Abstract
Multiple micronutrient supplementation (MMS) in pregnancy has previously been associated with positive effects on fetal growth, but its value in high-income countries remains controversial. In this study, we investigated effects of pregnancy MMS on offspring size at birth and adiposity, along with risks of various maternal outcomes of pregnancy, using the prospective Cambridge Baby Growth Study. Maternal MMS was reported in 528 out of 970 women who completed pregnancy questionnaires. Gestational diabetes (GDM) was assessed using results from 75 g oral glucose tolerance tests at week 28 of pregnancy. Offspring size at birth was assessed using standard anthropometric measurements and adiposity using skinfold calipers. MMS was associated with increased risk of developing GDM (risk ratio = 1.86 (1.13–3.08), p = 0.02), as well as increased offspring size at birth in terms of weight (p = 0.03), head circumference (p = 0.04), and flank, and subscapular and triceps skinfold thicknesses (p = 0.04, 0.03, and 0.003, respectively). There was no association with quadriceps skinfold thickness (p = 0.2), suggesting that the increased adiposity was partially regionalized. In women who underwent oral glucose tolerance testing, nearly all of these associations were attenuated by adjusting for GDM. These results suggest that the increased offspring size at birth, including (regionalized) adiposity associated with pregnancy, and MMS may be partially related to the development of GDM.
Highlights
Multiple micronutrient supplementation in pregnancy, as shown in a recent Cochrane review covering clinical trials that included a total of over 141,000 participants [1], leads to a number of positive effects in pregnancy, including a lowering of the prevalence of low birth weight babies, numbers born small for gestational age (SGA), and the prevalence of preterm deliveries
We investigated the potential effects of multiple micronutrient supplementation on adverse maternal outcomes and offspring growth in a relatively contemporary pregnancy and birth cohort recruited from a single center in Cambridge, UK [8]
With the exception of the number of twin pregnancies, which were excluded from the analysis, only smoking during pregnancy differed in prevalence between those included in the analysis than in those excluded from it
Summary
Multiple micronutrient supplementation in pregnancy, as shown in a recent Cochrane review covering clinical trials that included a total of over 141,000 participants [1], leads to a number of positive effects in pregnancy, including a lowering of the prevalence of low birth weight babies, numbers born small for gestational age (SGA), and the prevalence of preterm deliveries. Nineteen of the twenty clinical trials included in this analysis took place in low- or middle-income countries where multiple micronutrient deficiencies are prevalent during pregnancy. The remaining trial was conducted in the UK, where a low-income population with nutritional deficiencies was studied, despite being in a high-income country [2]. This trial found no effect of supplementation on low birth weight, SGA, or preterm birth rates. It did report a reduced prevalence of anemia in pregnancy [2]. In contrast to the numbers of studies in low- and middle-income countries [3], formal studies are rarely undertaken in high-income countries [4], such as the UK, where pregnant women may be better
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