Skip to main page content
U.S. flag

An official website of the United States government

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Dec;146(12):2520-2529.
doi: 10.3945/jn.116.235994. Epub 2016 Oct 19.

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Shirin Ziaei  1 , Anisur Rahman  2 , Rubhana Raqib  2 , Bo Lönnerdal  3 , Eva-Charlotte Ekström  4
Affiliations
Randomized Controlled Trial

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Shirin Ziaei et al. J Nutr. 2016 Dec.

Abstract

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 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg 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.

Keywords: Bangladesh; effectiveness; efficacy; ferritin; folate; food supplementation; maternal micronutrient status; prenatal micronutrient supplementation; vitamin B-12; zinc.

PubMed Disclaimer

Conflict of interest statement

2Author disclosures: S Ziaei, A Rahman, R Raqib, B Lönnerdal, and E-C Ekström, no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of participating women.
FIGURE 2
FIGURE 2
Lowess curves of associations between total numbers of capsules consumed from week 14 to 30 of pregnancy and maternal plasma concentrations of vitamin B-12 (A), folate (B), ferritin (C), and zinc (D) at week 30 of pregnancy, by micronutrient supplementation type. Plasma concentrations of micronutrients are presented in loge scale. Fe30F, 30 mg Fe and 400 μg folic acid; Fe60F, 60 mg Fe and 400 μg folic acid; MMN, multiple micronutrient supplement.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Peña-Rosas JP, De-Regil LM, Garcia-Casal MN, Dowswell T. Daily oral iron supplementation during pregnancy. Cochrane Database Syst Rev 2015;7:CD004736. - PMC - PubMed
    1. Ezzati M, Lopez A, Rodgers A, Murray C. Comparative quantification of health risks: the global and regional burden of disease attributable to selected major risk factors. Geneva (Switzerland): World Health Organization; 2004.
    1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, Mathers C, Rivera J. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008;371:243–60. - PubMed
    1. Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev 2015;11:CD004905. - PMC - PubMed
    1. Sloan NL, Jordan E, Winikoff B. Effects of iron supplementation on maternal hematologic status in pregnancy. Am J Public Health 2002;92:288–93. - PMC - PubMed

Publication types