Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

Fawzi, Wafaie W.; Msamanga, Gernard I.; Urassa, Willy; Hertzmark, Ellen; Petraro, Paul; Willett, Walter C.; Spiegelman, Donna

doi:10.1056/nejmoa064868

Cited by 166 publications

(157 citation statements)

References 27 publications

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“…A detailed description of the trial has been published elsewhere. 8 Trial participants were HIV-negative, between 12 and 27 weeks of gestation, and planning to stay in Dar es Salaam for at least 1 year after delivery. At the time of enrollment, participants were randomly assigned to receive a daily oral dose of a multivitamin containing 20 mg of vitamin B 1 , 20 mg of vitamin B 2 , 25 mg of vitamin B 6 , 100 mg of niacin, 50 μg of vitamin B 12 , 500 mg of vitamin C, and 20 mg of vitamin E, or a placebo.…”

Section: Methodsmentioning

confidence: 99%

“…We defined SGA births as those falling below the 10 th percentile of birth weight for gestational age as in the parent study. 8 …”

Section: Methodsmentioning

confidence: 99%

“…Because multivitamin supplementation reduced the risk of SGA in the parent trial, 8 we considered assigned treatment arm in the parent trial as a potential modifier of the relationship between each biomarker and the risk of an SGA birth. To do so, we dichotomized each biomarker at the median to create “high” and “low” categories, computed cross product terms by multiplying the dichotomous biomarker variables by the indicator variable for treatment arm, and assessed the significance of this cross-product term using a likelihood ratio test.…”

Section: Methodsmentioning

confidence: 99%

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Angiogenic and inflammatory biomarkers in midpregnancy and small-for-gestational-age outcomes in Tanzania

Darling

McDonald

Conroy

et al. 2014

American Journal of Obstetrics and Gynecology

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OBJECTIVE To investigate the relationship between a panel of angiogenic and inflammatory biomarkers measured in mid-pregnancy and small-for-gestational age (SGA) outcomes in sub-Saharan Africa. STUDY DESIGN Concentrations of 18 angiogenic and inflammatory biomarkers were determined in 432 pregnant women in Dar es Salaam, Tanzania who participated in a trial examining the effect of multivitamins on pregnancy outcomes. Infants falling below the 10th percentile of birth weight for gestational age relative to the applied growth standards were considered SGA. Multivariate binomial regression models with the log link function were used to determine the relative risk of SGA associated with increasing quartiles of each biomarker. Stepwise cubic restricted splines were used to test for non-linearity of these associations. Receiver operating curves obtained from multivariate logistic regression models were used to assess the discriminatory capability of selected biomarkers. RESULTS A total of 60 participants (13.9%) gave birth to SGA infants. Compared to those in the first quartile, the risk of SGA was reduced among those in the fourth quartiles of VEGF-A (adjusted risk ratio (RR) 0.38, 95% Confidence Interval (CI), 0.19-0.74), PGF (adjusted RR 0.28, 95% CI, 0.12-0.61), sFlt-1 (adjusted RR 0.48, 95% CI, 0.23-1.01), MCP-1 (adjusted RR 0.48, 95% CI, 0.25-0.92), and Leptin (adjusted RR 0.46, 95% CI, 0.22-0.96) CONCLUSION Our findings provide evidence of altered angiogenic and inflammatory mediators, at mid-pregnancy, in women who went on to deliver small for gestational age infants.

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Section: Methodsmentioning

confidence: 99%

“…We defined SGA births as those falling below the 10 th percentile of birth weight for gestational age as in the parent study. 8 …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Angiogenic and inflammatory biomarkers in midpregnancy and small-for-gestational-age outcomes in Tanzania

Darling

McDonald

Conroy

et al. 2014

American Journal of Obstetrics and Gynecology

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“…Maternal nutritional status is associated with improved placental growth, including higher periconceptional BMI and gestational weight gain (9,11,12) as well as micronutrient intake by diet and supplementation (13)(14)(15). Nutritional factors associated with poor placental growth include increased maternal carbohydrate intake in early and late pregnancy and decreased maternal protein intake in late pregnancy (16,17).…”

Section: Introductionmentioning

confidence: 98%

Maternal Weight and Body Composition during Pregnancy Are Associated with Placental and Birth Weight in Rural Bangladesh,

Gernand

Christian

Paul³

et al. 2012

The Journal of Nutrition

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Placental growth is a strong predictor of fetal growth, but little is known about maternal predictors of placental growth in malnourished populations. Our objective was to investigate in a prospective study the associations of maternal weight and body composition [total body water (TBW) estimated by bioelectrical impedance and fat and fat-free mass derived from upper arm fat and muscle areas (UAFA, UAMA)] and changes in these with placental and birth weights. Within a cluster-randomized trial of maternal micronutrient supplementation, a subsample of 350 women was measured 3 times across gestation. Longitudinal analysis was used to examine independent associations of ∼10-wk measurements and ∼10-20 wk and ∼20-32 wk changes with birth outcomes. Weight, TBW, and UAMA, but not UAFA, at ∼10 wk were each positively and independently associated with placental weight and birth weight (P < 0.05). Of the maternal ∼10-20 wk changes in measurements, only TBW change and placental weight, and maternal weight and birth weight were positively associated (P < 0.05). Gains in weight, TBW, and UAMA from 20 to 32 wk were positively and UAFA gain was negatively associated with placental weight (P ≤ 0.01). Gains in weight and UAMA from 20 to 32 wk were positively associated with birth weight (P ≤ 0.01). Overall, higher maternal weight and measures of fat-free mass at ∼10 wk gestation and gains from 20 to 32 wk are independently associated with higher placental and birth weight.

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“…Impaired growth is a consequence of undernutrition, with an increasing recognition that micronutrient deficiencies may also play a role in this process. Recently, much research on whether micronutrient interventions delivered during pregnancy can improve birth weight and reduce early infant mortality in developing countries has been conducted (3)(4)(5)(6)(7)(8)(9)(10)(11)(12), and a meta-analysis concluded that multiple micro-nutrient supplementation provides little benefit over a traditionally recommended iron + folic acid supplement (13). Few of these studies have provided any data on the longer-term growth, health, and survival of the children born during these trials.…”

Section: Introductionmentioning

confidence: 98%

Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal

Stewart

Christian

LeClerq

et al. 2009

The American Journal of Clinical Nutrition

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Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

Cited by 166 publications

References 27 publications

Angiogenic and inflammatory biomarkers in midpregnancy and small-for-gestational-age outcomes in Tanzania

Angiogenic and inflammatory biomarkers in midpregnancy and small-for-gestational-age outcomes in Tanzania

Maternal Weight and Body Composition during Pregnancy Are Associated with Placental and Birth Weight in Rural Bangladesh,

Antenatal supplementation with folic acid + iron + zinc improves linear growth and reduces peripheral adiposity in school-age children in rural Nepal

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