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Effects of Prenatal Multiple Micronutrient Supplementation on Fetal Growth Factors: A Cluster-Randomized, Controlled Trial in Rural Bangladesh.

Gernand AD, Schulze KJ, Nanayakkara-Bind A, Arguello M, Shamim AA, Ali H, Wu L, West KP, Christian P - PLoS ONE (2015)

Bottom Line: Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh.IFA group.IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States of America.

ABSTRACT

Unlabelled: Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height <145 cm, insulin was higher by 59% (95% CI: 3, 115%; p = 0.05 for interaction) in the MM vs. IFA group. Maternal hPL and cord blood insulin and IGF-1 were positively, and IGFBP-1 was negatively, associated with birth weight z score and other measures of birth size (all p<0.05). IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth. Prenatal MM supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies.

Trial registration: ClinicalTrials.gov NCT00860470.

No MeSH data available.


Related in: MedlinePlus

CONSORT flow diagram showing maternal and infant participation through the study.There were 16 clusters in the folic-acid group and 15 clusters in the multiple micronutrient group. Some mothers were not met at 32 weeks, but were met at birth for cord blood collection.
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pone.0137269.g001: CONSORT flow diagram showing maternal and infant participation through the study.There were 16 clusters in the folic-acid group and 15 clusters in the multiple micronutrient group. Some mothers were not met at 32 weeks, but were met at birth for cord blood collection.

Mentions: Fig 1 displays the flow of participants from enrollment to analysis. In all, 500 pregnant women were enrolled in the substudy, from whom 396 paired maternal blood samples and 325 cord blood samples were included in the analysis. Pregnancy loss (miscarriage, abortion, or stillbirth) occurred in 16% of enrolled women. Pregnant women at baseline were young (27% were <20 years old), parous (63%), short (22% with height <145 cm), and had few years of education (31% <4 years of school; Table 1). Sixteen percent were anemic (hemoglobin <110 g/L). Only 16% of households had electricity while 36% owned a mobile phone and 14% owned a television. Eight percent of infants were born preterm (<37 weeks), 63% were born small-for-gestational age, and a third were low birth weight (Table 1). Mean (SD) placental weight was 351 (74) g and birth weight was 2683 (414) g. These and other characteristics did not differ by supplementation groups (Table 1). Compliance was high–women consumed a median (IQR) of 95.5% (89.1, 98.4) of supplement tablets and compliance did not differ between supplementation groups (median 95.5% vs. 95.5% for MM vs. IFA, p = 0.39 by Kruskal-Wallis test).


Effects of Prenatal Multiple Micronutrient Supplementation on Fetal Growth Factors: A Cluster-Randomized, Controlled Trial in Rural Bangladesh.

Gernand AD, Schulze KJ, Nanayakkara-Bind A, Arguello M, Shamim AA, Ali H, Wu L, West KP, Christian P - PLoS ONE (2015)

CONSORT flow diagram showing maternal and infant participation through the study.There were 16 clusters in the folic-acid group and 15 clusters in the multiple micronutrient group. Some mothers were not met at 32 weeks, but were met at birth for cord blood collection.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591978&req=5

pone.0137269.g001: CONSORT flow diagram showing maternal and infant participation through the study.There were 16 clusters in the folic-acid group and 15 clusters in the multiple micronutrient group. Some mothers were not met at 32 weeks, but were met at birth for cord blood collection.
Mentions: Fig 1 displays the flow of participants from enrollment to analysis. In all, 500 pregnant women were enrolled in the substudy, from whom 396 paired maternal blood samples and 325 cord blood samples were included in the analysis. Pregnancy loss (miscarriage, abortion, or stillbirth) occurred in 16% of enrolled women. Pregnant women at baseline were young (27% were <20 years old), parous (63%), short (22% with height <145 cm), and had few years of education (31% <4 years of school; Table 1). Sixteen percent were anemic (hemoglobin <110 g/L). Only 16% of households had electricity while 36% owned a mobile phone and 14% owned a television. Eight percent of infants were born preterm (<37 weeks), 63% were born small-for-gestational age, and a third were low birth weight (Table 1). Mean (SD) placental weight was 351 (74) g and birth weight was 2683 (414) g. These and other characteristics did not differ by supplementation groups (Table 1). Compliance was high–women consumed a median (IQR) of 95.5% (89.1, 98.4) of supplement tablets and compliance did not differ between supplementation groups (median 95.5% vs. 95.5% for MM vs. IFA, p = 0.39 by Kruskal-Wallis test).

Bottom Line: Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh.IFA group.IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth.

View Article: PubMed Central - PubMed

Affiliation: Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America; Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States of America.

ABSTRACT

Unlabelled: Prenatal multiple micronutrient (MM) supplementation improves birth weight through increased fetal growth and gestational age, but whether maternal or fetal growth factors are involved is unclear. Our objective was to examine the effect of prenatal MM supplementation on intrauterine growth factors and the associations between growth factors and birth outcomes in a rural setting in Bangladesh. In a double-blind, cluster-randomized, controlled trial of MM vs. iron and folic acid (IFA) supplementation, we measured placental growth hormone (PGH) at 10 weeks and PGH and human placental lactogen (hPL) at 32 weeks gestation in maternal plasma (n = 396) and insulin, insulin-like growth factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) in cord plasma (n = 325). Birth size and gestational age were also assessed. Early pregnancy mean (SD) BMI was 19.5 (2.4) kg/m2 and birth weight was 2.68 (0.41) kg. There was no effect of MM on concentrations of maternal hPL or PGH, or cord insulin, IGF-1, or IGFBP-1. However, among pregnancies of female offspring, hPL concentration was higher by 1.1 mg/L in the third trimester (95% CI: 0.2, 2.0 mg/L; p = 0.09 for interaction); and among women with height <145 cm, insulin was higher by 59% (95% CI: 3, 115%; p = 0.05 for interaction) in the MM vs. IFA group. Maternal hPL and cord blood insulin and IGF-1 were positively, and IGFBP-1 was negatively, associated with birth weight z score and other measures of birth size (all p<0.05). IGF-1 was inversely associated with gestational age (p<0.05), but other growth factors were not associated with gestational age or preterm birth. Prenatal MM supplementation had no overall impact on intrauterine growth factors. MM supplementation altered some growth factors differentially by maternal early pregnancy nutritional status and sex of the offspring, but this should be examined in other studies.

Trial registration: ClinicalTrials.gov NCT00860470.

No MeSH data available.


Related in: MedlinePlus