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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

Effect of multiple micronutrient supplementation compared to iron and folic acid on a) human placental lactogen, by infant sex (p = 0.09 for interaction), and b) cord plasma insulin, by maternal stature (p = 0.04 for interaction).Solid line for multiple micronutrient group; dashed line for iron and folic acid group.
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pone.0137269.g002: Effect of multiple micronutrient supplementation compared to iron and folic acid on a) human placental lactogen, by infant sex (p = 0.09 for interaction), and b) cord plasma insulin, by maternal stature (p = 0.04 for interaction).Solid line for multiple micronutrient group; dashed line for iron and folic acid group.

Mentions: Examination of possible interacting variables revealed that among short women (<145 cm), insulin was 59% higher (95% CI: 3, 115) in cord blood of the newborns of women consuming multiple micronutrients compared to iron-folic acid (p = 0.039 for interaction; Table 3). There was no difference by supplementation group in cord insulin for women of normal height. Similarly, there was an interaction (p = 0.090) by fetal sex such that MM increased hPL in mothers carrying a female (but not male) fetus at 32 weeks gestation (Table 3). These interactions were reflected in distributions for insulin and hPL that were right-shifted among short women and mothers of female fetuses, respectively, who were taking the MM supplement compared to IFA (Fig 2). No other interactions between supplementation and infant sex, maternal BMI, age, and parity were statistically significant for any fetal growth factors.


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)

Effect of multiple micronutrient supplementation compared to iron and folic acid on a) human placental lactogen, by infant sex (p = 0.09 for interaction), and b) cord plasma insulin, by maternal stature (p = 0.04 for interaction).Solid line for multiple micronutrient group; dashed line for iron and folic acid group.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0137269.g002: Effect of multiple micronutrient supplementation compared to iron and folic acid on a) human placental lactogen, by infant sex (p = 0.09 for interaction), and b) cord plasma insulin, by maternal stature (p = 0.04 for interaction).Solid line for multiple micronutrient group; dashed line for iron and folic acid group.
Mentions: Examination of possible interacting variables revealed that among short women (<145 cm), insulin was 59% higher (95% CI: 3, 115) in cord blood of the newborns of women consuming multiple micronutrients compared to iron-folic acid (p = 0.039 for interaction; Table 3). There was no difference by supplementation group in cord insulin for women of normal height. Similarly, there was an interaction (p = 0.090) by fetal sex such that MM increased hPL in mothers carrying a female (but not male) fetus at 32 weeks gestation (Table 3). These interactions were reflected in distributions for insulin and hPL that were right-shifted among short women and mothers of female fetuses, respectively, who were taking the MM supplement compared to IFA (Fig 2). No other interactions between supplementation and infant sex, maternal BMI, age, and parity were statistically significant for any fetal growth factors.

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