Micronutrient Status during Pregnancy and Effects of Antenatal Supplementation with Multiple Micronutrients versus Iron-folic Acid in Rural Bangladesh.

Objectives: Women often enter pregnancy with micronutrient deficiencies, exacerbated by demands of pregnancy. Yet, gestational micronutrient status is uncommonly assessed, even as momentum builds toward preventing multiple micronutrient (MM) deficiencies. We assessed micronutrient status of women early in pregnancy in a rural setting in northern Bangladesh. Methods: In a substudy of women participating in a randomized trial of MM versus iron-folic acid (IFA) supplementation we identified a population-based subsample of n=1526 women from whom plasma samples were obtained in the 1st trimester (TM), prior to supplementation, and in the 3rd TM, to evaluate micronutrient status and response to supplementation. Results: In available 1st TM data (n=491-1448 per nutrient assay), 6.8% of women were vitamin A deficient (retinol < 0.70 μmol/L), 41.7% had low β-carotene (<0.09 μmol/L), and 57.7% were vitamin E deficient (α-tocopherol < 12 μmol/L). Folate deficiency (plasma folate < 6.8 nmol/L) was 2.6%, while prevalence of vitamin B12 deficiency (cobalamin < 150 pmol/L) was 29.8%. Anemia affected 20.6% of women, but iron deficiency by TfR (4.7% > 8.3 μg/L) and ferritin (1.8% < 12 μg/L) was uncommon. Plasma zinc was low (<10 μmol/L) in 30.6% of women. Inflammation, by α-1 acid glycoprotein (AGP > 1 g/L), was present in 8.1% of women. Baseline vitamin D and iodine status, and MM versus IFA effects on micronutrient status by the 3rd TM, are being determined. Conclusions: Women in rural Bangladesh experience a variety of micronutrient deficiencies in early pregnancy, supporting the need to address "hidden hunger" with multiple micronutrient supplementation during pregnancy.

A North-South-South Collaborative Action to Prevent Micronutrient Deficiencies in Women and Young Children in South-East Asia: The SMILING Project.

Objectives: SMILING "Sustainable Micronutrient Interventions to Control Deficiencies and Improve Nutritional status and General Health in Asia" (FP7), is a transnational collaboration of research institutions and implementation agencies in five SEA countries: Cambodia, Indonesia, Laos PDR, Thailand and Vietnam, with European partners, to introduce state-of-the-art knowledge into policy to alleviate micronutrient malnutrition in SEA women of reproductive age (WRA) and young children. Objectives were to: build capacity on problem analysis; identify priority interventions and develop roadmaps for national policies. Methods: SMILING has been built around a consortium that worked on Optifood software to identify nutrient gaps; nutritional problem analysis and potential interventions by reviewing current situation and program, and knowledge on effective interventions and multi-criteria mapping for stakeholder analysis to develop national guidelines. Results: Iron, zinc, vitamin A and iodine deficiency remain common in SEA. Even though the five SEA countries differ in nutritional situation and stages of development, iron intake in young children in all countries was inadequate, as folate intake in WRA, even with theoretical best possible diets. Consequently, interventions including supplementation, food-based strategies and public health measures were appraised through multi-stakeholder analysis. Successful experiences and lessons in implementing nutrition programs in these countries were also critically reviewed. Policy roadmaps by country are being drafted accordingly. Conclusions: SMILING conducted an analysis of nutrition situation in each SEA country. Gaps in intake of several micronutrients cannot be currently solved by dietary solution and e.g. food fortification needs to be considered. Roadmaps for each country policy-makers are being formulated. Funding: European Commission-FP7, GA-2896-16.