Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Neural tube defects are among the most common birth defects in the US. Objective: To review new evidence on the benefits and harms of folic acid supplementation for the prevention of neural tube defects to inform the US Preventive Services Task Force. Evidence Review: Sources included PubMed, Cochrane Library, Embase, and trial registries from July 1, 2015, through July 2, 2021; references; and experts, with surveillance through February 10, 2023. Two investigators independently reviewed English-language randomized studies and nonrandomized cohort studies in very highly developed countries that focused on the use of folic acid supplementation for the prevention of neural tube defect-affected pregnancies; methodological quality was dually and independently assessed. Findings: Twelve observational studies (reported in 13 publications) were eligible for this limited update (N = 1 244 072). Of these, 3 studies (n = 990 372) reported on the effect of folic acid supplementation on neural tube defects. For harms, 9 studies were eligible: 1 randomized clinical trial (n = 431) reported on variations in twin delivery, 7 observational studies (n = 761 125) reported on the incidence of autism spectrum disorder, and 1 observational study (n = 429 004) reported on maternal cancer. Two cohort studies and 1 case-control study newly identified in this update reported on the association between folic acid supplementation and neural tube defects (n = 990 372). One cohort study reported a statistically significant reduced risk of neural tube defects associated with folic acid supplementation taken before pregnancy (adjusted relative risk [aRR], 0.54 [95% CI, 0.31-0.91]), during pregnancy (aRR, 0.62 [95% CI, 0.39-0.97]), and before and during pregnancy (aRR, 0.49 [95% CI, 0.29-0.83]), but this association occurred for only the later of 2 periods studied (2006-2013 and not 1999-2005). No other statistically significant benefits were reported overall. No study reported statistically significant harms (multiple gestation, autism, and maternal cancer) associated with pregnancy-related folic acid exposure. Conclusions and Relevance: New evidence from observational studies provided additional evidence of the benefit of folic acid supplementation for preventing neural tube defects and no evidence of harms related to multiple gestation, autism, or maternal cancer. The new evidence was consistent with previously reviewed evidence on benefits and harms.

Evaluating the Factor Structure and Criterion Validity of the Canadian Little DCDQ: Associations Between Motor Competence, Executive Functions, Early Numeracy Skills, and ADHD in Early Childhood.

The Canadian Little Developmental Coordination Disorder Questionnaire (Little DCDQ-CA) is a parent-report screening instrument that identifies 3- to 4-year-old children who may be at risk for Developmental Coordination Disorder (DCD). We tested the factor structure and criterion validity of the Little DCDQ-CA in a sample of preschool-aged children in the United States (N = 233). Factor analysis indicated that the DCDQ-CA was best represented by one factor. Using cutoff scores that were proposed by the developer, 45% of the sample was identified as at-risk for DCD. Although a much larger percentage of children was identified as at-risk than would be expected based on the prevalence of formal DCD diagnoses in the population, the Little DCDQ-CA demonstrated good criterion validity. Specifically, compared with their peers, children who exceeded the at-risk criterion demonstrated worse motor competence, executive functioning skills, and early numeracy skills and were rated as having greater ADHD behaviors by their teachers, all consistent with expectations for children who are at risk for DCD. Results are discussed as they relate to future use of the Little DCDQ-CA.

Short report: Improving motor competence skills in early childhood has corollary benefits for executive function and numeracy skills.

Previous studies have documented that individual differences in fine and gross motor skills are associated with executive function (EF) skills. This study used an experimental design to test whether participating in cognitively challenging motor skills activities was causally related to improvements in motor skills and two key indicators of school readiness: executive function and early numeracy skills. The motor skill program involved fine and gross motor game-like activities that were delivered in a small group format. Activities were socially engaging and progressively challenged children based on their motor competencies. Fifty-three preschool-aged children participated in 16 motor skill sessions across 8 weeks. There were significant treatment effects for all outcomes, such that children in the treatment condition exhibited significant improvements in motor, EF, and early numeracy skills, compared to their peers in the waitlist control condition. Treatment effects on EF skills were stronger for inhibitory control than working memory. Improvements in numeracy were most pronounced for children with initially lower levels of ability. Motor skill-based interventions are an ecologically valid and developmentally appropriate approach for fostering school readiness skills in early childhood.