Micronutrient Status during Pregnancy and Effects of Antenatal Supplementation with Multiple Micronutrients versus Iron-folic Acid in Rural Bangladesh
Kerry Schulze *
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Saijuddin Shaikh
The JiVitA Project, Gaibandha, Bangladesh.
Hasmot Ali
The JiVitA Project, Gaibandha, Bangladesh.
Abu Ahmed Shamim
The JiVitA Project, Gaibandha, Bangladesh.
Lee Wu
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Alain Labrique
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Rolf Klemm
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sucheta Mehra
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Pongtorn Sungpuag
Institute of Nutrition, Mahidol University, Salaya, Thailand.
Emorn Wasantwisut
Institute of Nutrition, Mahidol University, Salaya, Thailand.
Parul Christian
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Keith West
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Women often enter pregnancy with micronutrient deficiencies, exacerbated by demands of pregnancy. Yet, gestational micronutrient status is uncommonly assessed, even as momentum builds toward preventing multiple micronutrient (MM) deficiencies. We assessed micronutrient status of women early in pregnancy in a rural setting in northern Bangladesh.
Methods: In a substudy of women participating in a randomized trial of MM versus iron-folic acid (IFA) supplementation we identified a population-based subsample of n=1526 women from whom plasma samples were obtained in the 1st trimester (TM), prior to supplementation, and in the 3rd TM, to evaluate micronutrient status and response to supplementation.
Results: In available 1st TM data (n=491-1448 per nutrient assay), 6.8% of women were vitamin A deficient (retinol < 0.70 μmol/L), 41.7% had low β-carotene (<0.09 μmol/L), and 57.7% were vitamin E deficient (α-tocopherol < 12 μmol/L). Folate deficiency (plasma folate < 6.8 nmol/L) was 2.6%, while prevalence of vitamin B12 deficiency (cobalamin < 150 pmol/L) was 29.8%. Anemia affected 20.6% of women, but iron deficiency by TfR (4.7% > 8.3 μg/L) and ferritin (1.8% < 12 μg/L) was uncommon. Plasma zinc was low (<10 μmol/L) in 30.6% of women. Inflammation, by α-1 acid glycoprotein (AGP > 1 g/L), was present in 8.1% of women. Baseline vitamin D and iodine status, and MM versus IFA effects on micronutrient status by the 3rd TM, are being determined.
Conclusions: Women in rural Bangladesh experience a variety of micronutrient deficiencies in early pregnancy, supporting the need to address "hidden hunger" with multiple micronutrient supplementation during pregnancy.