Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh

Kerry J. Schulze, Sucheta Mehra, Saijuddin Shaikh, Hasmot Ali, Abu Ahmed Shamim, Lee S.F. Wu, Maithilee Mitra, Margia A. Arguello, Brittany Kmush, Pongtorn Sungpuag, Emorn Udomkesmelee, Rebecca Merrill, Rolf D.W. Klemm, Barkat Ullah, Alain B. Labrique, Keith P. West, Parul Christian

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

Original languageEnglish (US)
Pages (from-to)1260-1270
Number of pages11
JournalThe Journal of nutrition
Volume149
Issue number7
DOIs
StatePublished - Jul 1 2019

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Bangladesh
Micronutrients
Folic Acid
Pregnant Women
Iron
Randomized Controlled Trials
Pregnancy
Zinc
Women's Rights
Vitamin B 12
Ferritins
Food
Vitamin B 12 Deficiency
Transferrin Receptors
Tocopherols
Nutritional Support
Thyroglobulin
Vitamin A
Vitamin E
Vitamin D

Keywords

  • antenatal
  • Bangladesh
  • micronutrients
  • minerals
  • pregnancy
  • South Asia
  • supplementation
  • trial
  • vitamins

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh. / Schulze, Kerry J.; Mehra, Sucheta; Shaikh, Saijuddin; Ali, Hasmot; Shamim, Abu Ahmed; Wu, Lee S.F.; Mitra, Maithilee; Arguello, Margia A.; Kmush, Brittany; Sungpuag, Pongtorn; Udomkesmelee, Emorn; Merrill, Rebecca; Klemm, Rolf D.W.; Ullah, Barkat; Labrique, Alain B.; West, Keith P.; Christian, Parul.

In: The Journal of nutrition, Vol. 149, No. 7, 01.07.2019, p. 1260-1270.

Research output: Contribution to journalArticle

Schulze, KJ, Mehra, S, Shaikh, S, Ali, H, Shamim, AA, Wu, LSF, Mitra, M, Arguello, MA, Kmush, B, Sungpuag, P, Udomkesmelee, E, Merrill, R, Klemm, RDW, Ullah, B, Labrique, AB, West, KP & Christian, P 2019, 'Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh', The Journal of nutrition, vol. 149, no. 7, pp. 1260-1270. https://doi.org/10.1093/jn/nxz046
Schulze, Kerry J. ; Mehra, Sucheta ; Shaikh, Saijuddin ; Ali, Hasmot ; Shamim, Abu Ahmed ; Wu, Lee S.F. ; Mitra, Maithilee ; Arguello, Margia A. ; Kmush, Brittany ; Sungpuag, Pongtorn ; Udomkesmelee, Emorn ; Merrill, Rebecca ; Klemm, Rolf D.W. ; Ullah, Barkat ; Labrique, Alain B. ; West, Keith P. ; Christian, Parul. / Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh. In: The Journal of nutrition. 2019 ; Vol. 149, No. 7. pp. 1260-1270.
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title = "Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh",
abstract = "BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6{\%}; iron by ferritin, 4.0{\%}; iron by transferrin receptor, 4.7{\%}; folate, 2.5{\%}; vitamin B-12, 35.4{\%}; vitamin A, 6.7{\%}; vitamin E, 57.7{\%}; vitamin D, 64.0{\%}; zinc, 13.4{\%}; and iodine, 2.6{\%}. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7{\%} higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6{\%} lower, for the MM group compared with the IFA group, with a 15-38{\%} lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.",
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author = "Schulze, {Kerry J.} and Sucheta Mehra and Saijuddin Shaikh and Hasmot Ali and Shamim, {Abu Ahmed} and Wu, {Lee S.F.} and Maithilee Mitra and Arguello, {Margia A.} and Brittany Kmush and Pongtorn Sungpuag and Emorn Udomkesmelee and Rebecca Merrill and Klemm, {Rolf D.W.} and Barkat Ullah and Labrique, {Alain B.} and West, {Keith P.} and Parul Christian",
year = "2019",
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TY - JOUR

T1 - Antenatal Multiple Micronutrient Supplementation Compared to Iron-Folic Acid Affects Micronutrient Status but Does Not Eliminate Deficiencies in a Randomized Controlled Trial Among Pregnant Women of Rural Bangladesh

AU - Schulze, Kerry J.

AU - Mehra, Sucheta

AU - Shaikh, Saijuddin

AU - Ali, Hasmot

AU - Shamim, Abu Ahmed

AU - Wu, Lee S.F.

AU - Mitra, Maithilee

AU - Arguello, Margia A.

AU - Kmush, Brittany

AU - Sungpuag, Pongtorn

AU - Udomkesmelee, Emorn

AU - Merrill, Rebecca

AU - Klemm, Rolf D.W.

AU - Ullah, Barkat

AU - Labrique, Alain B.

AU - West, Keith P.

AU - Christian, Parul

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

AB - BACKGROUND: Antenatal multiple micronutrient (MM) supplementation improves birth outcomes relative to iron-folic acid (IFA) in developing countries, but limited data exist on its impact on pregnancy micronutrient status. OBJECTIVE: We assessed the efficacy of a daily MM (15 nutrients) compared with IFA supplement, each providing approximately 1 RDA of nutrients and given beginning at pregnancy ascertainment, on late pregnancy micronutrient status of women in rural Bangladesh. Secondarily, we explored other contributors to pregnancy micronutrient status. METHODS: Within a double-masked trial (JiVitA-3) among 44,500 pregnant women, micronutrient status indicators were assessed in n = 1526 women, allocated by cluster to receive daily MM (n = 749) or IFA (n = 777), at 10 wk (baseline: before supplementation) and 32 wk (during supplementation) gestation. Efficacy of MM supplementation on micronutrient status indicators at 32 wk was assessed, controlling for baseline status and other covariates (e.g., inflammation and season), in regression models. RESULTS: Baseline status was comparable by intervention. Prevalence of deficiency among all participants was as follows: anemia, 20.6%; iron by ferritin, 4.0%; iron by transferrin receptor, 4.7%; folate, 2.5%; vitamin B-12, 35.4%; vitamin A, 6.7%; vitamin E, 57.7%; vitamin D, 64.0%; zinc, 13.4%; and iodine, 2.6%. At 32 wk gestation, vitamin B-12, A, and D and zinc status indicators were 3.7-13.7% higher, and ferritin, γ-tocopherol, and thyroglobulin indicators were 8.7-16.6% lower, for the MM group compared with the IFA group, with a 15-38% lower prevalence of deficiencies of vitamins B-12, A, and D and zinc (all P < 0.05). However, indicators typically suggested worsening status during pregnancy, even with supplementation, and baseline status or other covariates were more strongly associated with late pregnancy indicators than was MM supplementation. CONCLUSIONS: Rural Bangladeshi women commonly entered pregnancy deficient in micronutrients other than iron and folic acid. Supplementation with MM improved micronutrient status, although deficiencies persisted. Preconception supplementation or higher nutrient doses may be warranted to support nutritional demands of pregnancy in undernourished populations. This trial was registered at clinicaltrials.gov as NCT00860470.

KW - antenatal

KW - Bangladesh

KW - micronutrients

KW - minerals

KW - pregnancy

KW - South Asia

KW - supplementation

KW - trial

KW - vitamins

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U2 - 10.1093/jn/nxz046

DO - 10.1093/jn/nxz046

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JO - Journal of Nutrition

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