PROLONGING MICRONUTRIENTS SUPPLEMENTATION 2-6 MONTHS PRIOR TO PREGNANCY SIGNIFICANTLY IMPROVES BIRTH WEIGHT BY INCREASING HPL PRODUCTION AND CONTROLLING IL-12 CONCENTRATION: A RANDOMIZED DOUBLE BLIND CONTROLLED STUDY

• Published in: Annals of nutrition and metabolism 2017-10, Vol.71 (Suppl. 2), p.554
• Main Authors: Sri Sumarmi, Sri Sumarmi, Melaniani, Soenarnatalina, Kuntoro, Kuntoro, Wirjatmadi, Bambang, Dachlan, Erry Gumilar, Thaha, Abdul Razak, Soekirman, Soekirman
• Format: Article
• Language: English
• Subjects: Birth weight; Childbirth & labor; Covariance; Data analysis; Data processing; Effects; Ferritin; Folic acid; Gestational age; Immune response; Immune system; Interleukin 12; Interleukins; Iron; Micronutrients; Nutrients; Placenta; Pregnancy; Randomization; Supplements; Vitamin A; Weight reduction
• ISSN: 0250-6807; 1421-9697
• DOI: 10.1159/000480486

Background and objectives: The role of multi-micronutrients (MMN) supplementation to improve birth weight is still debatable. Its role on pregnancy outcomes may involve the Interleukin 12 (IL-12) and human Placental Lactogen (hPL). This research was conducted to evaluate the effect of prolonging multi-micronutrients supplementation 2-6 months prior to pregnancy on birth weight in relation to IL-12 and hPL concentration during the 3rd trimester of pregnancy. Methods: A randomized double blind community-based trial was conducted at District of Probolinggo East Java, Indonesia. A two-arms study consists of group I received placebo before pregnancy and continued with daily iron and folic acid (IFA) during pregnancy, and group II received multi-micronutrient containing 15 micronutrients, 2 other days before pregnancy and continued with daily dose during pregnancy. A sample size of 115 pregnancy outcomes was obtained from 420 eligible brides-to-be. The primary outcome variable is birth weight. Concentration of IL-12 and hPL in the last trimester, gestational age, maternal weight gain and placental weight were assessed as the intervening variables. Preconceptional BMI, concentration of serum retinol, serum zinc, and serum ferritin prior to pregnancy were assed as baseline data. Data were analyzed using analysis of covariance to evaluate effect of supplementation. Causal relationship among variables was tested by using analysis of structural equation modelling. Results: The characteristic between treatment group and control group were not different (Box's M value p = 0,398; Hotelling's Trace value p = 0,478I). Results show that compare to iron folic acid supplementation, subjects who received multi-micronutrients supplementation 2-6 months prior to pregnancy have lower IL-12 concentration by 0.10 pg/mL (p=0,665), higher hPL concentration by 1.14 mg/L (p=0,014), longer gestational age by 1.66 weeks (p=0,539), but no difference of total weight gain (p=0,995). There is significantly higher of placental weight and birth weight by 83.59 grams (p=0,000) and 309.89 grams (p=0,000) respectively (p=0,000). Conclusions: It implies that prolonging multi-micronutrient supplementation 2-6 months prior to pregnancy and being continued during pregnancy improves birth weight by increasing hPL production and placental weight, as well as controlling maternal immune response, particularly reducing IL-12 concentration in last trimester.