B-Vitamins and Choline in Human Milk Are Not Impacted by a Preconception Lipid-Based Nutrient Supplement, but Differ Among Three Low-to-Middle Income Settings—Findings From the Women First Trial

Abstract

Introduction: Optimal human milk (HM) B-vitamin concentrations remain undefined, especially in areas where undernutrition is prevalent. The impact of supplementation pre-conception through pregnancy on HM B-vitamin composition remains unknown.Methods: Human milk (HM) was collected at 2-weeks postpartum from 200 women in Guatemala, India, and Pakistan (the Women First Trial). The women were randomized to start a lipid-based nutrient supplement before conception, at end of the first trimester, or not at all; intervention continued until delivery. HM concentrations of eight B-vitamins and choline were assessed via ultra-performance liquid chromatography-tandem mass spectrometry. Maternal diet was assessed in early pregnancy, and infant growth followed through 6 months post-delivery.Results: Despite supplement exposure averaging 15.7 (pre-conception arm) and 6.0 months (prenatal arm), HM B-vitamins did not differ between arms, but site differences were evident. Guatemala had higher HM concentrations of vitamin B3 than Pakistan and India. Pakistan had higher HM concentrations of thiamin and vitamin B6 than India and Guatemala. Cohort average HM vitamin B2 (162 ± 79 μg/L) and B6 (31.8 ± 24.6 μg/L) fell below values defined as deficient in 81.5 and 85.5% of samples, potentially reflecting sampling procedures and timing. Maternal dietary intakes of only vitamin B6 and choline were associated with the corresponding concentrations in HM (p < 0.005). No HM B-vitamin concentrations were associated with infant growth.Conclusion: Prenatal supplementation for at least 6 months had no impact on HM B-vitamin concentrations at 2-weeks postpartum. Results suggest that the adequacy of HM composition was generally maintained, with potential exceptions of vitamin B2 and B6.

Human Milk Micronutrients and Child Growth and Body Composition in the First 2 years: A Systematic Review

“…In total, 9992 unique abstracts were identified, 1001 full texts were assessed, and 139 articles met inclusion criteria, of which 28 articles reported HM micronutrients [ [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] ] ( Figure 1 ). The main reasons for excluding articles were: no HM analytes of interest were reported ( n = 89); no infant anthropometrics or only birth anthropometrics were reported ( n = 512); or no associations between HM analytes and infant anthropometrics were reported ( n = 165).…”

“…Among the 28 included micronutrient articles ( Table 1 and Supplementary Table 3 ), 8 (29%) were published before 1998 [ 27 , 29 , 31 , 35 , 38 , 39 , 41 , 45 ]; 19 (67%) were published in 2010 or later [ 25 , 26 , 28 , 30 , [32] , [33] , [34] , 36 , 37 , 40 , [42] , [43] , [44] , [46] , [47] , [48] , [49] , [50] , [51] ]. These 28 articles represented 26 unique studies involving 2526 dyads; 17 studies were conducted in low- or middle-income countries (according to World Bank criteria) [ [24] , [25] , [26] , 30 , [32] , [33] , [34] , [36] , [37] , [38] , [39] , [41] , [42] , [43] , [44] , 46 , 48 , 49 ]. Five studies were conducted as diet interventions or maternal micronutrient trials [ 24 , 31 , 36 , 44 , 49 ].…”

“…These 28 articles represented 26 unique studies involving 2526 dyads; 17 studies were conducted in low- or middle-income countries (according to World Bank criteria) [ [24] , [25] , [26] , 30 , [32] , [33] , [34] , [36] , [37] , [38] , [39] , [41] , [42] , [43] , [44] , 46 , 48 , 49 ]. Five studies were conducted as diet interventions or maternal micronutrient trials [ 24 , 31 , 36 , 44 , 49 ].…”

“…Four studies addressed B vitamins [ 31 , 39 , 43 , 49 ]. A micronutrient trial conducted in the United States reported that maternal vitamin B-6 intake was directly correlated with infant vitamin B-6 intake (Pearson r = 0.99; P < 0.0001) and infant vitamin B-6 status (measured as plasma pyridoxal-5’-phosphate [PLP], pyridoxal [PL], and PL/PLP ratio; Pearson r : 0.72–0.93; all P values < 0.006).…”

“…The Women’s First Trial conducted in Guatemala, India, and Pakistan [ 49 ] examined the impact of a lipid-based nutrient supplement on 8 vitamin B concentrations (thiamin, vitamins B-2, B-3, B-6, B1-2, pantothenic acid, and biotin) in HM. In this trial, supplementation had no meaningful impact on vitamin B concentrations in HM, and there were no associations between B vitamin concentrations and infant growth outcomes (LAZ, WAZ, and WLZ).…”