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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (3): 434-442. doi: 10.19723/j.issn.1671-167X.2022.03.007

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Relationship between micronutrients supplementation during periconceptional period and serum concentration of vitamin E in the 1st trimester of gestational period

Yun-fei XING1,Chun-yi LIU1,Wen-ying MENG2,Jie ZHANG1,Ming-yuan JIAO3,Lei JIN4,Lei JIN1,*()   

  1. 1. Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
    2. Department of Obstetrics, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    3. Department of Clinical Laboratory, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
    4. Department of Maternal Health Care, Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
  • Received:2022-01-28 Online:2022-06-18 Published:2022-06-14
  • Contact: Lei JIN E-mail:jinlei@bjmu.edu.cn
  • Supported by:
    National Key Research and Development Program of China(2021YFC2700700);National Key Research and Development Program of China(2021YFC2700704);Capital's Funds for Health Improvement and Research(2020-1-5112)

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Abstract:

Objective: To explore the association of maternal periconceptional folic acid or multiple micronutrients supplementation during periconceptional period and the serum vitamin E (Vit.E) concentration in the 1st trimester of gestational period. Methods: A retrospective cohort study was conducted based on the prenatal health care system and clinical laboratory information system. Totally, 22 171 pregnant women who had their prenatal health care and gave birth in Tongzhou Maternal & Child Health Hospital of Beijing from Jan. 2016 to Dec. 2018 were recruited. The usage patterns of nutritional supplements [folic acid (FA) or multiple micronutrients (MM)] during periconceptional period were independent variables, and serum Vit.E concentration and serum Vit.E concentration≥11.2 mg/L in the 1st trimester of gestational period were outcome variables for generalized linear regression model and Logistic regression model, respectively, to analyze the relationships between the independent and outcome variables. Results: The range of the serum Vit.E concentration in the 1st trimester of gestational period was 5.2-24.0 mg/L, and the median concentration was 10.1 (8.8-11.6) mg/L; the excess rate of the serum Vit.E of those who took MM supplementation was 0.3%, and the rates for the groups of FA only or no nutritional supplements used were both 0.1%. Compared with women without nutritional supplement or the women taking FA, the women who took MM had higher serum Vit.E levels in the 1st trimester of gestational period (both P < 0.05). The women taking FA or MM initiated before the conception showed that the serum Vit.E concentration in the 1st trimester of gestational period was higher than that after the conception (P < 0.05), and the serum Vit.E concentration of women who took regularly was higher than that of irregular taking (P < 0.05); with taking compliance elevated, the serum Vit.E concentration of the two groups of women taking FA or MM increased (P < 0.05). The risk of serum Vit.E concentration≥11.2 mg/L among the women taking MM was higher than that of the women without nutritional supplements or taking FA only [odds ratio (OR)=1.36, 95% confidence interval (95%CI): 1.21-1.53; OR=1.39, 95%CI: 1.31-1.48)]; women who took FA or MM showed a lower risk for serum Vit.E concentration≥11.2 mg/L of taking it after the conception than before, the ORs (95%CI) were 0.86 (95%CI: 0.77-0.96) and 0.88 (95%CI: 0.81-0.95), respectively; the women taking the two supplements regularly had higher risk for serum Vit.E concentration≥11.2 mg/L than irregular taking, the ORs (95%CI) were 1.16 (95%CI: 1.05-1.29) and 1.13 (95%CI: 1.04-1.22) for FA and MM users, respectively; with the compliance increasing, the women taking MM had a higher risk of serum Vit.E levels≥11.2 mg/L in the 1st trimester [OR (95%CI) was 1.10 (1.07-1.14)], but for FA users, the OR (95%CI) was 1.04(1.00-1.08). Conclusion: Vit.E nutritional status in women in early gestational period in Beijing was generally good, and the excess rate of serum Vit.E was higher in women who took MM during periconceptional period than those without nutritional supplement or taking FA only, suggesting that women need to consider their own Vit.E nutritional status to choose the type of nutritional supplements during periconceptional period, so as to avoid related health hazards.

Key words: Micronutrients, Vitamin E, Folic acid, Periconceptional period, Pregnant women

CLC Number: 

  • R169

Figure 1

Flow chart of participants selection FA, folic acid only; MM, multiple micronutrients; BMI, body mass index."

Table 1

The characteristics of the pregnant women in the study"

Characteristics Total, n(%) No-use, n(%) FA, n(%) MM, n(%) χ2 P
Delivery year 174.44 < 0.001
  2016 7 113 (32.1) 439 (25.7) 3 002 (36.9) 3 672 (29.8)
  2017 7 692 (34.7) 647 (37.8) 2 767 (34.0) 4 278 (34.7)
  2018 7 366 (33.2) 624 (36.5) 2 364 (29.1) 4 378 (35.5)
Ethnic groups 4.05 0.132
  Han 20 853 (94.1) 1 624 (95.0) 7 662 (94.2) 11 567 (93.8)
  Others 1 318 (5.9) 86 (5.0) 471 (5.8) 761 (6.2)
Maternal age 31.11 < 0.001
  17 years- 1 965 (8.9) 194 (11.3) 703 (8.6) 1 068 (8.7)
  25 years- 10 470 (47.2) 714 (41.8) 3 897 (48.0) 5 859 (47.5)
  30 years- 7 266 (32.8) 589 (34.4) 2 614 (32.1) 4 063 (33.0)
  35-51 years 2 470 (11.1) 213 (12.5) 919 (11.3) 1 338 (10.9)
Education level 349.16 < 0.001
  Middle school or lower 1 882 (8.5) 275 (16.1) 781 (9.6) 826 (6.7)
  High school or technical school 4 162 (18.8) 463 (27.1) 1 545(19.0) 2 154 (17.5)
  College 7 148 (32.2) 501 (29.3) 2 616 (32.2) 4 031 (32.7)
  University or above 8 979 (40.5) 471 (27.5) 3 191 (39.2) 5 317 (43.1)
Household registration 56.97 < 0.001
  Both of couple are local 8 340 (37.6) 534 (31.2) 3 121 (38.4) 4 685 (38.0)
  The women are local 9 765 (44.0) 828 (48.4) 3 415 (42.0) 5 522 (44.8)
  Only the spouses are local 4 066 (18.3) 348 (20.4) 1 597 (19.6) 2 121 (17.2)
Occupation 231.64 < 0.001
  Government agency 1 954 (8.8) 223 (13.0) 598 (7.4) 1 133 (9.2)
  Professional technicians 4 834 (21.8) 237 (13.9) 1 851 (22.8) 2 746 (22.3)
  Office clerk or related personnel 3 613 (16.3) 207 (12.1) 1 258 (15.5) 2 148 (17.4)
  Business / services 4 529 (20.4) 308 (18.0) 1 665 (20.5) 2 556 (20.7)
  Unemployment 2 985 (13.5) 286 (16.7) 1 115 (13.7) 1 584 (12.8)
  Others 4 256 (19.2) 449 (26.3) 1 646 (20.2) 2 161 (17.5)
Pre-pregnancy BMI 17.30 0.008
  Normal (18.5-23.9 kg/m2) 13 120 (59.2) 960 (56.1) 4 882 (60.0) 7 278 (59.0)
  Underweight (< 18.5 kg/m2) 2 317 (10.5) 166 (9.7) 823 (10.1) 1 328 (10.8)
  Overweight (24.0-27.9 kg/m2) 5 062 (22.8) 432 (25.3) 1 846 (22.7) 2 784 (22.6)
  Obesity (≥28.0 kg/m2) 1 672 (7.5) 152 (8.9) 582 (7.2) 938 (7.6)
Parity 210.67 < 0.001
  Nulliparity 12 005 (54.1) 639 (37.4) 4 544 (55.9) 6 822 (55.3)
  Multiparity 10 166 (45.9) 1 071 (62.6) 3 589 (44.1) 5 506 (44.7)

Table 2

Serum Vit.E nutritional status of the women in the 1st trimester of gestational period"

Nutritional supplements use n(%) Vit.E concentration/(mg/L), median (P25-P75) Vit.E nutritional status
Normal, n(%) Excessive, n(%)
No-use 1 710 (7.7) 9.9 (8.7-11.5) 1 709 (99.9) 1 (0.1)
FA 8 133 (36.7) 9.9 (8.6-11.3) 8 126 (99.9) 7 (0.1)
MM 12 328 (55.6) 10.3 (8.9-11.8) 12 293 (99.7) 35 (0.3)
Total 22 171 (100.0) 10.1 (8.8-11.6) 22 128 (99.8) 43 (0.2)

Table 3

Nutritional supplements use during periconceptional period and its relationship with serum Vit.E concentration among the women in the 1st trimester of gestational period"

Use of nutritional supplements n (%) Vit.E concentration/(mg/L), median (P25-P75) Mann-Whitney U test, P Adjusted βa
Nutritional supplements
  No-use 1 710 (7.7) 9.9 (8.7-11.5) 0
  FA 8 133 (36.7) 9.9 (8.6-11.3) 0.205 -0.031
  MM 12 328 (55.6) 10.3 (8.9-11.8) < 0.001 0.375#
Supplements formula < 0.001
  FA 8 133 (39.7) 9.9 (8.6-11.3) 0
  MM 12 328 (60.3) 10.3 (8.9-11.8) 0.406#
Timing of supplementation initiation
  FA 0.037
    Before the conception 5 091 (62.6) 9.9 (8.7-11.3) 0
    After the conception 3 042 (37.4) 9.8 (8.6-11.2) -0.165#
  MM 0.007
    Before the conception 5 331 (43.2) 10.3 (9.0-11.9) 0
    After the conception 6 997 (56.8) 10.3(8.9-11.8) -0.155#
Frequency (in 10 d)
  FA 0.084
    Irregular(< 8 d) 3 569 (43.9) 9.8 (8.6-11.2) 0
    Regular(≥8 d) 4 564 (56.1) 9.9 (8.7-11.4) 0.144*
  MM 0.003
    Irregular(< 8 d) 7 555 (61.3) 10.3 (8.9-11.8) 0
    Regular(≥8 d) 4 773 (38.7) 10.3 (9.0-11.9) 0.152#

Table 4

The association between compliance score of taking FA or MM during periconceptional period and serum Vit.E concentration in the 1st trimester of gestational period among the women"

Compliance score n Vit.E concentration/(mg/L) β Adjusted βa
$\bar x \pm s$ Median (P25-P75)
FA 0.012 0.037*
  0 1 710 10.19±2.20 9.9 (8.7-11.5)
  1 3 040 10.03±2.10 9.8 (8.6-11.2)
  2 529 10.14±2.02 9.95 (8.6-11.3)
  3 4 562 10.15±2.17 9.9 (8.7-11.4)
MM 0.115# 0.118#
  0 1 710 10.19±2.20 9.9 (8.7-11.5)
  1 6 988 10.48±2.26 10.3 (8.9-11.7)
  2 567 10.57±2.57 10.2 (8.8-12.0)
  3 4 764 10.64±2.38 10.3 (9.0-11.9)

Table 5

The association between taking nutritional supplements during periconceptional period and the risk of serum Vit.E concentration ≥11.2 mg/L in the 1st trimester of gestational period among the women"

Use of nutritional supplements n Vit.E concentration ≥11.2 mg/L, n(%) Crude OR (95%CI) Adjusted OR (95%CI)a
Nutritional supplements
  No-use 1 710 495 (28.9) 1 1
  FA 8 133 2 212 (27.2) 0.92 (0.82-1.03) 0.99 (0.88-1.12)
  MM 12 328 4 289 (34.8) 1.31 (1.17-1.46)# 1.36 (1.21-1.53)#
Supplements formula
  FA 8 133 2 212 (27.2) 1 1
  MM 12 328 4 289 (34.8) 1.43 (1.34-1.52)# 1.39 (1.31-1.48)#
Timing of initiation
  FA
    Before the conception 5 091 1 422 (27.9) 1 1
    After the conception 3 042 790 (26.0) 0.91 (0.82-1.00) 0.86 (0.77-0.96)*
  MM
    Before the conception 5 331 1 943 (36.4) 1 1
    After the conception 6 997 2 346 (33.5) 0.88 (0.82-0.95)* 0.88 (0.81-0.95)*
Frequency (10 in days)
  FA
    Irregular(< 8 d) 3 569 930 (26.1) 1 1
    Regular(≥8 d) 4 564 1 282 (28.1) 1.11 (1.00-1.22)* 1.16 (1.05-1.29)*
  MM
    Irregular(< 8 d) 7 555 2 547 (33.7) 1 1
    Regular(≥8 d) 4 773 1 742 (36.5) 1.13 (1.05-1.22)* 1.13 (1.04-1.22)*

Figure 2

The associations between the proportion of serum Vit.E concentration≥11.2 mg/L and the compliance scores for FA (A) or MM (B) usage during periconceptional period FA, folic acid only; MM, multiple micronutrients; AOR, adjusted odds ratios. The compliance of FA or MM supplementation was divided into no-use (score=0), irregular use and initiated after pregnancy (score=1), irregular use and initiated before pregnancy (score=2), regular use and initiated before pregnancy (score=3). Consideration of the number of women who started to take FA regularly initiating after pregnancy was only 2, and the number of women who take MM regularly initiating after pregnancy was 9, the two groups were deleted in the analysis."

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