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Am J Clin Nutr. 2015 Dec;102(6):1450-9. doi: 10.3945/ajcn.113.072413. Epub 2015 Nov 11.

Periconceptional multiple-micronutrient supplementation and placental function in rural Gambian women: a double-blind, randomized, placebo-controlled trial.

Author information

1
Children's Unit, Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom; Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia; stephen.owens@ncl.ac.uk.
2
Medical Research Council (MRC) International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom, and MRC Keneba, Fajara, The Gambia;
3
MRC Centre for Reproductive Health, The Queen's Medical Research Institute, Edinburgh, United Kingdom; and.
4
Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

Abstract

BACKGROUND:

Maternal micronutrient deficiencies are commonly associated with clinical indicators of placental dysfunction.

OBJECTIVE:

We tested the hypothesis that periconceptional multiple-micronutrient supplementation (MMS) affects placental function.

DESIGN:

We conducted a double-blind, randomized, placebo-controlled trial of MMS in 17- to 45-y-old Gambian women who were menstruating regularly and within the previous 3 mo. Eligible subjects were pre-randomly assigned to supplementation with the UNICEF/WHO/United Nations University multiple micronutrient preparation (UNIMMAP) or placebo on recruitment and until they reached their first antenatal check-up or for 1 y if they failed to conceive. Primary outcome measures were midgestational indexes of utero-placental vascular-endothelial function [ratio of plasminogen-activator inhibitor (PAI) 1 to PAI-2 and mean uterine-artery resistance index (UtARI)] and placental active transport capacity at delivery [fetal to maternal measles antibody (MMA) ratio].

RESULTS:

We recruited 1156 women who yielded 415 pregnancies, of which 376 met all of the inclusion criteria. With adjustment for gestational age at sampling, there were no differences in PAI-1 to PAI-2 or MMA ratios between trial arms, but there was a 0.02-unit reduction in UtARI between 18 and 32 wk of gestation (95% CI: -0.03, -0.00; P = 0.040) in women taking UNIMMAP.

CONCLUSIONS:

Placental vascular function was modifiable by periconceptional micronutrient supplementation. However, the effect was small and supplementation did not further affect other variables of placental function. This trial was registered at www.controlled-trials.com as ISRCTN 13687662.

KEYWORDS:

Africa; birth weight; fetal growth; micronutrients; periconceptional; placenta; pregnancy

PMID:
26561613
PMCID:
PMC4658455
DOI:
10.3945/ajcn.113.072413
[Indexed for MEDLINE]
Free PMC Article

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