Breast Milk Retinol Concentrations of Ghanaian Women: Effect of Lipid-Based Nutrient Supplements Taken During Pregnancy and the First 6 Months Postpartum, and Associations with Maternal Dietary Patterns and Sociodemographic Factors.

Abstract

Vitamin A deficiency (VAD) is associated with increased morbidity and mortality among children. Despite decades of efforts to control it, VAD remains a global public health problem. Among Ghanaian pregnant and lactating women, we examined: (i) the effect of lipid-based nutrient supplements (LNS) and multiple micronutrient supplements (MMN) intake during pregnancy and the first 6 months postpartum on breast milk retinol concentrations at 6 mo postpartum; (ii) associations between maternal background and demographic factors and breast milk retinol concentrations at 6 mo postpartum; and, (iii) relationships between maternal dietary patterns and breast milk retinol concentrations at 6 mo postpartum. The first study assessed (i) the effect of LNS providing daily low doses of vitamin A during pregnancy and the first 6 mo postpartum on breast milk retinol concentrations at 6 mo postpartum, and (ii) interaction effect of daily low dose vitamin A and high dose postpartum vitamin A supplementation on breast milk retinol concentration at 6 mo postpartum. This study forms part of the International Lipid-Based Nutrient Supplement (iLiNS)-DYAD trial in Ghana, a randomized controlled trial to examine the effect of LNS on maternal and child outcomes. Women were enrolled at ≤ 20 wk gestation and assigned to receive LNS or MMN during pregnancy and the first 6 mo postpartum; the control group received iron and folic acid supplements (IFA) during pregnancy and a placebo during the first 6 mo postpartum. We measured the breast milk retinol concentrations at 6 mo postpartum. There were no significant PREVIEW 2 differences in mean breast milk retinol per gram of fat concentration at 6 mo postpartum among the 3 supplement groups (LNS = 58.5 ± 2.4, MMN = 55.2 ± 2.4, IFA 55.4 ± 2.4 nmol/g, p = 0.78). No significant interaction was observed between daily low dose vitamin A and high dose postpartum vitamin A supplementation on breast milk retinol concentration at 6 mo postpartum (p = 0.41). The second study explored whether milk retinol concentration (per gram of fat) at 6 mo postpartum was associated with any of the following maternal factors: age, education, high dose postpartum vitamin A supplementation, gestational age at enrolment, baseline body mass index (BMI) and hemoglobin concentration, household assets and housing indices, household food insecurity access scores, primiparity, and season of sample collection. This was analyzed as a cohort study within the iLiNS-DYAD Ghana trial, controlling for supplement group assignment. Maternal age was positively associated with milk retinol concentration (p = 0.02), and milk fat content was negatively associated with milk retinol concentration (p < 0.0001). Sample collection during the dry season was associated with lower milk retinol concentration, but the association was no longer significant after controlling for milk fat content. Prevalence of low milk retinol concentration (≤ 28 nmol/g fat) was 17.1%; again, higher maternal age was associated with lower odds of having low milk retinol concentration (p = 0.006), and higher milk fat content was associated with increased odds of having low milk retinol concentration (p < 0.0001). High dose postpartum vitamin A supplementation and primiparity were not associated with milk retinol concentration. The final study examined whether milk retinol concentration at 6 mo postpartum was associated with maternal: (i) intakes of vitamin A-rich foods at 6 mo postpartum; (ii) intake of study supplements containing vitamin A (LNS and MMN) during the first 6 mo postpartum; or (iii) PREVIEW 3 intake of non-study supplements containing vitamin A, iron or zinc during the first 6 mo postpartum Maternal intake of vitamin A-rich foods (colored roots and tubers, dark green leafy vegetables, colored fruits, organ meats including liver, eggs, dairy products and red palm oil) was not associated with milk retinol concentration at 6 mo postpartum. Adherence to LNS or MMN intake during the first 6 mo postpartum was not associated with milk retinol concentration, nor was intake of non-study supplements was not associated with milk retinol concentration at 6 mo postpartum. The lack of associations between dietary and supplemental vitamin A intake and breast milk retinol concentrations can be due to an adequate dietary vitamin A intake and normal vitamin A status among participants.