, 3.62) |
| Model 1 | 0 | −1.84 (−4.85, 1.16) | 0.29 (−2.72, 3.30) | −0.52 (−3.53, 2.48) |
| Model 2 | 0 | −1.78 (−4.86, 1.30) | 0.27 (−2.96, 3.51) | −0.54 (−4.16, 3.09) |
| KBIT-II verbal | ||||
| T1 (n = 1093) | ||||
| Model 0 | 0 | −0.03 (−2.72, 2.67) | −0.53 (−3.22, 2.15) | 1.45 (−1.20, 4.10) |
| Model 1 | 0 | −0.62 (−2.93, 1.69) | −1.47 (−3.78, 0.83) | 0.29 (−1.99, 2.57) |
| Model 2 | 0 | −0.61 (−2.96, 1.74) | −1.51 (−3.96, 0.93) | 0.21 (−2.43, 2.85) |
| T2 (n = 1051) | ||||
| Model 0 | 0 | 1.15 (−1.64, 3.93) | 2.18 (−0.72, 5.08) | 2.58 (−0.16, 5.33) |
| Model 1 | 0 | 0.25 (−2.14, 2.65) | 0.28 (−2.17, 2.74) | 0.88 (−1.51, 3.26) |
| Model 2 | 0 | 0.04 (−2.43, 2.50) | 0.05 (−2.58, 2.67) | 0.35 (−2.51, 3.20) |
| WRAVMA drawing | ||||
| T1 (n = 1099) | ||||
| Model 0 | 0 | −0.47 (−3.45, 2.51) | −1.33 (−4.30, 1.64) | −0.89 (−3.77, 2.00) |
| Model 1 | 0 | −0.41 (−3.40, 2.57) | −1.53 (−4.52, 1.46) | −1.17 (−4.07, 1.74) |
| Model 2 | 0 | −0.75 (−3.81, 2.31) | −2.27 (−5.46, 0.92) | −2.32 (−5.71, 1.07) |
| T1 (n = 1058) | ||||
| Model 0 | 0 | −0.68 (−3.68, 2.33) | −0.01 (−3.06, 3.05) | 0.14 (−2.85, 3.14) |
| Model 1 | 0 | −1.26 (−4.27, 1.75) | −0.61 (−3.67, 2.44) | −0.53 (−3.55, 2.49) |
| Model 2 | 0 | −0.89 (−3.98, 2.20) | −0.16 (−3.41, 3.08) | 0.27 (−3.36, 3.90) |
| WRAML total | ||||
| T1 (n = 1094) | ||||
| Model 0 | 0 | −0.21 (−1.00, 0.57) | 0.09 (−0.68, 0.86) | 0.33 (−0.43, 1.09) |
| Model 1 | 0 | −0.18 (−0.96, 0.61) | 0.02 (−0.75, 0.79) | 0.25 (−0.51, 1.01) |
| Model 2 | 0 | −0.29 (−1.09, 0.51) | −0.18 (−1.01, 0.65) | −0.03 (−0.92, 0.86) |
| T2 (n = 1052) | ||||
| Model 0 | 0 | −0.19 (−1.01, 0.64) | −0.55 (−1.36, 0.27) | 0.17 (−0.64, 0.98) |
| Model 1 | 0 | −0.27 (−1.09, 0.55) | −0.72 (−1.53, 0.09) | 0.01 (−0.80, 0.83) |
| Model 2 | 0 | −0.20 (−1.04, 0.64) | −0.70 (−1.57, 0.16) | 0.07 (−0.90, 1.05) |
| BRIEF GEC | ||||
| T1 (n = 1174) | ||||
| Model 0 | 0 | 0.00 (−1.54, 1.54) | 0.16 (−1.41, 1.72) | −0.18 (−1.70, 1.33) |
| Model 1 | 0 | 0.27 (−1.26, 1.80) | 0.40 (−1.15, 1.94) | 0.10 (−1.41, 1.60) |
| Model 2 | 0 | −0.23 (−1.77, 1.32) | −0.28 (−1.90, 1.33) | −1.43 (−3.17, 0.30) |
| T2 (n = 1132) | ||||
| Model 0 | 0 | 1.32 (−0.33, 2.96) | −0.12 (−1.72, 1.48) | 0.45 (−1.19, 2.08) |
| Model 1 | 0 | 1.65 (0.02, 3.27)5 | 0.16 (−1.43, 1.75) | 0.79 (−0.83, 2.41) |
| Model 2 | 0 | 1.50 (−0.13, 3.14) | −0.40 (−2.07, 1.27) | −0.07 (−1.95, 1.81) |
| SDQ total | ||||
| T1 (n = 1191) | ||||
| Model 0 | 0 | −0.48 (−1.29, 0.32) | −0.14 (−0.95, 0.67) | −0.81 (−1.60, −0.02)5 |
| Model 1 | 0 | −0.25 (−1.02, 0.53) | 0.10 (−0.67, 0.87) | −0.54 (−1.30, 0.23) |
| Model 2 | 0 | −0.39 (−1.17, 0.39) | −0.09 (−0.90, 0.72) | −1.02 (−1.91, −0.12)5 |
| T2 (n = 1148) | ||||
| Model 0 | 0 | 0.28 (−0.56, 1.13) | 0.02 (−0.80, 0.85) | −0.14 (−0.96, 0.69) |
| Model 1 | 0 | 0.55 (−0.27, 1.38) | 0.35 (−0.45, 1.16) | 0.22 (−0.58, 1.02) |
| Model 2 | 0 | 0.57 (−0.25, 1.40) | 0.24 (−0.61, 1.09) | 0.07 (−0.86, 1.01) |
L/Z-rich foods: top 10 contributors to total maternal lutein and zeaxanthin intake in eligible sample (cooked spinach, raw spinach, romaine or leaf lettuce, kale, broccoli, peas or lima beans, orange juice with calcium, corn, eggplant or zucchini, mixed vegetables) and any food with lutein and zeaxanthin ≥1 mg per 100 g (Brussels sprouts, dark squash, popcorn, eggs). 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.
Median maternal L/Z-rich foods intake (range), in servings/d, for each quartile. First trimester: Q1 = 0.77 (0.07≤ and ≤1.06), Q2 = 1.35 (1.06< and ≤1.63), Q3 = 1.93 (1.63< and <2.35), Q4 = 3.06 (2.35≤ and ≤9.58). Second trimester: Q1 = 0.84 (0.00≤ and ≤1.13), Q2 = 1.42 (1.13< to ≤1.70), Q3 = 1.99 (1.70< to ≤2.42), Q4 = 3.21 (2.42< to ≤10.44).
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-rich foods intake (reference).
95% CI for the difference in mean cognitive/behavioral scores excludes zero.