The Effect of Antenatal Multiple Micronutrient Supplementation on Placental Angiogenesis and Fetal Growth Factors in Rural Bangladesh.
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Date
2015
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Abstract
Objectives: Pathways by which micronutrients may influence birth size are not well understood.
To elucidate these, we assessed markers of placental angiogenesis and fetal growth factors in a
substudy of a community-based, double blinded, cluster-randomized trial of maternal multiple
micronutrient (MM) supplementation versus iron and folic acid (IFA) in rural Bangladesh.
Methods: We collected maternal blood (n=395) at 10 and 32 weeks gestation and cord blood
(n=325) at home deliveries, where infant and placental weight were measured. Angiogenic factors
assessed in maternal plasma were placental growth factor (PlGF), angiopoietin 2 (Ang-2), vascular
endothelial growth factor (VEGF), and VEGF receptor 1 (VEGFR-1). Insulin, insulin-like growth
factor-1 (IGF-1), and IGF binding protein-1 (IGFBP-1) were measured in cord plasma.
Results: Mothers had a mean (SD) BMI in early pregnancy of 19.5 (2.5) kg/m2 and infants
weighed 2.68 (0.41) kg at birth. Ang-2 at 32 weeks gestation was 3.1 (95% CI: 0.20, 6.0) ng/mL
higher in mothers taking MM vs. IFA suggesting improved vascular remodeling. Other angiogenic
factors and insulin, IGF-1, and IGFBP-1 did not differ by maternal supplementation, but significant
interactions were observed with infant sex and maternal height. For male fetuses, change in VEGF
from 10 to 32 weeks was lower by 7.5 (95% CI: -13.3, -1.7) pg/mL for MM vs. IFA groups reflecting improved angiogenesis across pregnancy. Among shorter women (<145 cm), MM increased insulin
by 1.8 (95% CI: 1.0, 3.1) μIU/ML indicating improved fetal energy metabolism.
Conclusions: MM supplementation has a biologic basis for improving fetal growth beyond
improved micronutrient status of the fetus.
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Gernand Alison D, Schulze Kerry J, Shaikh Saijuddin, Shamim Abu Ahmed, Ali Hasmot, Nanayakkara-Bird Ashika, Arguello Margia, Wu Lee, West Keith P, Christian Parul. The Effect of Antenatal Multiple Micronutrient Supplementation on Placental Angiogenesis and Fetal Growth Factors in Rural Bangladesh. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 999-1000.