Preconception Micronutrient Supplementation Affects Maternal BMI and Body Composition Postpartum: A Randomized Controlled Trial in Vietnam

Overview

Journal J Nutr

Publisher Elsevier

Specialty Nutritional Sciences

Date 2024 Feb 28

PMID 38417549

Authors

Usha Ramakrishnan

Sonia Tandon Wimalasena

Melissa F Young

Long Q Khuong

Lan M Tran

Daniel J Hoffman

Reynaldo Martorell

Phuong H Nguyen

Affiliations

Soon will be listed here.

Abstract

Background: Although there is growing evidence on the role of preconception nutrition for birth outcomes, limited evidence exists for its effects on maternal health.

Objectives: This study evaluates the impact of preconception micronutrient supplementation on maternal BMI (kg/m) and body composition at 6 to 7 y postpartum (PP).

Methods: We followed females who participated in a randomized controlled trial of preconception supplementation in Vietnam and delivered live offspring (n = 1599). Females received weekly supplements containing either 2800 μg folic acid (FA) only, 60 mg iron and 2800 μg FA (IFA), or multiple micronutrients (MMs) (15 micronutrients including IFA) from baseline until conception followed by daily prenatal IFA supplements until delivery. Height, weight, mid-upper arm circumference, triceps skinfold, and waist-hip circumference were measured at recruitment and at 1, 2, and 6 to 7 y PP. Body fat was assessed using bioelectric impedance at 6 to 7 y PP (n = 867). Group comparisons were made using analysis of variance or chi-square tests and general linear models for adjusted models.

Results: At 6 to 7 y PP, we found significant differences (P < 0.05) by treatment group for mean percent fat (MM: 29.2%; IFA: 27.6%; FA: 27.8%), absolute fat mass (MM: 15.1 kg; IFA: 14.0 kg; FA: 14.3 kg), and prevalence of underweight based on BMI < 18.5 (MM: 5.8%; IFA: 10.3%; FA: 14.3%). Mean BMI and triceps skinfold thickness were higher in the MM group, but these differences were not statistically significant; the differences in absolute fat mass were also attenuated after controlling for body weight. No differences were observed for fat-free mass, prevalence of overweight (BMI >23), or other anthropometric measurements.

Conclusions: Preconception MM supplementation was associated with lower prevalence of underweight and higher percent fat when compared with IFA and/or FA only. Preconception micronutrient interventions may have long-term effects on maternal health and merit further examination. This trial was registered at clinicaltrials.gov as NCT01665378.

References

Yamada Y, Murakami H, Kawakami R, Gando Y, Nanri H, Nakagata T . Association between skeletal muscle mass or percent body fat and metabolic syndrome development in Japanese women: A 7-year prospective study. PLoS One. 2022; 17(10):e0263213. PMC: 9536572. DOI: 10.1371/journal.pone.0263213. View

Khan N, Khoi H . Double burden of malnutrition: the Vietnamese perspective. Asia Pac J Clin Nutr. 2008; 17 Suppl 1:116-8. View

Young M, Nguyen P, Tran L, Khuong L, Hendrix S, Martorell R . Maternal preconception BMI and gestational weight gain are associated with weight retention and maternal and child body fat at 6-7 years postpartum in the PRECONCEPT cohort. Front Nutr. 2023; 10:1114815. PMC: 10254082. DOI: 10.3389/fnut.2023.1114815. View

Young M, Ramakrishnan U . Maternal Undernutrition before and during Pregnancy and Offspring Health and Development. Ann Nutr Metab. 2021; :1-13. DOI: 10.1159/000510595. View

Nguyen P, Young M, Tran L, Khuong L, Duong T, Nguyen H . Preconception micronutrient supplementation positively affects child intellectual functioning at 6 y of age: A randomized controlled trial in Vietnam. Am J Clin Nutr. 2021; 113(5):1199-1208. PMC: 8106753. DOI: 10.1093/ajcn/nqaa423. View

Moller A, Petzold M, Chou D, Say L . Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013. Lancet Glob Health. 2017; 5(10):e977-e983. PMC: 5603717. DOI: 10.1016/S2214-109X(17)30325-X. View

Han T, Al-Gindan Y, Govan L, Hankey C, Lean M . Associations of body fat and skeletal muscle with hypertension. J Clin Hypertens (Greenwich). 2018; 21(2):230-238. PMC: 8030364. DOI: 10.1111/jch.13456. View

Xu L, Cheng X, Wang J, Cao Q, Sato T, Wang M . Comparisons of body-composition prediction accuracy: a study of 2 bioelectric impedance consumer devices in healthy Chinese persons using DXA and MRI as criteria methods. J Clin Densitom. 2011; 14(4):458-64. DOI: 10.1016/j.jocd.2011.04.001. View

Filmer D, Pritchett L . Estimating wealth effects without expenditure data--or tears: an application to educational enrollments in states of India. Demography. 2001; 38(1):115-32. DOI: 10.1353/dem.2001.0003. View

10.

Going S, Lohman T, Cussler E, Williams D, Morrison J, Horn P . Percent body fat and chronic disease risk factors in U.S. children and youth. Am J Prev Med. 2011; 41(4 Suppl 2):S77-86. DOI: 10.1016/j.amepre.2011.07.006. View

11.

Cetin I, Buhling K, Demir C, Kortam A, Prescott S, Yamashiro Y . Impact of Micronutrient Status during Pregnancy on Early Nutrition Programming. Ann Nutr Metab. 2019; 74(4):269-278. DOI: 10.1159/000499698. View

12.

Hoffman D, Powell T, Barrett E, Hardy D . Developmental origins of metabolic diseases. Physiol Rev. 2020; 101(3):739-795. PMC: 8526339. DOI: 10.1152/physrev.00002.2020. View

13.

Ma R, Schmidt M, Tam W, McIntyre H, Catalano P . Clinical management of pregnancy in the obese mother: before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol. 2016; 4(12):1037-1049. PMC: 6691730. DOI: 10.1016/S2213-8587(16)30278-9. View

14.

Vyas S, Kumaranayake L . Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006; 21(6):459-68. DOI: 10.1093/heapol/czl029. View

15.

Dhaded S, Hambidge K, Ali S, Somannavar M, Saleem S, Pasha O . Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in South Asia: The Women First Randomized Controlled Trial. PLoS One. 2020; 15(1):e0218960. PMC: 6988936. DOI: 10.1371/journal.pone.0218960. View

16.

. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363(9403):157-63. DOI: 10.1016/S0140-6736(03)15268-3. View

17.

Trinh O, Nguyen N, van der Ploeg H, Dibley M, Bauman A . Test-retest repeatability and relative validity of the Global Physical Activity Questionnaire in a developing country context. J Phys Act Health. 2009; 6 Suppl 1:S46-53. DOI: 10.1123/jpah.6.s1.s46. View

18.

Si J, Kang L, Liu Y . Association between Body Fat Percentage and Cardiometabolic Diseases in General Population. Endocr Metab Immune Disord Drug Targets. 2024; 24(12):1395-1400. DOI: 10.2174/0118715303274348231130052050. View

19.

Nguyen P, Lowe A, Martorell R, Nguyen H, Pham H, Nguyen S . Rationale, design, methodology and sample characteristics for the Vietnam pre-conceptual micronutrient supplementation trial (PRECONCEPT): a randomized controlled study. BMC Public Health. 2012; 12:898. PMC: 3533960. DOI: 10.1186/1471-2458-12-898. View

20.

Sahariah S, Potdar R, Gandhi M, Kehoe S, Brown N, Sane H . A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India. J Nutr. 2016; 146(7):1453S-60S. PMC: 4926846. DOI: 10.3945/jn.115.223461. View