Adequacy of nutritional intake from food and supplements in a cohort of pregnant women in Québec, Canada: the 3D Cohort Study (Design, Develop, Discover).

Background: Assessments of the dietary intakes in various populations suggest that pregnant women have difficulty meeting all their nutritional requirements through diet alone. Few large-scale studies have considered both food sources and supplements in assessing the adequacy of nutritional intakes during pregnancy.Objective: Our study aimed to assess nutritional intakes during pregnancy by examining dietary sources and supplements. It then compared these findings with Dietary Reference Intakes.Design: We conducted a nutrition study in a large pregnancy cohort using a 3-d food record during the second trimester of pregnancy. Detailed information about supplement consumption was obtained by interview at each prenatal visit. We estimated the distribution of total usual intakes for energy, macronutrients, and micronutrients for 1533 pregnant women.Results: A third of the participants had total fat intakes that exceeded the Acceptable Micronutrient Distribution Range. A majority of women (85%) had sodium intakes above the Tolerable Upper Intake Level (UL). Median intakes for fiber and potassium were lower than Adequate Intakes. Dietary intakes of vitamin B-6, magnesium, and zinc were below the Estimated Average Requirements (EARs) for 10-15% of the women. A majority of the women had dietary intakes below the EARs for iron (97%), vitamin D (96%), and folate (70%). When we considered micronutrient intakes from both food and supplements, we found that the prevalence of inadequate intake was <10% for all nutrients except vitamin D (18%) and iron (15%), whereas 32% and 87% of the women had total intakes above the ULs for iron and folic acid, respectively.Conclusions: The level of intake of some nutrients from food alone remains low in the diets of pregnant women. Supplement use reduces the risk of inadequate intake for many micronutrients, but diet-related issues during pregnancy remain and deserve to be addressed in public health interventions. This trial was registered at clinicaltrials.gov as NCT03113331.

Rankings of iron, vitamin D, and calcium intakes in relation to maternal characteristics of pregnant Canadian women.

Iron, vitamin D, and calcium intakes in the prenatal period are important determinants of maternal and fetal health. The objective of this study was to examine iron, vitamin D, and calcium intakes from diet and supplements in relation to maternal characteristics. Data were collected in a subsample of 1186 pregnant women from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a cohort study including pregnant women recruited from 10 Canadian sites between 2008 and 2011. A food frequency questionnaire was administered to obtain rankings of iron, calcium, and vitamin D intake (16-21 weeks of pregnancy). Intakes from supplements were obtained from a separate questionnaire (6-13 weeks of pregnancy). Women were divided into 2 groups according to the median total intake of each nutrient. Supplement intake was an important contributor to total iron intake (median 74%, interquartile range (IQR) 0%-81%) and total vitamin D intake (median 60%, IQR 0%-73%), while the opposite was observed for calcium (median 18%, IQR 0%-27%). Being born outside of Canada was significantly associated with lower total intakes of iron, vitamin D, and calcium (p ≤ 0.01 for all). Consistent positive indicators of supplement use (iron, vitamin D, and calcium) were maternal age over 30 years and holding a university degree. In conclusion, among Canadian women, the probability of having lower iron, vitamin D, and calcium intakes is higher among those born outside Canada; supplement intake is a major contributor to total iron and vitamin D intakes; and higher education level and age over 30 years are associated with supplement intake.

Is there a relationship between tea intake and maternal whole blood heavy metal concentrations?

The aim of this analysis was to examine the association between tea intake during pregnancy and maternal and infant metal exposures. Data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a pan-Canadian pregnancy cohort, were used. All participants with a gestational age of ⩾20 weeks (n=1954) with available biomarkers were included. Geometric means (GMs) for lead, arsenic, mercury, cadmium and manganese in maternal (first and third trimesters) and cord blood, as well as speciated arsenic in maternal urine in the first trimester, were calculated for participants who drank regular, green or herbal tea and for those who did not. Differences between groups were examined using chi-square tests. Adjusted least squares geometric means (LSGMs) were estimated by tea intake, controlling for factors such as country of birth, coffee intake and maternal smoking. Concentrations of all metals were above the limits of detection in most participants in the first trimester: lead (GM): 0.62 µg/dl), mercury (GM: 2.99 nmol/l); cadmium (GM 1.93 nmol/l), arsenic (GM 9.75 nmol/l) and manganese (GM 160.1 nmol/l). Adjusted LSGMs for lead in the first trimester were higher for tea drinkers than for those who were non-tea drinkers (LSGM 0.65 µg/dl, 95%CI: 0.62, 0.69 and 0.61 µg/dl, 95%CI: 0.59, 0.62), and there was evidence of a dose-response relationship for green and herbal tea. Those who consumed herbal tea in the third trimester had significantly higher third trimester maternal and cord blood lead concentrations than non-herbal tea drinkers. This study provides evidence of an association between blood lead concentrations and green or herbal tea consumption. However, the GM blood lead concentrations of the highest tea consumers were still less than 1 µg/dl and within the normal range of blood lead concentrations in the Canadian population.

Prevalence and correlates of high red blood cell folate concentrations in the Canadian population using 3 proposed cut-offs.

A distinct shift towards higher folate concentrations has emerged in Canada. These higher concentrations have known benefits, including prevention of neural tube defects, but concerns have been raised regarding potential associations with adverse health outcomes. The aim of this research was to propose cut-offs for high red blood cell (RBC) folate concentrations and identify their correlates. RBC folate was measured in a nationally representative cross-sectional sample of Canadians (N = 5248) aged 6 to 79 years. RBC folate concentrations were adjusted from the IMMULITE 2000 immunoassay to a microbiologic assay. The population was characterized at 3 RBC folate cut-offs: 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L. We used t tests to examine differences by age, sex, income, and body mass index (BMI) at each cut-off and logistic regression to explore associations with folic acid supplement intake. The prevalence of high RBC folate was 16%, 6%, and 2% at thresholds of 1450 nmol/L, 1800 nmol/L, and 2150 nmol/L, respectively. Females, those aged 60 to 79 years, and overweight or obese participants had the greatest prevalence of having high RBC folate at each cut-off. Folic acid supplement users were more likely than non-users to have high RBC folate concentrations. Older age, higher BMI, and folic acid supplement use were identified as correlates of high folate status. A high RBC folate concentration cut-off will advance the field towards consistent measurement and reporting of high folate status. This may facilitate future investigation of associations between RBC folate concentrations at the upper end of the distribution and health outcomes.

Tea consumption in pregnancy as a predictor of pesticide exposure and adverse birth outcomes: The MIREC Study.

INTRODUCTION: Pesticide residues in tea may contribute to exposure during pregnancy; however, the impact on maternal and infant health is not well understood. The aim of this study was to determine whether tea intake in the first trimester was associated with elevated concentrations of various pesticides in maternal blood or urine. Further, we examined the relationship between tea consumption and adverse birth outcomes. METHODS: Data from the Maternal-Infant Research on Environmental Chemicals (MIREC) Study, a pan-Canada pregnancy cohort, were used. All singleton, live births (n=1898) with available biomarkers were included in the analyses. Descriptive statistics were used to characterize the population. The geometric means (GM) of organochlorine (OC) pesticide constituents or metabolites in maternal plasma (lipid adjusted) and organophosphate (OP) pesticide metabolites (adjusted for specific gravity) in maternal urine were calculated for participants who drank regular, green or herbal tea in the first trimester and for those who did not. Differences between groups were examined using chi-square or t-tests. Associations between frequency of drinking tea and adverse birth outcomes were examined using logistic regression (preterm birth and small-for-gestational-age) or generalized linear models (birthweight decile and head circumference). RESULTS: The GM of the OC pesticide constituent trans-nonachlor was 2.74 mg/g lipid, and for metabolites oxychlordane and p,p'-DDE this was 1.94 ng/g lipid and 55.8 ng/g lipid, respectively. OP pesticide metabolite concentrations adjusted for specific gravity, were dimethylphosphate (GM: 3.19 µg/L), dimethylthiophosphate (GM: 3.29 µg/L), dimethyldithiophosphate (GM: 0.48 µg/L), diethlphosphate (GM: 2.46), and diethylthiophosphate (GM: 0.67 µg/L). There was no significant difference in mean concentrations for these OC or OP pesticide constituents or metabolites between tea drinkers - of any type - and non-tea drinkers. Further, no association was found between tea intake and adverse birth outcomes. CONCLUSIONS: Pesticide concentrations did not differ by tea intake. Further, tea intake in the first trimester was not associated with adverse birth outcomes. In this study population, there was no evidence for concern about tea intake being a source of the OP or OC pesticide metabolites measured or adversely affecting birth outcomes; however, tea intake was lower than national Canadian data for women of reproductive age.

Prevalence and correlates of folic acid supplement use in Canada.

Dietary supplements are an important source of folic acid, a nutrient that is vital in reducing the risk of neural tube defects. As part of the 2007 to 2009 Canadian Health Measures Survey, data were collected on supplement use, and biomarkers were directly measured. Use of supplements that contain folic acid was reported by 25% of Canadians aged 6 to 79. Females were more likely than males to report taking folic acid supplements. People who ate fruit and vegetables less than once a day had significantly lower odds of taking folic acid-containing supplements than did those who ate fruit and vegetables at least three times a day. Of those who consumed a folic acid supplement, 91% reported also taking a supplement that contained vitamin B12. Red blood cell folate concentrations below the median (less than 1,248 nmol/L), low-to-marginal serum vitamin B12 concentrations (221 pmol/L or less), and high concentrations of plasma homocysteine were negatively correlated with folic acid-containing supplement use.

Folic acid supplement use is the most significant predictor of folate concentrations in Canadian women of childbearing age.

One-fifth of Canadian women of childbearing age (WCBA) have red blood cell (RBC) folate concentrations below those considered optimal for neural tube defect risk reduction (≥906 nmol·L(-1)). Determinants of optimal concentrations have not been examined in a nationally representative sample of Canadian WCBA since food fortification with folic acid was implemented. This study explored correlates of optimal RBC folate concentrations and characteristics of folic acid supplement users in a sample of Canadian WCBA. RBC folate concentrations from the 2007-2009 Canadian Health Measures Survey were assessed in women aged 15 to 45 years (n = 1162). Sociodemographic, behavioural, and clinical determinants of RBC folate ≥906 nmol·L(-1) were examined using univariate and separate multiple logistic regression models that controlled for age and household income. t tests were used to study differences between folic acid supplement users and nonusers. WCBA not taking folic acid supplements were less likely to achieve a RBC folate concentration ≥906 nmol·L(-1) compared with folic acid supplement users (odds ratio, 0.47; 95% confidence interval, 0.24, 0.92). Twenty-five percent of WCBA reported folic acid supplement use, and there was a higher percentage of folic acid supplement users in the highest income group. Folic acid supplement users were also more frequent consumers of supplemental vitamin B(12) and of fruit and vegetables (>3 times per day). Folic acid supplement use was the most significant predictor of WCBA achieving optimal RBC folate concentrations. These results indicate a need for targeted strategies to improve compliance with folic acid supplement recommendations among WCBA.