title: A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women.
abstract: BACKGROUND
  The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.
  
  
  OBJECTIVE
  We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.
  
  
  METHODS
  In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.
  
  
  RESULTS
  At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.
  
  
  CONCLUSIONS
  Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.
authors: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors: Shirin
authors: http://orcid.org/0000-0001-5396-6624
authors: S
authors: Ziaei
authors: International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and.
authors: Anisur
authors: A
authors: Rahman
authors: International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh; and.
authors: Rubhana
authors: R
authors: Raqib
authors: Department of Nutrition, University of California, Davis, Davis, CA.
authors: Bo
authors: B
authors: Lönnerdal
authors: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; lotta.ekstrom@kbh.uu.se.
authors: Eva-Charlotte
authors: EC
authors: Ekström
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000097:blood*; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood* / Q000494:pharmacology; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000494:pharmacology; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D012424:Rural Population; D014805:Vitamin B 12 / Q000097:blood*; D015032:Zinc / Q000097:blood*
chemical_list: D005293:Ferritins; D005492:Folic Acid; D007501:Iron; D015032:Zinc; D014805:Vitamin B 12
keywords: Bangladesh; effectiveness; efficacy; ferritin; folate; food supplementation; maternal micronutrient status; prenatal micronutrient supplementation; vitamin B-12; zinc