Nutrient Supplementation during the Prenatal Period in Substance-Using Mothers: A Narrative Review of the Effects on Offspring Development.

Substance use during pregnancy increases the risk for poor developmental outcomes of the offspring, and for substance-dependent mothers, abstaining from substance use during pregnancy is often difficult. Given the addictive nature of many substances, strategies that may mitigate the harmful effects of prenatal substance exposure are important. Prenatal nutrient supplementation is an emerging intervention that may improve developmental outcomes among substance-exposed offspring. We provide a narrative review of the literature on micronutrient and fatty acid supplementation during pregnancies exposed to substance use in relation to offspring developmental outcomes. We first discuss animal models exposed to ethanol during pregnancy with supplementation of choline, zinc, vitamin E, iron, and fatty acids. We follow with human studies of both alcohol- and nicotine-exposed pregnancies with supplementation of choline and vitamin C, respectively. We identified only 26 animal studies on ethanol and 6 human studies on alcohol and nicotine that supplemented nutrients during pregnancy and reported offspring developmental outcomes. There were no studies that examined nutrient supplementation during pregnancies exposed to cannabis, illicit substances, or polysubstance use. Implementations and future directions are discussed.

Origins of food reinforcement in infants.

BACKGROUND: Rapid weight gain in infancy is associated with a higher risk of obesity in children and adults. A high relative reinforcing value of food is cross-sectionally related to obesity; lean children find nonfood alternatives more reinforcing than do overweight/obese children. However, to our knowledge, there is no research on how and when food reinforcement develops. OBJECTIVE: This study was designed to assess whether the reinforcing value of food and nonfood alternatives could be tested in 9- to 18-mo-old infants and whether the reinforcing value of food and nonfood alternatives is differentially related to infant weight status. DESIGN: Reinforcing values were assessed by using absolute progressive ratio schedules of reinforcement, with presentation of food and nonfood alternatives counterbalanced in 2 separate studies. Two nonfood reinforcers [Baby Einstein-Baby MacDonald shows (study 1, n = 27) or bubbles (study 2, n = 30)] were tested against the baby's favorite food. Food reinforcing ratio (FRR) was quantified by measuring the reinforcing value of food (Food Pmax) in proportion to the total reinforcing value of food and a nonfood alternative (DVD Pmax or BUB Pmax). RESULTS: Greater weight-for-length z score was associated with a greater FRR of a favorite food in study 1 (FRR-DVD) (r = 0.60, P < 0.001) and FRR of a favorite food in study 2 (FRR-BUB) (r = 0.49, P = 0.006), primarily because of the strong association between greater weight-for-length z score and lower DVD Pmax (r = -0.71, P < 0.0001) and BUB Pmax (r = -0.53, P = 0.003). Infant monthly weight gain was positively associated with FRR-DVD (r = 0.57, P = 0.009) and FRR-BUB (r = 0.37, P = 0.047). CONCLUSIONS: Our newly developed paradigm, which tested 2 different nonfood alternatives, demonstrated that lean infants find nonfood alternatives more reinforcing than do overweight/obese infants. This observation suggests that strengthening the alternative reinforcers may have a protective effect against childhood obesity.