Journal
JOURNAL OF NUTRITION
Volume 146, Issue 12, Pages 2520-2529Publisher
OXFORD UNIV PRESS
DOI: 10.3945/jn.116.235994
Keywords
efficacy; effectiveness; prenatal micronutrient supplementation; food supplementation; maternal micronutrient status; folate; ferritin; vitamin B-12; zinc; Bangladesh
Categories
Funding
- International Center for Diarrheal Disease Research, Bangladesh
- UNICEF
- Swedish International Development Cooperation Agency
- United Kingdom Medical Research Council
- Swedish Research Council
- Department for International Development
- Japan Society for the Promotion of Science
- Child Health and Nutrition Research Initiative
- Uppsala University
- US Agency for International Development
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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 40014 folic acid (Fe30F), 60 mg Fe and 400 mu g 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. Conclusion: 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.
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