Maternal Lipid-based Nutrient and Multiple Micronutrient Supplementation Affect B-vitamins in Milk Differently in Malawian Compared to Ghanaian Mothers (P24-045-19)

Abstract

Abstract Objectives Little is known about the influence of maternal micronutrient (MN) supplementation during pregnancy/lactation on human milk (HM) MN concentrations. We evaluated B-vitamin (BV) concentrations in milk from mothers in Ghana and Malawi who participated in the International Lipid-Based Nutrient Supplements (iLiNS) Project. Methods Women (<20 wk gestation) were randomized to receive: 1 x daily iron/folic acid (IFA) during pregnancy only, or a multiple micronutrient (MMN) tablet or LNS containing equal amounts of vitamins during pregnancy and 6 mo of lactation. HM at 6mo postpartum was analyzed for vitamins B1, B2, B3 (nicotinamide only), B5, B6, and B12 and compared to the recommended Adequate Intakes (AI) for infants 0–6 mo, which are based on values from milk from well-nourished mothers, assuming 780 mL/d milk intake. Results Concentrations and responses to supplementation differed greatly between countries. Comparing the IFA groups’ concentrations (geom. mean), women in Ghana had significantly lower HM B1 (121 vs. 183 µg/L), B2 (139 vs. 321 µg/L), and B6 (21.3 vs. 89.2 µg/L), and significantly higher B3 (1057 vs. 151 µg/L) and B12 (439 vs. 239 pmol/L). In Ghana, use of MMN/LNS increased all HM BV (10 - 30%); but even with supplementation, only up to 5.7% (B1, B2, B3, B6), and 47.9 and 73.2% (B5 and B12) of the samples reached AI values. In Malawi, only HM B2 was significantly increased by MMN/LNS (371 vs. 321 µg/L), resulting in 47.2% of samples reaching the AI value, compared to 36.0% in the IFA group. None of Malawian samples reached the AI value for B3, and 9.0 to 34.6% reached the AI values for the remaining vitamins. Conclusions HM BV concentrations differed greatly by geographic origin, possibly due to differences in diet or fortification. Maternal MMN/LNS supplementation during pregnancy/lactation increased all HM B-vitamins in Ghana. Only HM B2 was increased in Malawi, for reasons that are unclear. Funding Sources Bill & Melinda Gates Foundation (OPP49817), USDA/ARS Intramural Project (5306–51,530-019–00), U.S. Agency for International Development (USAID, AID-OAA-A-12–00005), and the Food and Nutrition Technical Assistance III Project (FANTA). All authors declare no conflict of interest.