Providing lipid-based nutrient supplement during pregnancy does not reduce the risk of maternal P falciparum parasitaemia and reproductive tract infections: a randomised controlled trial

Abstract

BackgroundMaternal infections are associated with maternal and foetal adverse outcomes. Nutrient supplementation during pregnancy may reduce the occurrence of infections by improving maternal immunity. We aimed to investigate the impact of small-quantity lipid-based nutrient supplement (SQ-LNS) on the occurrence of Plasmodium falciparum parasitaemia during pregnancy and trichomoniasis, vaginal candidiasis and urinary tract infection (UTI) after delivery.MethodsPregnant Malawian women enrolled in the iLiNS-DYAD trial receiving daily supplementation with SQ-LNS, multiple micronutrients (MMN) or iron & folic acid (IFA) from <20 gestation weeks (gw) were assessed for P. falciparum parasitaemia at 32 gw using rapid diagnostic testing (RDT), at 36 gw using polymerase chain reaction (PCR) and at delivery using both RDT and PCR; and at one week after delivery for trichomoniasis and vaginal candidiasis using wet mount microscopy and for UTI using urine dipstick analysis. The prevalence of each infection by intervention group was estimated at the prescribed time points and the global null hypothesis was tested using logistic regression. Adjusted analyses were performed using preselected covariates.ResultsThe prevalence of P. falciparum parasitaemia was 10.7% at 32 gw, 9% at 36 gw, and 8.3% by RDT and 20.2% by PCR at delivery. After delivery the prevalence of trichomoniasis was 10.5%, vaginal candidiasis was 0.5%, and UTI was 3.1%. There were no differences between intervention groups in the prevalence of any of the infections.ConclusionIn this population, SQ-LNS did not influence the occurrence of maternal P. falciparum parasitaemia, trichomoniasis, vaginal candidiasis or UTI.Trial registrationIdentifier: NCT01239693 (10 November 2010).Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1215-2) contains supplementary material, which is available to authorized users.

A life history approach to prenatal supplementation: Building a bridge from biological anthropology to public health and nutrition

“…In the iLiNS‐DYAD study in Ghana, low‐calorie lipid‐nutrient supplements reduced maternal anemia, increased hemoglobin, and decreased iron deficiency (Adu‐Afarwuah et al, ), and younger women finished pregnancy with lower cortisol levels if they consumed lipid‐nutrient supplements relative to multiple micronutrients (Oaks et al, ). The same supplements administered in the iLiNS‐DYAD‐M study in Malawi did not differ in their effects on women's malaria immunity or risk, cortisol levels, or likelihood of being diagnosed with a reproductive tract infection (Chandrasiri et al, ; Nkhoma et al, ; Stewart et al, ).…”

“…Prenatal supplementation studies indicate that patterns of energetic and nutritional resource allocation among survival and current and future reproduction in women's bodies may have limited potential for responsiveness to supplementation. As public health and nutrition researchers recognize, attending to the consequences of supplementation for women's health is particularly important because interventions often take place among women in poverty who suffer food insecurity or face the double burden of obesity and micronutrient malnutrition, sometimes compounded by chronic and infectious disease (Black, ; Kumordzie et al, ; Nkhoma et al, ). Given the significance of the question, a partnership between public health and nutrition workers and biological anthropologists is important to clarify how supplemental nutrition is used in the maternal body and under what conditions women's bodies allocate supplemental resources to fetal development.…”

Do Micronutrient and Omega-3 Fatty Acid Supplements Affect Human Maternal Immunity during Pregnancy? A Scoping Review

“…It is postulated that supplementation may reduce infections by improving maternal immunity. As part of the same Malawian study, Nkhoma et al examined whether the above treatments influenced the occurrence of P. falciparum parasitemia during pregnancy, and trichomoniasis, vaginal candidiasis, and urinary tract infection (UTI) after delivery [62]. Again, there were no differences between intervention groups in the prevalence of any of the infections.…”