Topical Area: Vitamins and Minerals
Objectives : Little is known about the influence of maternal micronutrient (MN) supplementation during pregnancy/lactation on human milk (HM) MN concentrations. We evaluated B-vitamin (BV) concentrations in milk from mothers in Ghana and Malawi who participated in the International Lipid-Based Nutrient Supplements (iLiNS) Project.
Methods : Women (< 20 wk gestation) were randomized to receive: 1 x daily iron/folic acid (IFA) during pregnancy only, or a multiple micronutrient (MMN) tablet or LNS containing equal amounts of vitamins during pregnancy and 6 mo of lactation. HM at 6mo postpartum was analyzed for vitamins B1, B2, B3 (nicotinamide only), B5, B6, and B12 and compared to the recommended Adequate Intakes (AI) for infants 0-6 mo, which are based on values from milk from well-nourished mothers, assuming 780mL/d milk intake.
Results : Concentrations and responses to supplementation differed greatly between countries. Comparing the IFA groups’ concentrations (geom. mean), women in Ghana had significantly lower HM B1 (121 vs. 183 µg/L), B2 (139 vs. 321 µg/L), and B6 (21.3 vs. 89.2 µg/L), and significantly higher B3 (1057 vs. 151 µg/L) and B12 (439 vs. 239pmol/L). In Ghana, use of MMN/LNS increased all HM BV (10 - 30%); but even with supplementation, only up to 5.7% (B1, B2, B3, B6), and 47.9 and 73.2% (B5 and B12) of the samples reached AI values. In Malawi, only HM B2 was significantly increased by MMN/LNS (371 vs. 321 µg/L), resulting in 47.2% of samples reaching the AI value, compared to 36.0% in the IFA group. None of Malawian samples reached the AI value for B3, and 9.0 to 34.6% reached the AI values for the remaining vitamins.
Conclusions : HM BV concentrations differed greatly by geographic origin, possibly due to differences in diet or fortification. Maternal MMN/LNS supplementation during pregnancy/lactation increased all HM B-vitamins in Ghana. Only HM B2 was increased in Malawi, for reasons that are unclear.
Funding Sources : Bill & Melinda Gates Foundation (OPP49817), USDA/ARS Intramural Project (5306-51530-019-00), U.S. Agency for International Development (USAID, AID-OAA-A-12-00005), and the Food and Nutrition Technical Assistance III Project (FANTA). All authors declare no conflict of interest.
Daniela Hampel
UC Davis, USDA/ARS-WHNRC
Rebecca Young
Department of Nutrition, University of California, Davis, USA
Setareh Shahab-Ferdows
USDA-WHNRC
Kathryn Dewey
Department of Nutrition, University of California, Davis, USA;
Per Ashorn
Center for Child Health Research, Tampere University, Tampere, Finland
Kenneth Maleta
Professor
School of Public Health and Family Medicine, University of Malawi, College of Medicine
Ulla Ashorn
University of Tampere
Stephen Vosti
Department Of Agricultural And Resource Economics
Lindsay Allen
Director
ARS Western Human Nutrition Research Center, USDA
University of California, Davis