Maternal micronutrient supplementation with zinc and β-carotene affects morbidity and immune function of infants during the first 6 months of life

Abstract

Background/Objectives: Micronutrient deficiencies are prevalent worldwide, and a major cause of infant death. Supplementation with multiple micronutrients during pregnancy might improve micronutrient status of the newborn, thereby reducing morbidity and death. Moreover, maternal supplementation might affect the newborn's immune development. Therefore, this study investigated the effects of maternal zinc and b-carotene supplementation on the infant's morbidity and immune function during the first 6 months of life. Subjects/Methods: Mothers were supplemented during pregnancy with b-carotene and/or zinc, in addition to iron and folic acid, in a randomized, double-blind controlled trial. Newborn infants (n ¼ 136) were followed up for 6 months. Results: Infants born from mothers receiving zinc during pregnancy had significantly fewer episodes of diarrhoea than infants born from mothers not receiving zinc (0.2 and 0.4, respectively), but more episodes of cough (1.3 and 0.9 respectively) during the first 6 months. Maternal b-carotene supplementation had no effect on infants' morbidity. Cytokine production in the newborns was affected by maternal zinc and b-carotene supplementation, with zinc supplementation giving higher interleukin-6 production (16% higher), and b-carotene supplementation leading to lower interferon-g production (36% lower). Conclusions: This study shows that maternal supplementation with zinc and b-carotene affected the newborn's immune development in specific ways, but only maternal zinc supplementation significantly affected morbidity in the infants. Addition of zinc to routine iron and folic acid supplements for pregnant women could be an effective way to reduce diarrhoeal disease during the first 6 months of life, albeit at the expense of more episodes of cough.

Maternal zinc supplementation improves hepatitis B antibody responses in infants but decreases plasma zinc level

“…Enhanced T cell-dependent antibody responses to hepatitis B vaccine in infants born to zinc-supplemented mothers (Table 3) may be explained by an earlier study that reported induction of the antibody class switching cytokine IL-6 in newborns [23] by maternal zinc supplementation. In addition, higher IL-7 concentrations in infants of Table 2 Effect of maternal zinc supplementation on plasma zinc and copper concentration (µmol/L) in mothers and their infants * Mean value was different from that at third trimester (p < 0.01) † Mean value was different between the groups (p ≤ 0.05) a Effect size was 0.63 (large) for the zinc group compared with placebo group, indicating that the mean of the zinc group is at >73th percentile (>38.2 % of non-overlap) of the placebo group b Effect size was 0.67 (large) for the placebo group compared with zinc group, indicating that the mean of the placebo group is at ~76th percentile (~43 % of non-overlap) of the zinc group zinc-supplemented mothers were observed in our study (Table 3), which may aid such T cell-dependent antibody responses as IL-7 is essential for homeostatic proliferation and survival of T cells.…”

Malnutrition, Immunodeficiency, and Mucosal Infection

“…Zinc-fortified formula improved delayed-type hypersensitivity, skin test reactivity, lymphoproliferative response, and increased salivary IgA (Shah and Sachdev, 2006;Schlesinger et al, 1992). Prenatal maternal zinc supplementation improved infants' immune function (Shah and Sachdev, 2006), increased cytokine production of IL-6, and decreased morbidity in infants by decreasing episodes of diarrhea in the first 6 months of life when compared to infants born to mothers not receiving zinc, but was associated with more episodes of cough (Wieringa et al, 2010). In addition, zinc supplementation of infants after birth enhanced the response to one serotype of heptavalent pneumococcal protein conjugate vaccine (Osendarp et al, 2006(Osendarp et al, , 2007.…”

“…Attempts to enhance gastrointestinal development and protect against infection and necrotizing enterocolitis have included use of prebiotics and probiotics, which bolster development of the microbiota. A recent study showed that although enteral supplementation with a prebiotic mixture of neutral and Protein calorie malnutrition, dietary deficiency (Moynahan, 1974;Stevens and Lubitz, 1998), high phytate (Moynahan, 1974;Stevens and Lubitz, 1998), transport deficiency (Moynahan, 1974;Stevens and Lubitz, 1998) Supplementation in infection (Stafford et al, 2013) Prenatal maternal supplement (Shah and Sachdev, 2006;Wieringa et al, 2010) Maternal supplementation (Terrin et al, 2013) Infant supplementation (Osendarp et al, 2007;Osendarp et al, 2006) Thymic atrophy, lymphopenia altered T-cell subsets, (Youn et al, 2008;Smith et al, 2008) Humans (Chen, 2012) HIV-1 infection (Shah and Sachdev, 2006;Wieringa et al, 2010;Smith et al, 2008) ↑Microbial diversity, composition, & colonization (Kasaikina et al, 2011) Required for glutathione peroxidase activity ↓NF-κB activity, enhanced virulence of coxsackie B virus Deficiency in HIV-1 linked to progression, antiretroviral therapy increased levels acidic oligosaccharides did increase early postnatal intestinal colonization with a trend toward increased bifidobacteria, extensive use of broad-spectrum antibiotics counteracted the growth of all intestinal microbiota and delayed normal microbiota development (Westerbeek et al, 2013).…”

Challenges to rational prescribing and use of essential medicines in India

“…5 Furthermore there are indications that supplementation with zinc and vitamin A during pregnancy can affect the immune functions of the neonate and that these effects might be long lasting. 6 There are some studies indicating improvement in infant birth weight with multiple micronutrient supplementations 7 but studies by Ramakrishnan and Christian et al failed to detect any benefit for birth outcomes like reduction in prevalence of low birth weight and prematurity. 8,9 On the contrary the meta-analysis by Fall and coauthors, demonstrated the significant increase in the prevalence of large-for-gestational age babies with micronutrient supplementation during pregnancy raising the possibility of increasing the number of obstructed deliveries.…”