title: Antenatal supplementation with micronutrients and biochemical indicators of status and subclinical infection in rural Nepal.
abstract: BACKGROUND
  Previously we showed that women in rural Nepal experience multiple micronutrient deficiencies in early pregnancy.
  
  
  OBJECTIVE
  This study examined the effects of daily antenatal micronutrient supplementation on changes in the biochemical status of several micronutrients during pregnancy.
  
  
  METHODS
  In Nepal, we conducted a randomized controlled trial in which 4 combinations of micronutrients (folic acid, folic acid + iron, folic acid + iron + zinc, and a multiple micronutrient supplement containing folic acid, iron, zinc, and 11 other nutrients) plus vitamin A, or vitamin A alone as a control, were given daily during pregnancy. In a subsample of subjects (n = 740), blood was collected both before supplementation and at approximately 32 wk of gestation.
  
  
  RESULTS
  In the control group, serum concentrations of zinc, riboflavin, and vitamins B-12 and B-6 decreased, whereas those of copper and alpha-tocopherol increased, from the first to the third trimester. Concentrations of serum folate, 25-hydroxyvitamin D, and undercarboxylated prothrombin remained unchanged. Supplementation with folic acid alone or folic acid + iron decreased folate deficiency. However, the addition of zinc failed to increase serum folate, which suggests a negative inhibition; multiple micronutrient supplementation increased serum folate. Folic acid + iron + zinc failed to improve zinc status but reduced subclinical infection. Multiple micronutrient supplementation decreased the prevalence of serum riboflavin, vitamin B-6, vitamin B-12, folate, and vitamin D deficiencies but had no effect on infection.
  
  
  CONCLUSIONS
  In rural Nepal, antenatal supplementation with multiple micronutrients can ameliorate, to some extent, the burden of deficiency. The implications of such biochemical improvements in the absence of functional and health benefits remain unclear.
authors.affiliation: Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA. pchristi@jhsph.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.forename: Tianan
authors.initials: T
authors.lastname: Jiang
authors.forename: Subarna K
authors.initials: SK
authors.lastname: Khatry
authors.forename: Steven C
authors.initials: SC
authors.lastname: LeClerq
authors.forename: Sharada R
authors.initials: SR
authors.lastname: Shrestha
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D000328:Adult; D001774:Blood Chemical Analysis; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000188:drug therapy / Q000453:epidemiology*; D007501:Iron / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency*; D009390:Nepal; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D039401:Prenatal Nutritional Physiological Phenomena; D012423:Rural Health; D014801:Vitamin A / Q000008:administration & dosage; D015032:Zinc / Q000008:administration & dosage
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D005492:Folic Acid; D007501:Iron; D015032:Zinc