DOI: 10.1001/jama.2023.23727 ISSN: 0098-7484

Child Neurodevelopment After Multidomain Interventions From Preconception Through Early Childhood

Ravi Prakash Upadhyay, Sunita Taneja, Ranadip Chowdhury, Neeta Dhabhai, Savita Sapra, Sarmila Mazumder, Sitanshi Sharma, Mark Tomlinson, Tarun Dua, Harish Chellani, Rupali Dewan, Pratima Mittal, M. K. Bhan, Nita Bhandari, Ratan Shekhawat, Sabreen Siraj, Sugandhi Nagpal, Farah Abbasi, Heena Chaudhary, Karishma Sharma, Farhana Rafiqui, Kiran Bhatia, Jasmine Kaur, Medha Shekhar, Anita Kate, Gunjan Aggarwal, Runa Ghosh, Kunal Kishore, Navneet Mehra, Nikita Arya, Ritu Chaudhary, Anuradha Tamaria, Tivendra Kumar, Sowmya Karantha C, Purnima Modi, Neelam Kaur, Neha Tyagi, Geeta Mehto, Afifa Khatun, Sayeed Ahmed, Aparna Singh, Gulafshan Ansari, Ramanjeet Kaur, Manisha Gupta, Girish Chand Pant, Ankita Dutta, Deepak More, Mukesh Kumar, Sonia Kuruvilla, Anjali Chandra, Pradeep Debata, Anita Yadav, Abhinav Jain, Rahul Sachdev, Omprakash Bansal, Raghav Agarwal,
  • General Medicine


Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.


To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.

Design, Setting, and Participants

In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial’s secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022.


Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.

Main Outcomes and Measures

Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.


The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.

Conclusions and Relevance

Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children’s development warrant further evaluation.

Trial Registration

Clinical Trials Registry–India CTRI/2017/06/008908

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