Maternal Blood Pressure in Relation to Prenatal Lipid-Based Nutrient Supplementation and Adverse Birth Outcomes in a Ghanaian Cohort: A Randomized Controlled Trial and Cohort Analysis

Alyssa M Abreu, Rebecca R Young, Ashley Buchanan, Ingrid E Lofgren, Harriet E T Okronipa, Anna Lartey, Per Ashorn, Seth Adu-Afarwuah, Kathryn G Dewey, Brietta M Oaks, Alyssa M Abreu, Rebecca R Young, Ashley Buchanan, Ingrid E Lofgren, Harriet E T Okronipa, Anna Lartey, Per Ashorn, Seth Adu-Afarwuah, Kathryn G Dewey, Brietta M Oaks

Abstract

Background: It is unknown whether prenatal lipid-based nutrient supplements (LNSs) affect blood pressure (BP). Associations between hypertension and birth outcomes using recently updated BP cutoffs are undetermined.

Objectives: We aimed to assess the impact of LNSs on maternal hypertension and associations between hypertension and birth outcomes.

Methods: Pregnant Ghanaian women at ≤20 weeks of gestation (n = 1320) were randomly assigned to receive daily 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNSs until delivery. BP was measured at enrollment and 36 weeks of gestation. We analyzed the effect of LNSs on BP using ANOVA and associations between hypertension [systolic BP (SBP) ≥130 mm Hg or diastolic BP (DBP) ≥80 mm Hg] and birth outcomes by linear and logistic regressions.

Results: Mean ± SD SBP and DBP were 110 ± 11 and 63 ± 8 mm Hg at 36 weeks of gestation and did not differ by supplementation group (SBP, P > 0.05; DBP, P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter gestation; women with high DBP had greater risk of low birth weight (LBW) [risk ratio (RR): 2.58; 95% CI: 1.09, 6.08] and preterm birth (PTB) (RR: 3.30; 95% CI: 1.47, 7.40). At 36 weeks of gestation, higher SBP was associated with lower birth weight, length, and head circumference and shorter gestation; higher DBP was associated with lower birth weight and length; and women with high DBP had greater risk of LBW (RR: 3.39; 95% CI: 1.32, 8.69). Neither high SBP nor hypertension were associated with birth outcomes at either time point.

Conclusions: Daily provision of LNSs does not affect maternal hypertension, compared with IFA and MMN. Higher SBP and DBP are associated with a shorter gestation and smaller birth size; however, only high DBP is associated with LBW and PTB. The new BP cutoffs may help identify pregnancies at risk of adverse birth outcomes.This trial was registered at clinicaltrials.gov as NCT00970866.

Keywords: Ghana; birth outcomes; low birth weight; maternal blood pressure; maternal hypertension; prenatal supplements; preterm birth.

© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.

Figures

FIGURE 1
FIGURE 1
Study profile. The IFA group received 60 mg iron plus 400 mg folic acid. The MMN group received 1–2 Recommended Dietary Allowances of 18 vitamins and minerals (including 20 mg iron). The LNS group received LNS with the same micronutrients as the MMN group, plus another 4 minerals (Ca, P, K, and Mg), as well as macronutrients. All 3 supplements were intended for daily consumption. 1During the study, IFA and MMN capsules were unintentionally mislabeled, causing 92 participants in the IFA group and 85 participants in the MMN group to receive the incorrect supplement. A total of 86 women not-exposed in the LNS group, as well as the mixed-exposure women in the IFA or MMN groups were excluded.

References

    1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Himmelfarb CD, DePalma SM, Gidding S, Jamerson KA, Jones DWet al. . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):e13–e115.
    1. Adu-Bonsaffoh K, Ntumy MY, Obed SA, Seffah JD. Prevalence of hypertensive disorders in pregnancy at Korle-Bu Teaching Hospital in Ghana. J Gynecol Neonatal Biol. 2017;3(1):8–13.
    1. Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391–403.
    1. Der EM, Moyer C, Gyasi RK, Akosa AB, Tettey Y, Akakpo PK, Blankson A, Anim JT. Pregnancy related causes of deaths in Ghana: a 5-year retrospective study. Ghana Med J. 2013;47(4):158–63.
    1. Grindheim G, Estensen M, Langesaeter E, Rosseland LA, Toska K. Changes in blood pressure during healthy pregnancy: a longitudinal cohort study. J Hypertens. 2012;30(2):342–50.
    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JTet al. . The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA. 2003;289(19):2560–72.
    1. Nakhai-Pour HR. Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension. Am J Obstet Gynecol. 2009;201(2):180.e1–8.
    1. Chen J, Sun B, Zhang D. Association of dietary n3 and n6 fatty acids intake with hypertension: NHANES 2007–2014. Nutrients. 2019;11(6):1232.
    1. Jones ML, Mark PJ, Waddell BJ. Maternal dietary omega-3 fatty acids and placental function. Reproduction. 2014;147(5):R143.
    1. Salvig JD, Lamont RF. Evidence regarding an effect of marine n-3 fatty acids on preterm birth: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2011;90(8):825–38.
    1. Allen VM, Joseph KS, Murphy KE, Magee LA, Ohlsson A. The effect of hypertensive disorders in pregnancy on small for gestational age and stillbirth: a population based study. BMC Pregnancy Childbirth. 2004;4:17.
    1. Noubiap JJ, Bigna JJ, Nyaga UF, Jingi AM, Kaze AD, Nansseu JR, Fokom Domgue J. The burden of hypertensive disorders of pregnancy in Africa: a systematic review and meta-analysis. J Clin Hypertens. 2019;21(4):479–88.
    1. Bakker R, Steegers EAP, Hofman A, Jaddoe VWV. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the Generation R Study. Am J Epidemiol. 2011;174(7):797–806.
    1. Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ. 2014;348:g2301.
    1. Fanaroff AA, Korones SB, Wright LL, Verter J, Poland RL, Bauer CR, Tyson JE, Philips JB, Edwards W, Lucey JFet al. . Incidence, presenting features, risk factors and significance of late onset septicemia in very low birth weight infants. Pediatr Infect Dis J. 1998;17(7):593–8.
    1. Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. Am J Obstet Gynecol. 2000;182(1):198–206.
    1. Jornayvaz FR, Vollenweider P, Bochud M, Mooser V, Waeber G, Marques-Vidal P. Low birth weight leads to obesity, diabetes and increased leptin levels in adults: the CoLaus study. Cardiovasc Diabetol. 2016;15(1):73.
    1. Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Andreias L, Wilson-Costello D, Klein N. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA. 2005;294(3):318–25.
    1. Wegmüller R, Bentil H, Wirth JP, Petry N, Tanumihardjo SA, Allen L, Williams TN, Selenje L, Mahama A, Amoaful Eet al. . Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: findings from a national survey. PLoS One. 2020;15(1):e0228258.
    1. Nti CA. Household dietary practices and family nutritional status in rural Ghana. Nutr Res Pract. 2008;2(1):35–40.
    1. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2014(6):CD001059.
    1. Ofori-Asenso R, Agyeman AA, Laar A, Boateng D. Overweight and obesity epidemic in Ghana—a systematic review and meta-analysis. BMC Public Health. 2016;16(1):1239.
    1. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Peerson JM, Arimond M, Vosti S, Dewey KG. Lipid-based nutrient supplement increases the birth size of infants of primiparous women in Ghana. Am J Clin Nutr. 2015;101(4):835–46.
    1. Institute of Medicine . Dietary Reference Intakes for calcium and vitamin D. Washington (DC): National Academies Press; 2011.
    1. Institute of Medicine . Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington (DC): National Academies Press; 2001.
    1. Institute of Medicine . Dietary Reference Intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington (DC): National Academies Press; 2000.
    1. Institute of Medicine . Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington (DC): National Academies Press; 1998.
    1. Institute of Medicine . Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington (DC): National Academies Press; 1997.
    1. Institute of Medicine . Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). Washington (DC): National Academies Press; 2005.
    1. Arimond M, Zeilani M, Jungjohann S, Brown KH, Ashorn P, Allen LH, Dewey KG. Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project. Matern Child Nutr. 2015;11(Suppl 4):31–61.
    1. WHO, UNICEF . WHO Child Growth Standards and the identification of severe acute malnutrition in infants and children: a joint statement. [Internet]. Geneva (Switzerland): WHO; 2009. [Accessed 2019 Jan 13]. Available from: .
    1. Villar J, Ismail LC, Victora CG, Ohuma EO. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014;384:857–68.
    1. Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.
    1. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B. 1995;57(1):289–300.
    1. Ashorn P, Hallamaa L, Allen LH, Ashorn U, Chandrasiri U, Deitchler M, Doyle R, Harjunmaa U, Jorgensen JM, Kamiza Set al. . Co-causation of reduced newborn size by maternal undernutrition, infections, and inflammation. Matern Child Nutr. 2018;14(3):e12585.
    1. Mridha MK, Matias SL, Paul RR, Hussain S, Sarker M, Hossain M, Peerson JM, Vosti SA, Dewey KG. Prenatal lipid-based nutrient supplements do not affect pregnancy or childbirth complications or cesarean delivery in Bangladesh: a cluster-randomized controlled effectiveness trial. J Nutr. 2017;147(9):1776–84.
    1. Adu-Afarwuah S, Young RR, Lartey A, Okronipa H, Ashorn P, Ashorn U, Zeilani M, Dewey KG. Supplementation during pregnancy with small-quantity lipid-based nutrient supplements or multiple micronutrients, compared with iron and folic acid, increases women's urinary iodine concentration in semiurban Ghana: a randomized controlled trial. Matern Child Nutr. 2018;14(2):e12570.
    1. Oaks BM, Young RR, Adu-Afarwuah S, Ashorn U, Jackson KH, Lartey A, Maleta K, Okronipa H, Sadalaki J, Baldiviez LMet al. . Effects of a lipid-based nutrient supplement during pregnancy and lactation on maternal plasma fatty acid status and lipid profile: results of two randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids. 2017;117:28–35.
    1. Adu-Afarwuah S, Lartey A, Okronipa H, Ashorn P, Zeilani M, Baldiviez LM, Oaks BM, Vosti S, Dewey KG. Impact of small-quantity lipid-based nutrient supplement on hemoglobin, iron status and biomarkers of inflammation in pregnant Ghanaian women. Matern Child Nutr. 2017;13(2):e12262.
    1. Kumordzie SM, Adu-Afarwuah S, Young RR, Oaks BM, Tamakloe SM, Ocansey ME, Okronipa H, Prado EL, Dewey KG. Maternal–infant supplementation with small-quantity lipid-based nutrient supplements does not affect child blood pressure at 4–6 y in Ghana: follow-up of a randomized trial. J Nutr. 2019;149(3):522–31.
    1. Gaillard R, Steegers E, Tiemeier H, Hofman A, Jaddoe V. Placental vascular dysfunction, fetal and childhood growth, and cardiovascular development: the Generation R Study. Circulation. 2013;128(20):2202–10.
    1. Verburg BO, Jaddoe VWV, Wladimiroff JW, Hofman A, Witteman JCM, Steegers EAP. Fetal hemodynamic adaptive changes related to intrauterine growth: the Generation R Study. Circulation. 2008;117(5):649–59.
    1. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016;27(2):89–94.
    1. Rizzo G, Capponi A, Cavicchioni O, Vendola M, Arduini D. Low cardiac output to the placenta: an early hemodynamic adaptive mechanism in intrauterine growth restriction. Ultrasound Obstet Gynecol. 2008;32(2):155–9.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera