Abstract
Objectives
It is unknown whether prenatal lipid-based nutrient supplements (LNS) affect blood pressure. The cutoffs to define high blood pressure have recently changed and little research has examined the association between the newly proposed blood pressure cutoffs and birth outcomes. Our objectives were to assess 1) the impact of LNS on maternal blood pressure; and 2) the association between blood pressure and birth outcomes.
Methods
In total, 1320 pregnant women ≤ 20 wk gestation in Ghana were randomized to receive daily either: 1) iron and folic acid (IFA), 2) multiple micronutrients (MMN), or 3) LNS. Blood pressure was measured at enrollment and 36 wk gestation. Gestational age was determined by ultrasound and newborn anthropometry included weight, length, and head circumference. The effect of LNS on maternal blood pressure was analyzed using ANOVA and associations between maternal blood pressure and birth outcomes were examined by linear and logistic regressions.
Results
Mean (± SD) systolic and diastolic blood pressure (SBP and DBP) at 36 wk gestation were 110 ± 11 and 63 ± 8 mmHg, respectively, and did not differ by supplementation group (P > 0.05). At enrollment, higher DBP was associated with lower birth weight and shorter pregnancy duration; 6.6% of women had high SBP (≥ 130 mmHg) and 3.6% had high DBP (≥ 80 mmHg), and women with high DBP had greater odds of low birth weight (adjusted OR = 2.99 (95% CI = 1.04, 8.62)) and preterm birth (3.99 (1.46, 10.86)) but there were no significant associations with SBP. At 36 wk, higher SBP was associated with a lower birth weight, birth length, newborn head circumference, and a shorter pregnancy duration and higher DBP was associated with a lower birth weight and length; 4.3% of women had high SBP and 2.4% had high DBP and women with high DBP had greater odds of low birth weight (4.14 (1.26, 13.62)) but high SBP (≥ 130 mmHg) was not associated with any birth outcomes.
Conclusions
Daily LNS during pregnancy did not have a significant effect on maternal blood pressure compared with IFA or MMN in this setting. Both higher SBP and higher DBP were associated with a shorter pregnancy duration and birth size; however, only high DBP was associated with adverse birth outcomes. It is unclear whether the new cutoff for high SBP is useful for identifying pregnancies at risk for adverse birth outcomes.
Funding Sources
Funded through a grant from the Bill & Melinda Gates Foundation to the University of California, Davis.
Differential DNA Methylation in Placenta Associated With Maternal Blood Pressure During Pregnancy
