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American Journal of Clinical Nutrition, Vol. 84, No. 5, 1086-1092, November 2006
© 2006 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Effect of multiple micronutrient supplementation during pregnancy on inflammatory markers in Nepalese women1,2,3

Laura J Hindle, Rachel Gitau, Suzanne M Filteau, Katie J Newens, David Osrin, Anthony M Costello, Andrew M Tomkins, Anjana Vaidya, Raj Kumar Mahato, Birendra Yadav and Dharma S Manandhar

1 From the Institute of Child Health, London, United Kingdom (LJH, RG, SMF, KJN, DO, AMC, and AMT); Mother & Infant Research Activities, Janakpur, Nepal (AV, RKM, BY, and DSM); and the London School of Hygiene and Tropical Medicine, London, United Kingdom (SMF)

Background: Multiple micronutrient supplementation of Nepalese women during pregnancy is associated with a significant increase in birth weight.

Objective: We tested the hypothesis that improved birth weight in infants of mothers supplemented with micronutrients is associated with a decrease in inflammatory responses and an increase in the production of T helper 1 cells and T helper 2 cells.

Design: The study was embedded in a randomized controlled trial of 15 micronutrients, compared with iron-folate supplementation (control), given during pregnancy with the aim of increasing birth weight. Blood samples were collected at 32 wk of gestation, 12–20 wk after supplementation began, for the measurement of inflammatory markers. Breast-milk samples were collected 1 mo after delivery for the measurement of the ratio of milk sodium to potassium (milk Na:K). In an opportunistically selected subgroup of 70 women, mitogen-stimulated cytokine production was measured ex vivo in whole blood.

Results: Blood eosinophils; plasma concentrations of the acute phase reactants C-reactive protein, {alpha}1-acid glycoprotein (AGP), neopterin, and ferritin; milk Na:K; and the production of interleukin (IL) 10, IL-4, interferon {gamma}, and tumor necrosis factor {alpha} in whole blood did not differ significantly between the supplemented and control groups. Plasma C-reactive protein and AGP were higher in women who had a preterm delivery, and AGP was higher in women who delivered a low-birth-weight term infant than in women who delivered a normal-birth-weight term infant.

Conclusions: The results indicate an association between systemic inflammation in late pregnancy and compromised delivery outcome in Nepalese women but do not support the hypothesis that multiple micronutrient supplementation changes cytokine production or inflammatory markers.

Key Words: Micronutrients • pregnancy • cytokine • inflammation • interleukin 4 • acute phase proteins • subclinical mastitis






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