title: A prospective study of micronutrient status in adolescent pregnancy.
abstract: BACKGROUND
  Adolescents are more likely than adults to consume energy-dense, micronutrient-poor diets and to experience adverse pregnancy outcomes.
  
  
  OBJECTIVE
  The objectives were to assess micronutrient intake and blood biomarkers prospectively in pregnant adolescents recruited to the About Teenage Eating (ATE) Study and to determine associations with pregnancy outcome.
  
  
  METHODS
  Pregnant adolescents (n = 500) were recruited from 2 UK inner city populations. Dietary intake was assessed with three 24-h dietary recalls, and micronutrient status was assessed by measurement of third trimester blood biomarkers. Pregnancy outcomes included small-for-gestational age (SGA) birth and preterm delivery.
  
  
  RESULTS
  Median iron and folate intakes were lower than UK and US recommended amounts. Folate and vitamin B-12 status were lower in smokers, despite no differences in dietary intake. Serum folate was <7.0 nmol/L in 12% of subjects, and serum total homocysteine (tHcy) was elevated (>10 micromol/L) in 20% of subjects. Fifty-two percent of the subjects had iron deficiency anemia, and 30% had serum 25-hydroxyvitamin D concentrations <25 nmol/L. The incidence of SGA birth was higher in subjects with poorer folate status (red blood cell folate, P = 0.003; serum folate, P = 0.02; tHcy, P = 0.01; simple regression) and those with low folate intakes, regardless of the inclusion (P = 0.021) or exclusion (P = 0.049) of intake from supplements (simple regression). Adjustment for confounding variables confirmed the independence of these associations. The risk of SGA birth was also higher in subjects with low food iron intake (P = 0.049), but not when intake included iron from supplements (P = 0.21). The risk of SGA birth was lower in subjects with iron deficiency anemia (P = 0.002).
  
  
  CONCLUSIONS
  Poor micronutrient intake and status increase the risk of SGA births in pregnant adolescents.
authors.affiliation: Maternal and Fetal Health Research Group, School of Laboratory and Clinical Sciences, University of Manchester, St Mary's Hospital, Manchester, UK.
authors.forename: Philip N
authors.initials: PN
authors.lastname: Baker
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Wheeler
authors.forename: Tom A
authors.initials: TA
authors.lastname: Sanders
authors.forename: Jane E
authors.initials: JE
authors.lastname: Thomas
authors.forename: Cindy J
authors.initials: CJ
authors.lastname: Hutchinson
authors.forename: Karen
authors.initials: K
authors.lastname: Clarke
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Berry
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Jones
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.forename: Lucilla
authors.initials: L
authors.lastname: Poston
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D004032:Diet / Q000592:standards*; D019587:Dietary Supplements / Q000706:statistics & numerical data; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D007501:Iron / Q000097:blood; D019266:Iron, Dietary / Q000008:administration & dosage; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology*; D018977:Micronutrients / Q000008:administration & dosage* / Q000097:blood*; D009752:Nutritional Status; D011247:Pregnancy; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D015415:Biomarkers; D019266:Iron, Dietary; D018977:Micronutrients; D005492:Folic Acid; D007501:Iron