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Nutrition and Oxidative Parameters in Pregnancy, Size at Birth and Metabolic Status of the Offspring at 4.5 Years: The MINIMat Trial in Rural Bangladesh
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Undernutrition and oxidative stress in fetal life and infancy may lead to adverse health outcomes in the offspring. We studied nutrition and oxidative parameters in pregnancy and their associations with birth anthropometry and metabolic status in the children.

In Matlab in rural Bangladesh, women were randomized to either early (Early) invitation to food supplementation or to start at their own liking (Usual). Women were also allocated to either; 1) 60 mg iron and 400 µg folic acid (Fe60F), 2) multiple micronutrients including 30 mg iron and folic acid (MMS), or 3) 30 mg iron and folic acid (Fe30F). Micronutrients (hemoglobin, iron, zinc, folic acid, vitamin B-12) were assessed in pregnancy week 14, lipid peroxidation in week 14 and 30, and DNA oxidation in week 19. The offspring were assessed for anthropometric measurements at birth and metabolic status at 4.5 years.

Micronutrient deficiencies were common with zinc and vitamin B-12 deficiency being most prevalent. Anemia was present in approximately one third of women, however, iron deficiency was uncommon seen in only 2%.

Maternal Early food supplementation group resulted in an improved lipid status in the children at 4.5 years compared to Usual food group. Prenatal use of MMS lowered the children’s glucose, insulin, HOMA-IR, and growth factors compared to Fe60F.  

Lipid peroxidation in early pregnancy was associated with size at birth and insulin and HOMA-IR levels in the children. Lipid peroxidation in late pregnancy, however, was associated with the children’s lipid status. Both increasing lipid peroxidation and increasing DNA oxidation was associated with decreasing IGF-1 levels. 

The beneficial effects of an Early start of food supplementation show that an improved prenatal nutrition may have lasting effects in the offspring and highlights the importance of early timing food supplementation. Use of MMS, however, resulted in lower insulin levels, which, considering the already low level of insulin in these children, may be a cause of concern. MMS also resulted in growth factors indicative of slower growth and further research appears to be needed before scaling up the use of MMS. Oxidative parameters in pregnancy were associated with longer-term outcomes in the offspring, suggesting that oxidative stress may be involved in the development of later metabolic disease.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 65 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 764
Keyword [en]
Pregnancy, micronutrient deficiency, anemia, birth size, food supplementation, micronutrient supplementation, metabolic status, childhood
National Category
Medical and Health Sciences
Research subject
International Health
Identifiers
URN: urn:nbn:se:uu:diva-172419ISBN: 978-91-554-8343-2 (print)OAI: oai:DiVA.org:uu-172419DiVA: diva2:514612
Public defence
2012-05-25, Rosénsalen, Akademiska sjukhuset, entrance 95/96 lower ground, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2012-05-04 Created: 2012-04-10 Last updated: 2012-08-01Bibliographically approved
List of papers
1. Prevalence of anemia and micronutrient deficiencies in early pregnancy in rural Bangladesh, the MINIMat trial
Open this publication in new window or tab >>Prevalence of anemia and micronutrient deficiencies in early pregnancy in rural Bangladesh, the MINIMat trial
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2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 1, 47-56 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To describe the prevalence of anemia and micronutrient deficiencies as well as their determinants in early pregnancy. Design. Baseline data from a population-based randomized intervention trial. Setting. The study was conducted in Mat lab, a sub-district in rural Bangladesh from 1 January to 31 December 2002. Population. Pregnant women (n = 740) were enrolled in approximately week 14 in pregnancy. Methods. Data were collected using questionnaires, physical examinations and laboratory analyses of blood samples for concentrations of hemoglobin, ferritin, zinc, folate and vitamin B-12. Main Outcome Measures. Covariates associated with anemia and micronutrient deficiencies in bivariate analyses were evaluated in multivariate logistic regression models adjusting for potential confounders. Results. Anemia was present in 28% of the women, 55% were zinc deficient, 46% were vitamin B-12 deficient and 18% were folate deficient. Anemia was not associated with iron deficiency but rather with vitamin B-12 deficiency. Infestation with Ascaris was highly prevalent (67%) and associated with both folate and vitamin B-12 deficiency. Anemia and micronutrient deficiencies all varied significantly with season. Conclusions. The high prevalences of zinc and vitamin B-12 deficiencies in early pregnancy are a concern, as it could lead to adverse pregnancy outcomes and increased health risks for both mother and child. The prevalence of iron deficiency was low, but as this was during early pregnancy, the women might develop iron deficiency and consequently iron deficiency anemia as the pregnancy progresses.

Keyword
Maternal, developing countries, anemia, micronutrients
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-148668 (URN)10.1111/j.1600-0412.2010.01014.x (DOI)000287103300008 ()21275915 (PubMedID)
Available from: 2011-03-09 Created: 2011-03-09 Last updated: 2017-12-11Bibliographically approved
2. Prenatal food and micronutrient supplementation have effects on metabolic status at 4.5 years of age. The randomised MINIMat trial in rural Bangladesh
Open this publication in new window or tab >>Prenatal food and micronutrient supplementation have effects on metabolic status at 4.5 years of age. The randomised MINIMat trial in rural Bangladesh
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(English)Manuscript (preprint) (Other academic)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-172417 (URN)
Available from: 2012-04-10 Created: 2012-04-10 Last updated: 2012-05-07
3. Associations between oxidative parameters in pregnancy and birth anthropometry in a cohort of women and children in rural Bangladesh: The MINIMat-cohort
Open this publication in new window or tab >>Associations between oxidative parameters in pregnancy and birth anthropometry in a cohort of women and children in rural Bangladesh: The MINIMat-cohort
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2012 (English)In: Free radical research, ISSN 1071-5762, E-ISSN 1029-2470, Vol. 46, no 3, 253-264 p.Article in journal (Refereed) Published
Abstract [en]

Oxidative stress is suggested as a potential mechanism in impaired foetal growth, smaller birth size and thus subsequently adult chronic diseases. We have investigated associations between oxidative stress in pregnancy and birth anthropometry (weight, height, head and chest circumferences). In the MINIMat-trial (Maternal and Infant Nutrition Interventions, Matlab) in rural Bangladesh, free 8-iso-prostaglandin P-2 alpha (lipid peroxidation) was analysed in pregnancy week 14 and 30 and 8-Hydroxy-2 '-Deoxyguanosine (DNA oxidation) in week 19. We found that higher levels of lipid peroxidation in early pregnancy were associated with larger infant size (birth length and chest circumference). In late pregnancy, no clear pattern of associations was found. Increasing level of DNA oxidation was associated with lower birth length in girls but no other associations were found. In conclusion, a higher level of lipid peroxidation in early (but not late) pregnancy was associated with a favourable larger birth size suggesting that timing of lipid peroxidation is of importance.

Keyword
oxidative stress, isoprostane, 8-Hydroxy-2 '-Deoxyguanosine, pregnancy, birth anthropometry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-170320 (URN)10.3109/10715762.2011.651467 (DOI)000300444100003 ()
Available from: 2012-03-13 Created: 2012-03-12 Last updated: 2017-12-07Bibliographically approved
4. Associations between oxidative parameters in pregnancy and metabolic, oxidative and inflammatory markers in offspring in early childhood: The MINIMat trial in rural Bangladesh
Open this publication in new window or tab >>Associations between oxidative parameters in pregnancy and metabolic, oxidative and inflammatory markers in offspring in early childhood: The MINIMat trial in rural Bangladesh
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2012 (English)Article in journal (Other academic) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-172418 (URN)
Available from: 2012-04-10 Created: 2012-04-10 Last updated: 2012-05-07Bibliographically approved

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