Vitamin B12 and folate bioavailability from two prenatal multivitamin/multimineral supplements.

In this crossover, single-blind study, the bioavailability of B12 and folate, fasting and postprandially, was measured in 30 pregnant women for two prenatal multivitamin/multimineral supplements (Stuartnatal Plus and Materna, Wyeth-Ayerst Pharmaceuticals, Philadelphia, PA) and a placebo. Blood samples were obtained before supplementation and at 1, 3, 6, and 8 hr after supplementation serum levels of the two vitamins were measured by radioimmunoassay. The maximum postabsorption serum level was multiplied by the total body plasma levels to obtain the total rate of body absorption. The absorption peak of both vitamins occurred at 3 hours after ingestion of a supplement. The total body absorption of the two vitamins was greater during fasting than it was postprandially. There was 30% greater B12 absorption for Stuartnatal Plus (371 +/- 56 vs. 285 +/- 34 pmol) and 33% for Materna (315 +/- 34 vs. 236 +/- 4 pmol, p < or = 0.05). Similarly, there was 117% greater folate absorption fasting for Stuartnatal Plus (163 +/- 15 vs. 75 +/- 15 nmol, p < or = 0.001) and 57% greater absorption for Materna (207 +/- 21 vs. 132 +/- 13 nmol, p < or = 0.01). Both vitamins were readily absorbed (within 3 hours) into the maternal hepatic portal circulation. The absorption of both vitamins was significantly less when ingested after the test meal than when fasting.

Blood cell lead, calcium, and magnesium levels associated with pregnancy-induced hypertension and preeclampsia.

This study compares the red blood cell (Rbc) levels of lead (Pb), calcium (Ca), and magnesium (Mg) in relation to blood pressure in 39 pregnant women in the third trimester of pregnancy. The study population included 20 women with normal pregnancies, 15 with mild hypertension, and 4 with severe hypertension and preeclampsia. The mean +/- SD for each group was calculated and the difference between the means of the normotensive and the other groups were compared by analysis of variance. Significant differences from normal to the preeclamptic pregnancies were in (1) elevated Rbc Pb (p < or = 0.001), (2) lower Rbc Ca (p < or = 0.001), and (3) lower Rbc Mg/Pb ratio (p < or = 0.0001). Pearson's rank correlation between blood pressure showed a direct relation to the Rbc Pb level (p < or = 0.01) and an inverse relation to the Rbc Ca and Mg/Pb ratio (p < or = 0.004, < or = 0.007). Apparently, prenatal blood pressure is directly proportional to Rbc Pb content and related or modified by Rbc Ca and Mg.

Seminal plasma trace metal levels in industrial workers.

This study compares the seminal plasma trace metal levels of hospital workers with groups of industrial workers in a petroleum refinery, smelter, and chemical plant. The metals measured were the essential metals (copper, zinc, nickel, cobalt, and manganese) and the toxic metals (lead, cadmium, and aluminum). The group mean +/- SE metal level for each group (50 subjects per group) was calculated, and the statistical significance of the group mean differences of the industrial groups with the hospital group (control) was determined by the Student's t-test. The differences observed in the smelter group were increased copper and zinc (p < or = 0.001) and decreased nickel, cobalt, and manganese (p < or = 0.001, < or = 0.01). The refinery group differences were increased copper, zinc, and nickel (p < or = 0.001) but decreased cobalt and manganese (p < or = 0.001). The chemical group differences were increased zinc (p < or = 0.001) and decreased cobalt (p < or = 0.001). The seminal plasma levels of the toxic metals lead and aluminum were increased in each of the industrial groups (p < or = 0.001). Concurrent differences were (1) decreased accumulation of nickel, cobalt, and manganese in the smelter group, (2) decreased cobalt and manganese in the refinery group, and (3) only decreased cobalt in the chemical group.

Bioavailability of iron in two prenatal multivitamin/multimineral supplements.

OBJECTIVE: To determine the iron bioavailability in two popular prenatal multivitamin/multimineral supplement tablets containing 27 mg elemental iron. STUDY DESIGN: Iron absorption during an eight-hour period following ingestion of a multivitamin/multimineral formulation, both fasting and with a standardized meal, was measured in a group of 30 pregnant women (24-32 weeks of gestation) and statistically compared. The prenatal formulations were Stuartnatal Plus and Materna (Wyeth-Ayerst Pharmaceuticals, Philadelphia, Pennsylvania), and each contains 27 mg of elemental iron. A placebo was included in the study for the control group in this crossover, single-blind study. RESULTS: The net iron bioavailability (mean +/- SE) of Stuartnatal Plus and Materna, accounting for diurnal variation, and the iron ingested with the standardized meal was 5.4 +/- 0.4 and 4.6 +/- 0.2 mg, respectively, while fasting and 2.9 +/- 0.4 and 2.7 +/- 0.4 mg, respectively, postprandially. The total amount of iron absorption in the fasting states from both prenatal formulations exceeded the 3 mg of supplemental iron absorption per day recommended by the National Academy of Sciences. CONCLUSION: The results of this study indicate that these two prenatal multivitamin/multimineral formulations provide > 3.0 mg of supplemental iron absorption (fasting) as recommended by the National Academy of Sciences and 2.7 mg of iron absorption above the levels achieved following ingestion of a standard, low-iron test meal.

The apparent effect of iron supplementation on serum selenium levels in teenage pregnancy.

Numerous studies have suggested a significant role of selenium in the prevention of gynecological carcinoma. These were epidemiological and prospective in humans and therapeutic in laboratory animals. However, no studies have been reported regarding the normal serum selenium levels during pregnancy. The maternal total blood volume increases 30-50% during the second and third trimesters, resulting in lower measured serum levels for those metabolites, which are not increased significantly during pregnancy. A longitudinal study of the serum selenium levels in teenage pregnancy during the last two trimesters and 3 mo postpartum showed progressive elevation from 49 +/- 7 microg/dL after the 32nd week of pregnancy to 114 +/- 7 microg/dL at term, which was statistically significant (p < or = 0.001). Prenatal supplementation with 18 mg of iron per day prevented this elevation. The results of this study suggest that serum selenium levels in women normally double during pregnancy and this doubling is prevented by the minimal daily supplementation of 18 mg of iron, which may be due to increased absorption of selenium into the erythrocytes and incorporation into the glutathione peroxidase enzyme.

Amniotic fluid B12, calcium, and lead levels associated with neural tube defects.

The group mean differences and relationships between folate, B12, calcium, lead, and methionine levels in amniotic fluid from 29 non-NTD and 11 NTD pregnancies (15-20 weeks' gestation age) were determined. The study population was predominantly Hispanic in both groups (48% in non-NTD and 36% in NTD group) with an average maternal age of 29 years in the non-NTD group and 24 years in the NTD group; and, an average gestation age of 18.5 weeks in the non-NTD and 17.5 weeks in the NTD group. The folate, B12, lead, calcium, and methionine levels of the two groups were compared by Student's t-test and by Pearson's correlation. The NTD levels were lower for calcium (p< or =0.0001), B12 (p< or =0.001), and methionine (P< or =0.001); but, the lead level was higher (p< or =0.0001). A negative correlation was observed between lead and both B12 (p< or =0.007) and methionine (p< or =0.02).

The effect of ascorbic acid supplementation on the nicotine metabolism of smokers.

BACKGROUND: The relationship of serum ascorbic acid (AA) levels and excretion of nicotine metabolites was determined in 75 men who smoked at least one pack of cigarettes per day. METHODS: The subjects were randomly divided into three groups of 25 each who received a placebo, 200 mg of supplementation, or 1000 mg of supplementation of AA per day for 1 month. Baseline and weekly serum AA levels were determined and simultaneous estimates of urinary excretion of nicotine metabolites as cotinine equivalents (CE). RESULTS: The group mean serum AA levels in the placebo group decreased 13% after 2 weeks; the group mean serum levels of the supplemented groups increased significantly after 1 week (P

The effect of ascorbic acid supplementation on the blood lead levels of smokers.

BACKGROUND: The study subjects were 75 adult men (20 to 30 years of age), who smoked one pack of cigarettes per day (minimum) and had no clinical signs of ascorbic acid deficiency or lead toxicity. None had a history of industrial exposure to lead, and the blood-lead levels were anticipated to be below 1.45 micromol/L, the minimum blood level associated with toxicity symptoms. METHODS: The men were randomly assigned to three study groups of 25, and each group was provided a four-week supply of one level of daily ascorbic acid supplements (placebo, 200 mg or 1000 mg of ascorbic acid). We measured baseline and weekly serum and urine ascorbic-acid levels as well as blood and urine lead levels. The weekly group means and variations of the measured data were statistically compared by means of ANOVA and Pearson's correlation. RESULTS: The serum ascorbic-acid levels of the groups receiving ascorbic acid increased significantly after one week (p< or =.001). There was no effect of placebo or 200 mg ascorbic-acid supplementation on the blood or urine lead levels. However, there was a 81% decrease in blood-lead levels in the 1000 mg ascorbic acid group after one week of supplementation (p< or =.001). CONCLUSIONS: Daily supplementation with 1000 mg of ascorbic acid results in a significant decrease of blood-lead levels associated with the general population. Ascorbic acid supplementation may provide an economical and convenient method of reducing blood-lead levels, possibly by reducing the intestinal absorption of lead.

Amniotic fluid amino and nucleic acid in normal and neural tube defect pregnancies. A comparison.

OBJECTIVE: To explore the relationship between fetal amino acids (AAs), which are the components of structural proteins and nucleic acids, and the changes associated with neural tube defects (NTD). STUDY DESIGN: Ten weekly amniotic fluid (AF) samples from normal pregnancies (non-NTD) and 10 from NTD pregnancies between 16 and 20 weeks' gestational age were analyzed for AAs, and the weekly average for the non-NTD and NTD groups was determined. The group mean levels were compared by ANOVA. RESULTS: The weekly group mean levels of methionine, serine and aspartic acid were significantly lower than the weekly group mean levels of the other AAs. The group mean levels of methionine were significantly lower for NTD than for non-NTD pregnancies. CONCLUSION: The mean methionine level in NTD pregnancies was the only AA alteration in NTD. Although the AF levels of the non-NTD pregnancies showed that the levels of serine, aspartic acid and methionine were 3- to 19-fold lower than those of the other AAs, only methionine is essential. Consequently, methionine is rate limiting with respect to the role of structural proteins and nucleic acids in the fetus.

Third-trimester amniotic fluid metal levels associated with preeclampsia.

Studies of maternal amniotic fluid and serum at delivery have revealed the presence of toxic metals or deficiencies of essential metals associated with high-risk pregnancy. Essential and toxic metal levels were studied in 29 preeclamptic and 101 normal pregnancies. The authors grouped the samples according to the following gestation ages: 33-36 wk (48 normal and 10 preeclamptic) and 37-40 wk (53 normal and 19 preeclamptic). The metals studied were calcium, magnesium, zinc, selenium, copper, cadmium, and lead. Comparisons of the 33-36-wk gestation group showed significant differences between normal and preeclamptic amniotic fluid in levels of lead, calcium, magnesium, zinc, and selenium. There were also significant differences in levels of magnesium, copper, zinc, cadmium, and lead during the gestation period of 37-40 wk. The changes observed in calcium and lead levels were consistent with the results of animal studies in which investigators have found depressed calcium transport associated with subacute or chronic lead poisoning, resulting in a physical syndrome similar to preeclampsia.

Comparison of sperm viability with seminal plasma metal levels.

This study compares the semen levels of lead (Pb), cadmium (Cd), and aluminum (Al) in relation to live sperm in semen samples from 64 apparently healthy men. The measured levels were separated into live sperm count tertiles (<25% [18 subjects], 25-50% [26 subjects], and >50% [20 subjects]). The mean +/- SD for each group was calculated, and the difference between the means of the high and low tertiles were compared by ANOVA. Significant differences were observed between the high and low live sperm groups for Pb (p < 0.01) and Al (p < 0.05), but not Cd. Spearman's rank correlation between sperm viability and the semen plasma metal levels showed a direct relation to Mg (p < 0.05). However, there was an inverse relation to lead (p < 0.001), cadmium (p < 0.01), and aluminum (p < 0.01). There was no significant correlation between Ca and Zn. Linear regression between the live sperm counts and semen level of the three metals show that metal levels were inversely correlated with the percentage of live sperm (p < 0.001, < 0.01). Apparently, the presence of these metals in the environment and in seminal plasma exerts a toxic effect on sperm.

Iron in prenatal multivitamin/multimineral supplements. Bioavailability.

OBJECTIVE: To determine the effect of the differences in the content of essential and nonessential ingredients and of a standardized meal on iron bioavailability from four popular prenatal multivitamin/multimineral supplements. STUDY DESIGN: Iron absorption during an eight-hour period following ingestion of a multivitamin/multimineral formulation, both fasting and postprandial, after a standardized meal, was measured in five groups of 20 pregnant women (24-32 weeks of gestation) and statistically compared. The prenatal formulations were Natalins Rx, Prenatal 1/1, Stuartnatal Plus and Prenate 90. One-A-Day (without iron) was included in the study for the control group. RESULTS: The descending order of absorption, both fasting and postprandial, were Prenate 90, Stuartnatal Plus, Prenatal 1/1 and Natalins Rx. Total iron absorption for each formulation group during the postprandial phase was higher than during the fasting phase. However, the net amount of iron absorption (in both the fasting and postprandial phases) from three of the four formulations (Stuartnatal Plus, Prenatal 1/1 and Prenate 90) provided the minimal 3.0 mg of supplemental iron per day recommended by the National Academy of Science. CONCLUSION: The observed differences in iron absorption between prenatal supplements apparently reflect the effects of the various combinations of vitamins, essential minerals and additives. The absolute amount of elemental iron contained in a prenatal multivitamin/ multimineral formulation does not ensure availability.

Amniotic fluid B12 and folate levels associated with neural tube defects.

Amniotic fluid levels of B12 and folate in neural tube defect (NTD) affected pregnancies were compared with the weekly group mean +/-SD changes in amniotic fluid B12 and folate levels of 10 unaffected pregnancies each week between 15 and 20 weeks' gestation age. Comparison was by analysis of variance (ANOVA) and Pearson's correlation to B12 and folate levels and to the NTD samples of corresponding gestation age. Amniotic fluid B12 and folate decreased 67 and 62%, respectively, between 15 and 20 weeks' gestation in the unaffected pregnancies, associated with an increase in amniotic fluid volume. The mean +/-SD B12 and folate of the NTD affected pregnancies (308+/-156 pg/mL and 3.1+/-1.6 ng/mL) were below the mean +/-SD B12 and folate of the total population of unaffected pregnancies (453+/-155 pg/mL and 3.9+/-1.2 ng/mL). The correlation between gestation age and amniotic fluid B12 was -0.9914 (p< or =.0001) and -0.9599 (p< or =.002) for amniotic fluid folate. The B12 levels of the affected pregnancies were below the range of unaffected pregnancies in four of the nine affected pregnancies, and folate levels in two of the nine affected pregnancies.

Zinc and copper levels in premenstrual syndrome.

OBJECTIVE: To determine whether changes in peripheral zinc and copper levels are associated with symptoms of premenstrual syndrome (PMS). DESIGN: Ten PMS patients and 10 controls gave blood at 2- or 3-day intervals through three menstrual cycles. Serum zinc and copper were measured by flameless atomic absorption spectrophotometry. RESULTS: In the controls zinc values were not significantly different between the follicular and the luteal phases. In the patients, the values were significantly lower during the luteal phase than during the follicular phase. Lower levels of zinc during the luteal phase in PMS patients, compared with the controls, were noted. Copper levels were noted to be higher during the luteal phase in PMS patients compared with the controls. Because copper competes with zinc for intestinal absorption and serum protein binding sites, zinc:copper ratio can reflect the availability of zinc in the body. The computation of this ratio revealed that the ratio was significantly lower in the patients than those in the controls during the luteal phase. CONCLUSIONS: Our data suggest that zinc deficiency occurs in PMS patients during the luteal phase, and the availability of zinc in PMS patients during the luteal phase is further reduced by the elevated copper.

Effect of ascorbic acid supplementation on the sperm quality of smokers.

OBJECTIVE: To determine the effect of ascorbic acid supplementation on the sperm quality of heavy smokers. DESIGN: Microscopic examination of semen for 1 month during supplementation with placebo or ascorbic acid at dose levels of 200 or 1,000 mg/d. SETTING: Department of Obstetrics and Gynecology, The University of Texas Medical Branch. PARTICIPANTS: Seventy-five men (20 to 35 years old) randomly divided into one of three supplementation groups: placebo, 200 mg and 1,000 mg of ascorbic acid. MAIN OUTCOME: Improvement in sperm quality as compared with presupplementation levels and between the three treatment groups. RESULTS: The placebo group showed no improvement in sperm quality. The groups receiving ascorbic acid showed improvement in sperm quality with most improvement in the 1,000-mg group. Pearson's correlation showed statistically significant relationships between the weekly group means of serum and seminal plasma ascorbic acid levels and sperm qualities. CONCLUSIONS: Ascorbic acid supplementation of heavy smokers in excess of 200 mg/d results in improved sperm quality.

Vitamin E levels in premenstrual syndrome.

To determine whether changes in peripheral vitamin E levels are associated with symptoms of premenstrual syndrome, 10 patients with premenstrual syndrome and 10 control subjects were studied. They gave blood at 2- or 3-day intervals throughout three menstrual cycles. The vitamin E was measured by fluorometry after hexane extraction and luteinizing hormone was measured by radioimmunoassay. In the control group, vitamin E values were 854 +/- 45 micrograms/dl (mean +/- SE) during the luteal phase and 925 +/- 55 micrograms/dl during the follicular phase. No significant changes were noted between the two values. In the patients with premenstrual syndrome, the values were 849 +/- 53 micrograms/dl during the luteal phase, which was not significantly different from 858 +/- 48 micrograms/dl during the follicular phase. No significant changes were noted between the control group and the patients with premenstrual syndrome in either the luteal or the follicular phase. Vitamin E deficiency in patients with premenstrual syndrome was not shown by peripheral vitamin E levels in our study.

Vitamin A levels in premenstrual syndrome.

To determine whether changes in peripheral vitamin A levels are associated with symptoms of premenstrual syndrome (PMS), 10 PMS patients and 10 controls were studied. They gave blood at 2- or 3-day intervals through three menstrual cycles. The vitamin A was measured by fluorometry after cyclohexane extraction. In the controls, vitamin A values were 68.0 +/- 3.2 micrograms/dL (mean +/- SE) during the luteal phase and 69.8 +/- 4.2 micrograms/dL during the follicular phase. No significant changes were noted between the two values. In the patients, the values were 73.9 +/- 4.2 micrograms/dL during the luteal phase, which was not significantly different from 72.7 +/- 1.8 micrograms/dL during the follicular phase. No significant changes were noted between the controls and the patients in either the luteal or the follicular phase. Vitamin A deficiency in PMS patients was not demonstrated in our study.

Serum zinc changes due to iron supplementation in teen-age pregnancy.

Serum zinc and iron concentrations in a group of pregnant teen-agers supplemented with a multivitamin were compared during pregnancy with a group supplemented with a multivitamin containing 18 mg Fe. Serum measurements were at 13 wk of gestational age (prestudy) and during supplementation at 20, 32, and 38 wk, delivery, and 4 and 12 wk postpartum. Hematocrit measurements were used to adjust the measured metal concentrations for the diluting effect of the normal blood-volume increase. The non-Fe-group mean, adjusted serum Zn concentrations showed no change, but the serum Fe decreased to 28% below prestudy concentrations at 38 wk. In contrast, the Fe-supplementation group showed a progressive increase in Fe concentrations to a maximum of 38% above prestudy concentrations at 4 wk postpartum and a 35% decrease from prestudy Zn concentrations during the third trimester. The results of this study suggest that 18 mg Fe/d is adequate supplementation for nonanemic teen-age pregnancy and depresses the serum Zn concentration.