AUTHOR=Han Soo Min , Derraik José G. B. , Vickers Mark H. , Devaraj Surabhi , Huang Fang , Pang Wei Wei , Godfrey Keith M. , Chan Shiao-Yng , Thakkar Sagar K. , Cutfield Wayne S. ,  NiPPeR Study Group , Albert Benjamin B. , Barton Shelia J. , Binia Aristea , Cavanagh Mary , Fang Chang Hsin , Seng Chong Yap , Chong Mary F. , Conlon Cathryn , Cooper Cyrus , Costello Paula , Cox Vanessa , Creagh Christine , Depczynski Marysia , El-Heis Sarah , Hammond Judith , Han Zhang , Harvey Nicholas C. , Jagtap Mrunalini , Kenealy Timothy , Nield Heidi , O’Sullivan Justin M. , Satianegara Gernalia , Silva-Zolezzi Irma , Soh Shu E. , Tay Vicky , Taylor Rachael , Tham Elizabeth , Titcombe Philip , Wall Clare , Wong Ray , Woon Gladys 

TITLE=A nutritional supplement taken during preconception and pregnancy influences human milk macronutrients in women with overweight/obesity and gestational diabetes mellitus

JOURNAL=Frontiers in Nutrition

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1282376

DOI=10.3389/fnut.2023.1282376

ISSN=2296-861X

ABSTRACT=<sec id="sec1"><title>Rational</title><p>Maternal overweight/obesity and gestational diabetes mellitus (GDM) are associated with an increased risk of their offspring developing overweight/obesity or type 2 diabetes later in life. However, the impacts of maternal overweight/obesity and dysglycemia on human milk (HM) macronutrient composition are not well understood.</p></sec><sec id="sec2"><title>Objective</title><p>Through a double-blind randomised controlled trial, we investigated the effects of maternal supplementation from preconception throughout pregnancy until birth on HM macronutrient concentrations, in association with maternal and infant factors including maternal pre-pregnancy body mass index (BMI) and GDM status. In addition, we aimed to characterise longitudinal changes in HM macronutrients.</p></sec><sec id="sec3"><title>Methods</title><p>The control supplement contained calcium, iodine, iron, β-carotene, and folic acid. The intervention supplement additionally contained zinc, vitamins B<sub>2</sub>, B<sub>6</sub>, B<sub>12</sub>, and D<sub>3</sub>, probiotics, and myo-inositol. HM samples were collected across seven time points from 1 week to 12 months from Singapore and/or New Zealand. HM macronutrient concentrations were measured using a MIRIS Human Milk Analyser. Potential differences in HM macronutrient concentrations were assessed using linear mixed models with a repeated measures design.</p></sec><sec id="sec4"><title>Results</title><p>Overall, HM macronutrient concentrations were similar between control and intervention groups. Among the control group, overweight/obesity and GDM were associated with higher HM fat and energy concentrations over the first 3 months. Such associations were not observed among the intervention group. Of note, mothers with GDM in the intervention group had lower HM fat by 10% (<italic>p</italic> = 0.049) and energy by 6% (<italic>p</italic> = 0.029) than mothers with GDM in the control group. Longitudinal changes in HM macronutrient concentrations over 12 months of lactation in New Zealand showed that HM fat and energy decreased in the first 6 months then increased until 12 months. HM lactose gradually decreased from 1 week to 12 months while crude protein decreased from 1 week to 6 months then remained relatively constant until 12 months of lactation.</p></sec><sec id="sec5"><title>Conclusion</title><p>Maternal overweight/obesity or GDM were associated with increased HM fat and energy levels. We speculate the intervention taken during preconception and pregnancy altered the impact of maternal BMI or GDM status on HM macronutrient composition. Further studies are required to identify the mechanisms underlying altered HM macronutrient concentration in the intervention group and to determine any long-term effects on offspring health.</p></sec><sec id="sec143"><title>Clinical trial registration</title><p><ext-link xlink:href="http://ClinicalTrials.gov" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, NCT02509988, Universal Trial Number U1111-1171-8056. Registered on 16 July 2015. This is an academic-led study by the EpiGen Global Research Consortium.</p></sec>