Prenatal multiple micronutrient supplementation impact on biochemical indicators during pregnancy and postpartum.
OBJECTIVE
The objective of this analysis was to test the impact of daily supplementation with multiple micronutrients (MM) during pregnancy on Zn, vitamin A and folate status compared to iron only (Fe).


METHODS
The study was carried out during 1997-2000 in a semi-urban community in Morelos state, Mexico. Women were randomly assigned to MM (n= 249) or Fe (n= 258) and received supplements daily (6 d/wk) under supervision by the field team from recruitment (approximately 9 weeks pregnancy) until delivery. Blood samples were collected on a sub-sample of women at baseline, 32 weeks pregnancy and one month postpartum (1PP) and assessed for serum zinc, retinol and whole blood folate (baseline and 1PP only). A breast milk sample was extracted at 1PP and assessed for retinol content.


RESULTS
At baseline there was no significant difference between supplementation groups in mean Zn, retinol or folate concentrations or the prevalence of deficiencies (Zn 12.2%, vitamin A 2.8%, folate 5.3%). Mean change in Zn and retinol concentrations from baseline to 32 weeks pregnancy did not differ between groups or between baseline and 1PP for Zn, retinol or folate. At 1PP, there was a tendency (p= 0.09) towards a lower prevalence of folate deficiency/depletion in the MM group (10.0%) than the Fe group (18.5%).


CONCLUSIONS
MM supplementation during pregnancy did not improve zinc or vitamin A status compared to Fe only. There is some indication that folate status may have improved with MM supplementation despite low prevalence of deficiency. While lack of response in serum retinol may be explained by generally adequate status, the lack of impact on zinc status requires further exploration.
García-Guerra
Armando
A
Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
Neufeld
Lynnette M
LM
Hernández-Cordero
Sonia
S
Rivera
Juan
J
Martorell
Reynaldo
R
Ramakrishnan
Usha
U
D000293:Adolescent; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D044342:Malnutrition / Q000097:blood / Q000517:prevention & control; D008800:Mexico; D018977:Micronutrients / Q000008:administration & dosage / Q000627:therapeutic use*; D008895:Milk, Human / Q000737:chemistry; D049590:Postpartum Period / Q000097:blood*; D011203:Poverty; D011247:Pregnancy / Q000097:blood*; D011248:Pregnancy Complications / Q000097:blood / Q000517:prevention & control; D011295:Prenatal Care / Q000379:methods* / Q000706:statistics & numerical data; D039401:Prenatal Nutritional Physiological Phenomena; D015995:Prevalence; D011644:Puerperal Disorders / Q000097:blood / Q000517:prevention & control; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D055815:Young Adult; D015032:Zinc / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*
D018977:Micronutrients; D014801:Vitamin A; D005492:Folic Acid; D007501:Iron; D015032:Zinc