×
Home Current Archive Editorial board
News Contact
Review paper

A randomized, placebo-controlled trial of zinc supplementation during pregnancy for the prevention of stunting: analysis of maternal serum zinc, cord blood osteocalcin and neonatal birth length

By
Lili Rohmawati Orcid logo ,
Lili Rohmawati
Contact Lili Rohmawati

Department of Paediatrics, School of Medicine, Universitas Sumatera Utara , Medan , Indonesia

Dina Keumala Sari ,
Dina Keumala Sari

Department of Nutrition, School of Medicine, Universitas Sumatera Utara , Medan , Indonesia

Makmur Sitepu ,
Makmur Sitepu

Department of Obstetrics and Gynaecology, School of Medicine, Universitas Sumatera Utara , Medan , Indonesia

Kusnandi Rusmil
Kusnandi Rusmil

Department of Paediatrics, School of Medicine, Universitas Padjadjaran , Bandung , Indonesia

Abstract

Aim
To investigate the influence of zinc supplementation on pregnant women for the prevention of stunting through an analysis
of maternal serum zinc, cord blood osteocalcin and neonatal birth length.
Methods
This study was conducted with pre-test/post-test control groups and double-blind randomization. Patients were pregnant
mothers in second or third trimester and with their newborns who met the inclusion criteria. A total of 71 pregnant mothers and their newborns completed this study. They were divided into two groups of 35 and 36 patients, the supplementation (20 mg/day) and placebo groups, respectively for 12 weeks. The parameters assessed were maternal serum zinc levels, cord blood osteocalcin and birth length measurements.
Results
The mean maternal serum zinc level was 54.6±8.7 µg/dL from 71 patients. The mean maternal serum zinc levels after zinc
supplementation were significantly higher than those of the placebo group: 55.1±9.9 to 59.1±8.6) μg/dL (p=0.017) and 54.2±7.5 to 50±8.6 μg/dL (p=0.001), respectively. The comparison of mean cord blood osteocalcin levels and median neonatal birth lengths in the supplementation group was higher than in the placebo group: 131.8±35.3 vs 90.6±35.4 ng/ml (p=0.001) and 49.3 (46.5-51.3) vs 48.3 (46-50.8) cm (p=0.004), respectively. Maternal serum zinc levels after zinc supplementation had a positive significant correlation with cord blood osteocalcin and neonatal birth length: r=0.434
(p=0.001) and r=0.597 (p=0.001), respectively.
Conclusion
There was a significant correlation of maternal serum zinc with cord blood osteocalcin and neonatal birth length after
zinc supplementation. 

References

1
Rayahu S, Gumilang L, Astuti S, Nirmala S. Judiatiani R. Survei asupan asam folat dan seng pada ibu hamil di Jawa Barat (Survey of folic acid and zinc intake in pregnant women in West Java). J Kesehat Vokasional 2019:162–8.
2
Choi J, Park I, Lee S, Ju H, Lee H, Kim J. serum procollagen type I N-terminal propeptide and osteocalcin levels in Korean children and adolescents. Yonsei Med J 2019:1174–80.
3
Bayer M. Reference values of osteocalcin and procollagen type I N-propeptide plasma levels in a healthy Central European population aged 0-18 years. Osteoporos Int 2014:729–36.
4
Han Y, Xu G, Zhang J, Yan M, Li X, Ma B, et al. Leptin induces osteocalcin expression in ATDC5 cells through activation of the MAPK-ERK1/2 signaling pathway. Oncotarget 2016:64021–9.
5
Gundberg C. Biochemical markers of bone formation. Clin Lab Med 2000:489–501.
6
Prawirohartono E, Nyström L, Nurdiati D, Hakimi M, Lind T. The impact of prenatal vitamin A and zinc supplementation on birth size and neonatal survival -a double-blind, randomized controlled trial in a rural area of Indonesia. Int J Vitam Nutr Res 2013:14–25.
7
Merialdi M, Caulfield L, Zavaleta N, Figueroa A, Costigan K, Dominici F. Randomized controlled trial of prenatal zinc supplementation and fetal bone growth. Am J Clin Nutr 2004:826–30.
8
Oh C, Keats E, Bhutta Z. Birth, child health and development outcomes in low-and middle-income countries: a systematic review and meta-analysis. Nutrients 2020:491.
9
Mesdaghinia E, Naderi F, Bahmani F, Chamani M, Ghaderi A, Asemi Z. The effects of zinc supplementation on clinical response and metabolic profiles in pregnant women at risk for intrauterine growth restriction: a randomized, double-blind, placebo-controlled trial. J Matern Fetal Neonatal Med 2019:1–7.
10
Çelikel Ö, Doğan Ö, Aksoy Ö, N. A multilateral investigation of the effects of zinc level on pregnancy. J Clin Lab Anal 2018:22398.
11
Nasiadek M, Stragierowicz J, Klimczak M, Kilanowicz A. The role of zinc in selected female reproductive system disorders. Nutrients 2020:2464.
12
Gibson R, King J, Lowe N. A review of dietary zinc recommendations. Food Nutr Bull 2016:443–60.
13
Choi R, Sun J, Yoo H, Kim S, Cho Y, Kim H, et al. A prospective study of serum trace elements in healthy Korean pregnant women. Nutrients 2016:749.
14
Grzeszczak K, Kwiatkowski S, Kosik-Bogacka D. The role of Fe, Zn, and Cu in pregnancy. Biomolecules 2020:1176.
15
Wilson R, Grieger J, Bianco-Miotto T, Roberts C. Association between maternal zinc status, dietary zinc intake and pregnancy complications: a systematic review. Nutrients 2016:641.
16
Gala U, Godhia M, Nandanwar Y. Effect of maternal nutritional status on birth outcome. Int J Adv Nutr Health Sci 2016:226–33.
17
Reducing stunting in children: equity considerations for achieving the global nutrition targets 2025 2018.
18
Mekonnen A, Terefe W, Belachew A, Adhanu A, Gezae K. Prevalence and associated factors of zinc deficiency among pregnant women attending antenatal care at Gambella hospital, Gambella. AJLS 2018:91–9.
19
Seriana I, Yusrawati, Lubis G. Serum zinc level at term pregnancy and newborn anthropometry. Indones. J Obstet Gynecol 2015:190–5.
20
Nutrisurvey. Nutrition surveys and calculations 2007.
21
Hotz C, Peerson J, Brown K. Suggested lower cutoffs of serum zinc concentrations for assessing zinc status: reanalysis of the second national health and nutrition examination survey data (1976-1980). Am J Clin Nutr 2003:756–64.
22
Panero C, Cecchettin M, Mainard G, Sorice V, Granelli A, Tarquini B. Vitamins and Minerals in Pregnancy and Lactation 1988:145.
23
Rocha E, De Brito N, Dantas M, Silva A, Almeida M, Brandão-Neto J. Effect of zinc supplementation on GH, IGF1, IGFBP3, OCN, and ALP in non-zincdeficient children. J Am Coll Nutr 2015:1–10.
24
Suzuki T, Katsumata S, Matsuzaki H, Suzuki K. Dietary zinc deficiency induces oxidative stress and promotes tumor necrosis factor-α-and interleukin-1β-induced RANKL expression in rat bone. J Clin Biochem Nutr 2016:122–9.
25
King J, Brown K, Gibson R, Krebs N, Lowe N, Siekmann J. Biomarkers of nutrition for development (BOND): zinc review. J Nutr 2016:858–85.
26
Wang H, Hu Y, Hao J, Chen Y, Su P, Wang Y, et al. Maternal zinc deficiency during pregnancy elevates the risks of fetal growth restriction: a population-based birth cohort study. Sci Rep 2015:11262.
27
Terrin G, Canani R, Chiara D, Pietravalle M, Aleandri A, Conte V, et al. Zinc in early life: a key element in the fetus and preterm neonate. Nutrients 2015:10427–46.
28
Beluska-Turkan K, Korczak R, Hartell B, Moskal K, Maukonen J, Alexander D, et al. Nutritional gaps and supplementation in the first 1000 days. Nutrients 2019:2891.
29
Jakarta. Kementerian Kesehatan Republik Indonesia 2018.
30
Kemenkes R. Riset kesehatan dasar (Riskesdas) 2018. (Basic health research 2018.
31
Mousa A, Naqash A, Lim S. Macronutrient and micronutrient intake during pregnancy: an overview of recent evidence. Nutrients 2019:443.
32
Ashworth A. Nelson Textbook of Pediatrics 20AD:295–306.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.