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Randomized Controlled Trial
. 2015 Dec;102(6):1450-9.
doi: 10.3945/ajcn.113.072413. Epub 2015 Nov 11.

Periconceptional multiple-micronutrient supplementation and placental function in rural Gambian women: a double-blind, randomized, placebo-controlled trial

Stephen Owens  1 , Ruchi Gulati  2 , Anthony J Fulford  2 , Fatou Sosseh  2 , Fiona C Denison  3 , Bernard J Brabin  4 , Andrew M Prentice  2
Affiliations
Randomized Controlled Trial

Periconceptional multiple-micronutrient supplementation and placental function in rural Gambian women: a double-blind, randomized, placebo-controlled trial

Stephen Owens et al. Am J Clin Nutr. 2015 Dec.

Abstract

Background: Maternal micronutrient deficiencies are commonly associated with clinical indicators of placental dysfunction.

Objective: We tested the hypothesis that periconceptional multiple-micronutrient supplementation (MMS) affects placental function.

Design: We conducted a double-blind, randomized, placebo-controlled trial of MMS in 17- to 45-y-old Gambian women who were menstruating regularly and within the previous 3 mo. Eligible subjects were pre-randomly assigned to supplementation with the UNICEF/WHO/United Nations University multiple micronutrient preparation (UNIMMAP) or placebo on recruitment and until they reached their first antenatal check-up or for 1 y if they failed to conceive. Primary outcome measures were midgestational indexes of utero-placental vascular-endothelial function [ratio of plasminogen-activator inhibitor (PAI) 1 to PAI-2 and mean uterine-artery resistance index (UtARI)] and placental active transport capacity at delivery [fetal to maternal measles antibody (MMA) ratio].

Results: We recruited 1156 women who yielded 415 pregnancies, of which 376 met all of the inclusion criteria. With adjustment for gestational age at sampling, there were no differences in PAI-1 to PAI-2 or MMA ratios between trial arms, but there was a 0.02-unit reduction in UtARI between 18 and 32 wk of gestation (95% CI: -0.03, -0.00; P = 0.040) in women taking UNIMMAP.

Conclusions: Placental vascular function was modifiable by periconceptional micronutrient supplementation. However, the effect was small and supplementation did not further affect other variables of placental function. This trial was registered at www.controlled-trials.com as ISRCTN 13687662.

Keywords: Africa; birth weight; fetal growth; micronutrients; periconceptional; placenta; pregnancy.

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Figures

FIGURE 1
FIGURE 1
CONSORT (Consolidated Standards of Reporting Trials) diagram. UNIMMAP, UNICEF/WHO/United Nations University international multiple micronutrient preparation.
See this image and copyright information in PMC

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