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Randomized controlled trial of prenatal zinc supplementation and fetal bone growth^1,2,3

¹ From the Center for Human Nutrition, Department of International Health (MM and LEC), the Department of Biostatistics (FD), and the Department of Population and Family Health Sciences (JAD), the Bloomberg School of Public Health, The Johns Hopkins University, Baltimore; the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva (MM); the Instituto de Investigación Nutricional, Lima, Peru (NZ and AF); and the Division of Maternal-Fetal Medicine, The Johns Hopkins Medical Institutions, Baltimore (KAC).

Background: Maternal zinc deficiency is relatively common in developing countries, but its consequences for fetal growth are not established.

Objective: The goal was to examine whether improvement in maternal gestational zinc status is positively associated with fetal growth as assessed by ultrasonography.

Design: We conducted a double-masked, randomized trial among 242 pregnant Peruvian women in an impoverished shantytown in Lima, Peru. At 10–16 wk of gestation, the women were randomly assigned to receive daily supplements containing 60 mg Fe and 250 µg folic acid, with or without 25 mg Zn. We measured fetal head circumference, biparietal diameter, abdominal circumference, and femur diaphysis length at 20, 24, 28, 32, 36, and 38 wk of gestation. Fetal measures were analyzed longitudinally to evaluate differences in trends of fetal growth by supplement type, and within-subject correlations were taken into account.

Results: Femur diaphysis length was greater in fetuses whose mothers received zinc supplements (P < 0.05), and the difference tended to increase with gestational age. No significant differences by supplement type were observed for the other anatomical sites measured.

Conclusions: The observed positive effect of prenatal zinc on fetal femur diaphysis length is consistent with the results of experimental studies in animals and in vitro. The supplementation effect represents an upward shift in mean femur diaphysis length at term of about one-quarter of the reference SD. These findings suggest the potential importance of maternal zinc status for fetal bone growth in humans and illustrate the value of ultrasonography for evaluating the effect of prenatal nutritional interventions on components of fetal growth.

Key Words: Zinc • fetus • femur growth • Peru • pregnancy • supplementation

This article has been cited by other articles:

				L. L Iannotti, N. Zavaleta, Z. Leon, A. H Shankar, and L. E Caulfield Maternal zinc supplementation and growth in Peruvian infants Am. J. Clinical Nutrition, July 1, 2008; 88(1): 154 - 160. [Abstract] [Full Text] [PDF]

				D. A Leon Biological theories, evidence, and epidemiology Int. J. Epidemiol., December 1, 2004; 33(6): 1167 - 1171. [Full Text] [PDF]