A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Abstract

Background: The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.Objective: We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.Methods: In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.Results: At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.Conclusion: Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.

Effect of a Nutrient-Rich, Food-Based Supplement Given to Rural Vietnamese Mothers Prior to or during Pregnancy on the Trajectories of Nutrient Biomarkers

“…The effect of maternal micronutrient supplementation on nutritional biomarker status has been studied in several LMICs [ 16 , 17 , 36 ] and a Dutch study [ 14 ]. For example, in a Bangladeshi intervention study [ 16 ], supplementation with multiple micronutrients at the beginning of pregnancy improved late pregnancy micronutrient status (32 weeks), but micronutrient deficiencies persisted.…”

“…Plasma iron levels were not examined, but serum ferritin levels were not associated with dietary or supplemental iron intake. [ 14 ] Another Bangladesh trial examined the combined effect of food and micronutrient supplementation on biomarker concentrations at week 30 of pregnancy [ 17 ]. Women in the multiple micronutrient regimen had higher concentrations of plasma vitamin B12 at gestational week 30, but no other differences were observed between food and micronutrient regimens.…”

“…Women in the multiple micronutrient regimen had higher concentrations of plasma vitamin B12 at gestational week 30, but no other differences were observed between food and micronutrient regimens. Although starting the micronutrient supplement early (9 weeks) did not differ from initiating it at 20 weeks of gestation, a dose–response relationship between the number of capsules taken and plasma folate and ferritin concentrations was detected [ 17 ]. An intervention study in rural Nepal on the association between antenatal micronutrient supplementation and biochemical status indicators found a reduction in folate deficiency from the first to the third trimester (32 weeks), but there was only a modest effect on B12 and no effect on zinc status [ 36 ].…”

“…Studies evaluating the association between nutrient intakes and biomarker status are needed to better understand the link between maternal nutrition and pregnancy outcomes. To date, studies relating maternal micronutrient intakes to birth outcomes have been inconsistent [ 14 , 15 , 16 , 17 ]. In addition, research has started to focus on the optimal time point of nutritional interventions, suggesting benefits of starting prior to conception [ 18 , 19 ].…”

Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh

“…The WHO recommendations for iron supplementation during pregnancy is 30–60 mg per day, the higher dose recommended in settings where anaemia in pregnant women is widespread, such as rural Bangladesh, where the prevalence of anaemia in pregnant women is estimated to be 49.6%[ 35 ]. However, the prevalence of iron deficiency in Bangladesh and in the MINIMat population is reportedly low due to high levels of iron in the groundwater[ 36 , 37 ], suggesting that other micronutrient deficiencies or infections might be important causes. Further, superfluous supplementation of iron could contribute to an excess iron load with potential health hazards[ 38 , 39 ].…”