P18-050-23 Milk B-vitamin response to supplementation with multiple micronutrients versus iron-folic acid during pregnancy through 3 months postpartum in rural Bangladesh

Authors: SCHULZE, KERRY - Johns Hopkins University; HAMPEL, DANIELA - University Of California, Davis; BAKER, SARAH - Johns Hopkins University; WU, LEE - Johns Hopkins University; ALI, HASMOT - Johns Hopkins University; SHAIKH, SAIJUDDIN - Johns Hopkins University; Shahab-Ferdows, Setareh; Allen, Lindsay; WEST, KEITH - Johns Hopkins University; CHRISTIAN, PARUL - Johns Hopkins University

Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 6/1/2023
Publication Date: 7/27/2023
Citation: Schulze, K., Hampel, D., Baker, S., Wu, L., Ali, H., Shaikh, S., Shahab-Ferdows, S., Allen, L.H., West, K., Christian, P. 2023. P18-050-23 Milk B-vitamin response to supplementation with multiple micronutrients versus iron-folic acid during pregnancy through 3 months postpartum in rural Bangladesh. Meeting Abstract. https://doi.org/10.1016/j.cdnut.2023.101108.
DOI: https://doi.org/10.1016/j.cdnut.2023.101108

Interpretive Summary:

Technical Abstract: Objective: Many B-vitamin concentrations in human milk reflect maternal dietary intakes or status, thereby varying globally, and are lower than seemingly necessary to meet current infant intake recommendations. However, the extent to which milk B-vitamin concentrations respond to multiple micronutrient supplements (MMS) has rarely been characterized, in part due to challenges in measurement of milk vitamers. Here we report 3 month postpartum milk thiamin, riboflavin, niacin, and vitamin B6 from women of rural Bangladesh from a trial of a daily antenatal MMS which contained 1RDA of those nutrients, versus iron-folic acid (IFA). Methods: JiVitA-3 was a cluster-randomized trial conducted in rural Bangladesh (2008-2012) wherein antenatal supplementation of MMS and IFA was initiated in early pregnancy and sustained until 3 months postpartum, at which time a spot sample of milk was collected in a clinical substudy. Vitamers of thiamin, riboflavin, niacin, and vitamin B6, among others, were analyzed by LC-MS/MS in n=713 (n=342 IFA, n=371 MMS) samples. Differences in milk concentrations by intervention were tested, accounting for cluster randomization, and milk concentrations were compared to those used to set current adequate intake recommendations for infants 0-6 months of age. Results: Total thiamin did not differ by intervention (MMS 179±42 µg/L, n=222; IFA 182±43 µg/L, n=196), but free thiamin was 30.7 (95% CI: 19.4, 41.3)% higher in the MMS group (45±25 vs 34±17, p<0.0001). Total riboflavin was 71.2 (54.9, 87.4)% higher with MMS (88±60 vs 51±29 µg/L, p<0.0001), and total niacin was 34.6 (22.1, 47.0)% higher with MMS (1583±947 vs 1176±664 µg/L, p<0.0001), with all forms of each vitamin significantly higher with MMS. Total vitamin B6 was 15.7 (7.4, 24.0)% higher with MMS (137±64 vs 119±54 µg/L), with pyridoxal and pyridoxine higher, pyridoxamine lower (all p<0.0001) but pyridoxal-5-phosphate unchanged with MMS. The proportion of milk samples reaching vitamin concentrations on which recommended intakes for infants were based was 23.0% for thiamin (210 µg/L); 0% for IFA and 0.5% for MMS for riboflavin (350 µg/L); 12.6% for IFA and 29.7% for MMS for niacin (1800 µg/L); 38.3% for IFA and 48.9% for vitamin B6 (130 µg/L) . Conclusion: Despite benefits of antenatal MMS taken to 3 months postpartum on B-vitamins in milk of rural Bangladeshi women, all but vitamin B6 concentrations remained low, with potential consequences for infants.