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
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Date
2021
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ASN
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.
Description
Research Article
Keywords
birth outcomes, Ghana, maternal blood pressure, prenatal supplements, maternal hypertension, low birth weight, preterm birth