Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low-income, multi-ethnic population

Abstract

Poor nutrient intake during pregnancy can adversely affect both infant and maternal health. The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world. We conducted a randomised, double-blind, placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 mg folic acid, from the first trimester of pregnancy in 402 mothers, in East London, UK. Nutrient status was measured at recruitment, and at 26 and 34 weeks of gestation. Infants were weighed at birth. At recruitment the prevalence of anaemia was 13 %, vitamin D insufficiency 72 %, thiamin deficiency 12 % and folate deficiency 5 %, with no differences between groups. Only 39 % of women completed the study; rates of non-compliance were similar in both groups. Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation (110 (SD 10) v.108 (SD 10) g/l; P¼ 0·041) and 34 weeks of gestation (113 (SD 12) v.109 (SD 10) g/l; P¼0·003) and packed cell volume concentrations at 26 weeks of gestation (0·330 (SD 0·025) v. 0·323 (SD 0·026) l/l; P¼ 0·011) and 34 weeks of gestation (0·338 (SD 0·029) v. 0·330 (SD 0·028) l/l; P¼ 0·014) compared with controls. Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin, erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls. In the compliant subset (n 149), placebo mothers had more small-for-gestational age (SGA) infants (eight SGA v. thirteen; P¼0·042) than treatment mothers. Baseline micronutrient deficiencies were common; the multiple-micronutrient supplement was well-tolerated and improved nutrient status. Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development.Multiple-micronutrient supplementation: Low-income populations: Multi-ethnic populations: Micronutrient status

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

“…A decrease in ferritin concentration regardless of supplementation with iron has been observed in other studies (27–29). Plasma volume expansion and subsequent hemodilution may explain the lower ferritin concentrations in late pregnancy.…”

An optimal periconception maternal folate status for embryonic size: the Rotterdam Predict study

“…Results show positive associations with birthweight and head circumference. [9][10][11][12] This substantiates our positive association between embryonic size and RBC folate up to 1812 nmol/l, as the previously reported levels of first-trimester RBC folate were below this level. Only Takimoto et al 23 have reported a high first-trimester mean RBC folate of 1317 nmol/l (SD, 824 nmol/l), but they observed no associations with birthweight or head circumference, which may be because of the small sample size (n = 51) and the performance of continuous rather than stratified analysis for different cut-offs for RBC folate.…”

Serum cotinine and whole blood folate concentrations in pregnancy

“…Consistent with prior literature, women who reported taking prenatal vitamins weekly or every day had higher folate concentrations than women who reported rarely or never consuming prenatal vitamins. 41,42 In addition, women who reported adequate food security and frequent consumption of fresh fruits and vegetables had higher whole blood folate and lower serum cotinine concentrations. Associations between covariates and whole blood 5-methyltetrahydrofolate levels were similar to those observed for whole blood folate levels (Supplemental Table 1).…”