B-vitamins and choline in human milk are not impacted by a preconception lipid-based nutrient supplement, but differ among three low-to-middle income settings – Findings from the women first trial

Authors: YOUNG, BRIDGET - University Of Rochester; WESCOTT, JAMIE - University Of Colorado; KEMP, JENNIFER - University Of Colorado; Allen, Lindsay - A; HAMPEL, DANIELA - University Of California, Davis; GARCES, ANA - Instituto De Nutrición De Centroamérica Y Panamá (INCAP); FIGUEROA, LESTER - Instituto De Nutrición De Centroamérica Y Panamá (INCAP); GOUDAR, SHIVAPRASAD - Kle University; DHADED, SANGAPPA - Kle University; SOMANNAVAR, MANJUNATH - Kle University; SALEEM, SARAH - Aga Khan University; ALI, SUMERA - Aga Khan University; HAMBRIDGE, MICHAEL - University Of Colorado; KREBS, NANCY - University Of Colorado

Submitted to: Frontiers in Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/22/2021
Publication Date: 12/23/2021
Citation: Young, B.E., Wescott, J., Kemp, J., Allen, L.H., Hampel, D., Garces, A.L., Figueroa, L., Goudar, S.S., Dhaded, S.M., Somannavar, M., Saleem, S., Ali, S.A., Hambridge, M., Krebs, N.F.,The Women First Working Group. 2021. B-vitamins and choline in human milk are not impacted by a preconception lipid-based nutrient supplement, but differ among three low-to-middle income settings – Findings from the women first trial. Frontiers in Nutrition. 8. Article 750680. https://doi.org/10.3389/fnut.2021.750680.
DOI: https://doi.org/10.3389/fnut.2021.750680

Interpretive Summary: There is only little information available regarding "normal" and optimal human milk B-vitamin concentrations, and even less is known about effects of maternal supplementation on human milk when consumed starting before conception throughout pregnancy. In this study, we collected milk at 2 weeks in lactation from different studies in Guatemala, India, and Pakistan to evaluate such impact. Women randomly received a lipid-based nutrient supplement (LNS) either at least 3 months prior to conception or in the first trimester pregnancy, through delivery, or they were in the control group. Selected B-vitamins (thiamin, nicotinamide, pantothenic acid, biotin, B12) and choline concentrations in the milk were determined, and maternal dietary intake assessed in early pregnancy. The supplementation did now show any effect on the milk collected at 2 weeks postpartum, regardless of the study location. However, varying concentration were found based on country of origin, e.g. milk from Guatemalan women contained the highest concentration of nicotinamide, while Pakistani women had milk with highest thiamin concentrations. Milk B12 and choline was related to maternal intake of the respective vitamins. Thus, long-term supplementation of women even before pregnancy did not reveal any benefit to the milk 2 weeks after birth.

Technical Abstract: Introduction: Data regarding “normal” and optimal human milk (HM) B-vitamin concentrations are lacking, especially in areas where maternal and infant undernutrition is prevalent. The impact of maternal supplementation pre-conception through pregnancy on HM composition, including B-vitamins, also remains unknown. Methods: HM was collected at 2-weeks postpartum from 200 women on Guatemala, India and Pakistan participating in the Women First Trial. Women were randomized to receive a lipid-based nutrient supplement (LNS) at least 3 months pre-conception (Arm 1), in the first trimester of pregnancy (Arm 2) through delivery or control (Arm 3). HM concentrations of thiamin, vitamin B3, B12, pantothenic acid, biotin, and choline were assessed via ultra performance liquid chromatography – tandem mass spectrometry. Maternal dietary intake was assessed in early pregnancy. Results: There were no differences in HM vitamin concentrations by study arm. HM from Pakistani women had the highest concentrations of thiamin while HM from Guatemalan women had the highest concentrations of vitamin B3 (p<0.0001). 57% of HM samples had vitamin B3 concentrations less than half the reference used to set the dietary recommendation for infant intake. Maternal dietary intake of vitamin B12 and choline, but not thiamin was associated with the corresponding concentrations in HM (p<0.005). No HM vitamin concentrations were associated with infant growth outcomes. Conclusions: Long-term LNS micronutrient supplementation pre-conception does not impact HM vitamin concentration at 2-weeks postpartum. HM B-vitamin composition differs between these three low-to-middle income sites. Concentrations of vitamin B3 fall below reference concentrations but are not associated with any growth deficits.