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Instituto Nacional de Salud Pública

2009, Number 4

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salud publica mex 2009; 51 (4)

Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum

García-Guerra A, Neufeld LM, Hernández-Cordero S, Rivera J, Martorell R, Ramakrishnan U

Language: English
References: 77
Page: 327-335
PDF size: 150.28 Kb.


ABSTRACT

Objective. The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM) during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe). Material and Methods. The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249) or Fe (n= 258) and received supplements daily (6 d/wk) under supervision by the field team from recruitment (approximately 9 weeks pregnancy) until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP) and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only). A breast milk sample was extracted at 1PP and assessed for retinol content. Result. At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%). Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09) towards a lower prevalence of folate deficiency/depletion in the MM group (10.0%) than the Fe group (18.5%). Conclusions. MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.


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  30. Caulfield LE, Zavaleta N, Figueron A. Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. Am J Clin Nutr 1999;69:1257-1263.

  31. Harvey LF, Dainty JR, Hollands WJ, Bull VJ, Hoogewerff JA, Foxall RJ,

  32. et al J. Effect of high-dose iron supplements on fractional zinc absorption and status in pregnant women. Am J Clin Nutr 2007;85:131-136.

  33. O´Brien KO, Zavaleta N, Caulfield LE, Wen J, Abrams SA. Prenatal iron supplements impair zinc absorption in pregnant Peruvian women. J Nutr 2000;130:2251-2255.

  34. Lönnerdal B. Dietary factors influencing zinc absorption. J Nutr 2000;130:1378S-1383S.

  35. Solomons NW, Jacob RA. Studies on the bioavailability of zinc in humans: effect of heme and nonheme iron on the absorption of zinc. Am J Clin Nutr 1981;34:475-482.

  36. Flores ML, Neufeld LM, González-Cossío T, Rivera J, Martorell R, Ramakrishnan U. Multiple micronutrient supplementation and dietary energy intake in pregnant women. Salud Publica Mex 2007;49:190-198.

  37. Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr 2006;83:993-1016.

  38. Scholl TO, Hediger ML, Schall JI, Khoo CS, Fischer RL. Dietary and serum folate: their influence on the outcome of pregnancy. Am J Clin Nutr 1996;63:520-525.

  39. Lindblad B, Zaman S, Malik A, Martin H, Ekstrom AM, Amu S, et al. Folate, vitamin B12, and homocysteine levels in South Asian women with growth-retarded fetuses. Acta Obstet Gynecol Scand 2005;84:1055-1061.

  40. King JH. Determinants of maternal zinc status during pregnancy. Am J Clin Nutr 2000;71:1334S-1343S.

  41. Keen LC, Hurley LS. Zinc in reproduction: Effects of deficiency on fetal and postnatal development In: Mills CF, editor. Zinc in human biology, ILSI Human Nutrition Reviews. New York: Springer, 1989;183-211.

  42. Tamura T, Goldenberg RL. Zinc nutriture and pregnancy outcome. Nutr Research 1996;16:139-181.

  43. Scholl T, Hediger M, Schall J, Fischer R, Khoo CS. Low zinc intake during pregnancy: its association with preterm and very preterm delivery. Am J Epidemiol 1993;137:1115-1124.

  44. Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr 2005;81:1206S-1212S.

  45. Garn SF, Ridella SA, Petzold AS, Falkner F. Maternal hematologic levels and pregnancy outcomes. Semin Perinatol 1981;5:155-162.

  46. Mola G, Permezel M, Amoa AB, Klufio CA. Anaemia and perinatal outcome in Port Moresby. Aust N Z J Obstet Gynaecol 1999;39:31-34.

  47. Czeizel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327:1832-1835.

  48. Mills JL, McPartlin JM, Kirke PN, Lee YJ, Conley MR, Weir DG, et al. Homcysteine metabolism in pregnancies complicated by neural-tube defects. Lancet 1995;345(8943):149-151.

  49. Villalpando S, García-Guerra A, Ramírez-Silva CI, Mejía-Rodríguez F, Matute G, Shamah-Levy T, et al. Iron, zinc, and iodide status in Mexican children under 12 years and women 12-49 years: A probabilistic national survey. Salud Publica Mex 2003;45:S520-S529.

  50. Villalpando S, Montalvo-Velarde I, Zambrano N, García-Guerra A, Ramírez-Silva CI, Shamah-Levy T, et al. Vitamins A, and C and folate status in Mexican children under 12 years and women 12-49 years: A probabilistic national survey. Salud Publica Mex 2003;45:S508-S519.

  51. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2006 Oct 18;(4):CD004905.

  52. Hindle LJ, Gitau R, Filteau SM, Newens KT, Osrin D, Costello AM, et al. Effect of multiple micronutrient supplementation during pregnancy on inflammatory markers in Nepalese women. Am J Clin Nutr 2006;84:1086-1092.

  53. Christian P, Osrin D, Manandhar DS, Khatry SK, de L Costello ZM, West KP Jr. Antenatal micronutrient supplements in Nepal. Lancet 2005;366(9487):711-712.

  54. Christian P, Jiang T, Khatry SK, LeClerq SC, Shrestha SR, West KP. Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal. Am J Clin Nutr 2006;83:788-794.

  55. Ramakrishnan U, Gonzalez-Cossio T, Neufeld LM, Rivera J, Martorell R. Multiple micronutrient supplements during pregnancy do not increase birth size compared to iron-only supplements: a randomized controlled trial a semi-rural community in Mexico. Am J Clin Nutr 2003;77:720-725.

  56. Ramakrishnan U, Neufeld LM, Gonzalez-Cossio T, Villalpando S, García-Guerra A, Rivera J, et al. Multiple micronutrient supplements during pregnancy do not reduce anemia or improve iron status compared to iron-only supplements in semirural Mexico. J Nutr 2004;134:898-903.

  57. Ramakrishnan U, Gonzalez-Cossio T, Neufeld LM, Rivera J, Martorell R. Effect of prenatal multiple micronutrient supplements on maternal weight and skinfold changes: a randomized double-blind clinical trial in Mexico. Food Nutr Bull 2005;26:273-280.

  58. National Research Council (U.S.). Subcommittee on the Tenth Edition of the Recommended Dietary Allowances. Washington. DC: The National Academy Press, 1989.

  59. Neufeld L, Haas J, Grajeda R, Martorell R. Last menstrual period provides the best estimate of gestation length for women in rural Guatemala. Paediatr Perinat Epidemiol 2006;20:290-298.

  60. Stoltzfus R, Underwood B. Breastmilk vitamin A as an indicator of vitamin A status of women and infants. Bull WHO 1995;73:703-711.

  61. O’Broin SD, Gunther EW. Screening of folate status with the use of dried blood spots on filter paper. Am J Clin Nutr 1999;70:329-367.

  62. O’Broin SD, Kelleher B. Microbiological assay on microtitre plates of folate in serum and red cells. J Clin Pathol 1992;45:344-347.

  63. World Health Organization (WHO) Expert Committee. Physical status: the use and interpretation of anthropometry, p. 47 WHO Technical Report Series 854. Geneva: World Health Organization, 1995.

  64. International Zinc Nutrition Consultative Group (IZiNCG). Technical Document #1. Assessment of the risk of zinc deficiency in populations and options for its control. Hotz C and Brown KH (eds). Food Nutr Bull 2004;25:S94-S203.

  65. Pilch SM. Assessment of the vitamin A nutritional status of the US population based on data collected in the Health and Nutrition Examination Surveys. Bethesda, MD: Life Science Research Office, Federation of American Biological Societies, 1985.

  66. World Health Organization. Indicators for assessing vitamin A deficiency and their application in monitoring and evaluating intervention programs. WHO/NUT/96.10. Geneva: World Health Organization, 1996.

  67. Wagner C. Folic acid. In: Brown M (ed). Present knowledge in Nutrition. 5th Edition. Washington DC: The Nutrition Foundation, Inc. 1984:332-346.

  68. Osrin D, Vaidya A, Shrestha Y, Baniya RB, Manandhar DS, Adhikari RK, et al. Effects of antenatal multiple micronutrient supplementation on birthweight and gestational duration in Nepal: double-blind, randomized controlled trial. Lancet 2005;365(9463):955-962.

  69. Caulfield LE, Zavaleta N, Figueron A. Adding zinc to prenatal iron and folate supplements improves maternal and neonatal zinc status in a Peruvian population. Am J Clin Nutr 1999;69:1257-1263.

  70. Harvey LF, Dainty JR, Hollands WJ, Bull VJ, Hoogewerff JA, Foxall RJ, et al J. Effect of high-dose iron supplements on fractional zinc absorption and status in pregnant women. Am J Clin Nutr 2007;85:131-136.

  71. O´Brien KO, Zavaleta N, Caulfield LE, Wen J, Abrams SA. Prenatal iron supplements impair zinc absorption in pregnant Peruvian women. J Nutr 2000;130:2251-2255.

  72. Lönnerdal B. Dietary factors influencing zinc absorption. J Nutr 2000;130:1378S-1383S.

  73. Solomons NW, Jacob RA. Studies on the bioavailability of zinc in humans: effect of heme and nonheme iron on the absorption of zinc. Am J Clin Nutr 1981;34:475-482.

  74. Flores ML, Neufeld LM, González-Cossío T, Rivera J, Martorell R, Ramakrishnan U. Multiple micronutrient supplementation and dietary energy intake in pregnant women. Salud Publica Mex 2007;49:190-198.

  75. Tamura T, Picciano MF. Folate and human reproduction. Am J Clin Nutr 2006;83:993-1016.

  76. Scholl TO, Hediger ML, Schall JI, Khoo CS, Fischer RL. Dietary and serum folate: their influence on the outcome of pregnancy. Am J Clin Nutr 1996;63:520-525.

  77. Lindblad B, Zaman S, Malik A, Martin H, Ekstrom AM, Amu S, et al. Folate, vitamin B12, and homocysteine levels in South Asian women with growth-retarded fetuses. Acta Obstet Gynecol Scand 2005;84:1055-1061.




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