Associations of antenatal micronutrient supplementation with adolescent blood pressure: evidence from a 14-year follow-up study of a randomized controlled trial.

BACKGROUND

This study directly examined the effects of antenatal micronutrient supplementation on adolescent blood pressure (BP).

METHODS

This study involved adolescents from two rural counties in western China. Their mothers had previously participated in a cluster-randomized trial of antenatal micronutrient supplementation. All pregnant women were randomized to take a daily capsule of folic acid (FA) as control, folic acid plus iron (IFA), or multiple micronutrients (MMNs) until delivery. Adolescent BP was assessed using a validated electronic sphygmomanometer and converted into percentiles by population reference. We examined the effects of antenatal micronutrient supplementation on adolescent BP and BP percentiles using generalized estimation equations. Multinomial logistic regression was employed to examine the associations between antenatal micronutrient supplementation and categorical BP outcomes, with relative risk reduction estimated.

RESULTS

Among 4488 singleton births eligible for long-term follow-up, 1994 (44.4%) adolescents were followed, and among them, 59.2% were male, with a mean age of 11.73 (SD, 0.86) years old. After adjusting for a range of covariates, antenatal MMNs supplementation relative to FA alone was associated with a 1.13 (95% CI -2.09, -0.17) mmHg lower systolic blood pressure (SBP) and a 2.59 (95% CI -5.01, -0.17) points lower SBP percentile. The similar benefits of MMNs were observed for categorized adolescent high BP (SBP and/or diastolic blood pressure (DBP) ≥ the 95th percentile for age, sex, and height).

CONCLUSIONS

Compared with folic acid alone, antenatal MMNs supplementation was associated with lower adolescent SBP. This finding suggests that comprehensive antenatal nutritional interventions may offer a potential strategy for the primordial prevention of hypertension in offspring.

TRIAL REGISTRATION: ISRCTN08850194, retrospectively registered December 14, 2006. https://www.isrctn.com/ISRCTN08850194?q=ISRCTN08850194&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10 .