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Micronutrient supplementation affects maternal-infant feeding interactions and maternal distress in Bangladesh^1,2,3

¹ From Cornell University, Division of Nutritional Sciences, Ithaca, NY (ALF); ICDDR,B: Centre for Health and Population Research, Dhaka, Bangladesh (RTN); Uppsala University, Women's and Children's Health, International Maternal and Child Health, Uppsala, Sweden (E-CE); Cornell University, Division of Nutritional Sciences, Ithaca, NY (KMR); and the University of South Carolina, Department of Health Promotion, Education, and Behavior, Columbia, SC (EAF).

² ALF was supported by the American Institute of Bangladesh Studies, Cornell Einaudi Center for International Studies, Cornell University Field of Nutritional Studies, and NIH training grants 5T32DK07158 and 5T32HD007331. The MINIMat research study was funded by the United Nations Children's Fund, Swedish International Development Cooperation Agency, UK Medical Research Council, Swedish Research Council, Department for International Development, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Global Health Research Fund–Japan, Child Health and Nutrition Research Initiative, Uppsala University, and the US Agency for International Development. The following donors provided unrestricted support of the research efforts of the ICDDR,B: Australian International Development Agency, Government of Bangladesh, Canadian International Development Agency, The Kingdom of Saudi Arabia, Government of the Netherlands, Government of Sri Lanka, Swedish International Development Cooperative Agency, and the Swiss Development Cooperation and Department for International Development, United Kingdom.

³ Address correspondence to EA Frongillo, Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC. E-mail: efrongillo{at}sc.edu.

Background: Good maternal-infant interaction is essential for optimal infant growth, health, and development. Although micronutrient malnutrition has been associated with poorer interaction, the effects of maternal micronutrient supplementation on interaction are unknown.

Objectives: We examined differences in maternal-infant feeding interaction between 3 maternal pre- and postpartum micronutrient supplementation groups that differed in iron dose and inclusion of multiple micronutrients and determined whether any differences observed were mediated by maternal distress.

Design: A cohort of 180 pregnant women was selected from 3300 women in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk of gestation, women were randomly assigned to 1 of 3 groups to receive a daily supplement of micronutrients (14 wk gestation to 12 wk postpartum): 60 or 30 mg Fe each with 400 µg folic acid or multiple micronutrients (MuMS; 30 mg Fe, 400 µg folic acid, and other micronutrients). A maternal-infant feeding interaction was observed in the home when infants were 3.4–4.0 mo of age, and maternal distress was assessed.

Results: Compared with 30 mg Fe, 60 mg Fe decreased the quality of maternal-infant feeding interaction by 10%. Compared with 30 mg Fe, MuMS did not improve interaction but reduced maternal early postpartum distress. Distress did not mediate the effects of micronutrient supplementation on interaction.

Conclusion: For pregnant and postpartum women, micronutrient supplementation should be based on both nutritional variables (eg, iron status) and functional outcomes (eg, maternal-infant interaction and maternal distress).