The aim of this study is to collect information how adding a soft gel preparation of micronutrients such as vitamins, dietary minerals plus omega-3 fatty acid (docosahexaenoic acid, DHA) to the diet of pregnant women during the 2nd and 3rd trimesters of pregnancy effects the nutritional state of the mother and infants at delivery.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
TRIPLE
Enrollment
164
Once daily micronutrient plus DHA supplementation (Multi-micronutrients and docosahexaenoic acid (MMS) soft gel capsules)
Control study group of pregnant women non-supplemented with multi-micronutrients and docosahexaenoic acid (MMS) soft gel capsules
ASST Fatebenefratelli Sacco
Milan, Lombardy, Italy
ASST Fatebenefratelli Sacco
Milan, Lombardy, Italy
Change from baseline: Blood RBC DHA/wt% TFA
In order to assess the beneficial effects of supplementation with micronutrients and DHA (docosahexaenoic acid) during 2nd and 3rd trimesters of pregnancy, the red blood cell (RBC) DHA weight percent of total fatty acids (DHA wt% TFA) will be measured compared to baseline as primary maternal variable. Gestational age is a measure of the age of a pregnancy which is taken from the beginning of the woman's last menstrual period (LMP), or the corresponding age of the gestation as estimated by a more accurate method if available. Such methods include adding 14 days to a known duration since fertilization (as is possible in in vitro fertilization), or by obstetric ultrasonography. The popularity of using such a definition of gestational age is that menstrual periods are essentially always noticed, while there is usually a lack of a convenient way to discern when fertilization occurred.
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood RBC EPA/wt% TFA
Red blood cell (RBC) EPA (eicosapentaenoic acid) weight percent of total fatty acids (DHA wt% TFA).
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood RBC DHA/TFA ratio %
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood RBC Omega 3 index in RBC
The "omega-3 index" reflects the content of EPA plus DHA in erythrocyte membranes expressed as a percentage of total erythrocyte fatty acids.
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood 25-hydroxyvitamin D concentration %
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Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood Glutathione (GSH)/oxidized Glutathione (GSSG) ratio %
Glutathione exists in reduced (GSH) and oxidized (GSSG) states. Reduced glutathione is the most abundant antioxidant in aerobic cells and participates in the detoxification of lipid hydroperoxides and hydrogen peroxide exerted by glutathione peroxidases. When cells are exposes to increased oxidative stress levels, GSSG accumulates and the GSH/GSSG ratio decreases.
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood Reactive oxygen metabolites (ROMs) concentrations %
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Change from baseline: Blood 8-Isoprostane concentration %
Time frame: Baseline: Screening at gestational age (GA) week 11 to 13 and at GA week 24 to 26 and week 34 to 36
Infant sex
Time frame: At delivery
Infant gestational age
Time frame: At delivery
Infant head circumference
Time frame: At delivery
Infant weight measurements
Time frame: At delivery
Infant length measurements
Time frame: At delivery
Infant ponderal index
Time frame: At delivery
Infant skinfold thickness
Triplicate measurements: triceps, biceps, suprailiac, and subscapular on left side with standard skinfold caliper operated with constant pressure of 10 g/mm2)
Time frame: At delivery
Infant Apgar score
Time frame: At delivery
Infant bone density
Time frame: Up to 10 days after delivery
Umbilical cord blood gas analysis
Cord blood sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Umbilical cord blood pH analysis
Cord blood sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Cord blood metabolomic analysis
Cord blood sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Placental weight
Placenta tissue sample evaluation in a subset of women undergoing caesarean section. Placental efficiency will be estimated through the feto/placental weight (F/P) ratio, calculated as birth weight divided by the placental weight.
Time frame: At delivery
Placental biometric parameters
Placenta tissue sample evaluation in a subset of women undergoing caesarean section. i.e. larger (D) and smaller (d) diameters of the chorionic elliptical disc, feto/placental weight (F/P ratio)
Time frame: At delivery
Blood, cord blood and placental RBC DHA/wt% TFA
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Blood, cord blood and placental RBC EPA wt% TFA
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Blood, cord blood and placental DHA/TFA ratio %
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Blood, cord blood and placental RBC Omega 3 index
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Mitochondrial DNA content evaluation in placental tissue and isolated trophoblast cells
mtDNA is a well-accepted molecular marker to assess mitochondria content. Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
IL-6 (Interleukin 6), IL-10 (Interleukin 10) and TNF-α (Tumor Necrosis Factor Alpha) in placental tissue and isolated trophoblast cells
These genes are constitutively expressed in human placenta and are a reliable marker of inflammation. Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Placental tissue metabolomic analysis
Sample evaluations in a subset of women undergoing Caesarean section. The rationale for conducting metabolomic analysis is to understand if multi-micronutrient supplement (MMS) supplementation during the second and third trimester of pregnancy influences maternal and infant gestational outcomes (e.g. oxidative stress, placental function).
Time frame: At delivery
Blood, cord blood and placental 8-isoprostane
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Blood, cord blood and placental reactive oxygen metabolites (ROMs) concentrations %
Sample evaluations in a subset of women undergoing Caesarean section.
Time frame: At delivery
Number of Adverse Events (AEs)
Time frame: Within 7 days after Delivery
Severity of AEs
Time frame: Within 7 days after Delivery
AE relationship to the investigational product
Time frame: Within 7 days after Delivery