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Session: Nutrient Status and Supplementation in Life's Beginnings (Oral 30)

(OR30-02-24) Micronutrient Deficiencies Are Associated With Bacterial Vaginosis in the First Trimester of Pregnancy Among Women in Rural Northwest Bangladesh

Monday, July 1, 2024
4:12 PM – 4:24 PM CT
Location:  W375A
GSRA ELPC
Objectives: Bacterial vaginosis (BV) is associated with increased risks of preterm birth, miscarriage and stillbirth. Vitamin A (VA) supplementation has been shown to reduce risk of BV in later pregnancy and postpartum (Christian et al AJCN 2011), likely via strengthened epithelial defenses. It is not known if preexisting fat-soluble vitamin deficiencies affect risk of BV early in pregnancy.

Methods: We analyzed baseline plasma from a sub-cohort of 1,462 first trimester gravida being enrolled in a placebo-controlled vitamin A or β-carotene supplementation trial in Bangladesh (JiVitA-1). BV, defined as Nugent score 7-10, was assessed from self-administered vaginal swabs. Plasma deficiencies/insufficiencies were defined for VA/retinol ( < 0.70 and < 1.05 μmol/L), β-carotene ( < 0.09 μmol/L), vitamin E (VE)/a-tocopherol ( < 12.0 μmol/L) and vitamin D (VD) (deficiency < 30 and insufficiency < 50 nmol/L).  Prevalences were estimated and multivariable logistic regression models run to estimate adjusted odds ratios (OR) of BV associated with micronutrient deficient or insufficient versus normal status, adjusting for maternal age, body mass index, gestational age, season of blood draw, living standard index, education, and α1-acid glycoprotein.

Results: A total of 7.6% women had BV and while 8%, 72.4% and 7.1% were VA, VE, and VD deficient; 29.9% had insufficient levels of β-carotene. Adjusted ORs for BV among women were 1.65 (95% CI: 0.92, 2.95) for deficient and 1.31 (0.92, 1.88) for marginal retinol status, 1.59 (0.99, 2.56) for β-carotene insufficiency, 2.11 (1.20, 3.72) for a-tocopherol deficiency and 1.86 (0.72, 4.80) for deficient and 1.32 (0.63, 2.74) for insufficient VD status.

Conclusions: In rural Bangladeshi pregnant women, risk of BV increased with severity of VA deficiency, consistent with trial evidence, and VD deficiency, although confidence intervals included 1, suggesting potential roles in epithelial and immune defenses against BV.  VE deficiency and low β-carotene conferred significant 2-fold and 1.6-fold higher risks of BV, reflecting plausible antioxidant defenses. These findings show that fat-soluble vitamins may have the potential to reduce risk of adverse pregnancy outcomes, in part, by reducing risk of BV.

Funding Sources: USAID, Bill & Melinda Gates Foundation