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Title:   Author  item
                                            OAKES, BRIETTA - University Of Californiaitem
                                            Laugero, Kevinitem
                                            STEWART, CHRISTINE - University Of Californiaitem
                                            ADU-AFARWUAH, SETH - University Of Ghanaitem
                                            LARTEY, A - University Of Ghanaitem
                                            ASHORN, P - Tampere University Hospitalitem
                                            VOSTI, SA - University Of Californiaitem
                                            DEWEY, KATHRYN - University Of California
  Submitted to: Journal of Nutrition
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 11/30/2016
                                    Publication  Date: 1/13/2016
                                    Citation: Oakes, B.M., Laugero, K.D., Stewart, C.P., Adu-Afarwuah, S., Lartey, A., Ashorn, P., Vosti, S., Dewey, K.G. 2016. Late-pregnancy salivary cortisol concentrations of Ghanaian women participating in a randomized controlled trial of prenatal lipid-based nutrient supplements. Journal of Nutrition. 146(2):343-352. https://doi.org/10.3945/jn.115.219576.DOI: https://doi.org/10.3945/jn.115.219576                                                              
                                Interpretive Summary: Nutritional deficiencies may elevate cortisol concentrations.  During pregnancy, this may lead to preterm birth and lower birth weight.  Lower birthweight has been linked to poor development and health throughout life.  The objective of this study was to test whether women living in Ghana receiving a lipid-based micronutrient supplement (LNS) throughout pregnancy would have lower salivary cortisol concentrations at late gestation (36 wk) compared with women receiving other nutrient supplements.   Younger women, but not older women, receiving LNS had lower salivary cortisol compared with women receiving the micronutrients alone or iron-folic acid. In some, nutritionally related physical stress and related increase in cortisol may be reduced by improving maternal nutrition.
                                Technical Abstract: Background: High maternal circulating cortisol in pregnancy is associated with miscarriage, preterm birth, and low birth weight. Research in non-pregnant individuals suggests that reducing nutritional deficiencies may lower cortisol concentrations. It is unknown whether nutritional supplementation during pregnancy lowers cortisol. Objective: To determine whether women receiving a lipid-based micronutrient supplement (LNS) throughout pregnancy would have lower salivary cortisol at 36 wk gestation compared with women receiving other nutrient supplements. Methods: We conducted a randomized controlled trial of 1,320 pregnant Ghanaian women = 20 wk gestation assigned to receive daily throughout pregnancy either: 1) 60 mg iron + 400 μg folic acid (IFA); 2) multiple micronutrients (MMN); or 3) 20 g LNS (containing 118 kcal and  micronutrients). Morning salivary cortisol was collected from a subsample at baseline, 28 wk, and 36 wk gestation. Results: 758 women had a cortisol measurement at 28 wk or 36 wk gestation.  Mean (±SE) cortisol at 36 wk gestation was 7.97 ± 0.20 (IFA), 7.84 ± 0.19 (MMN), and 7.77 ± 0.20 nmol/L (LNS), p = 0.67, adjusting for baseline cortisol, time of waking and time between waking and saliva collection. There was an interaction between supplementation group and women’s age (continuous variable, p for interaction=0.03), and when women were dichotomized by the median age, significant differences in mean cortisol among groups were seen in women = 26 y (IFA = 8.23, MMN = 8.20, LNS = 7.44 nmol/L, p=0.03) but not women >26 y (IFA = 7.71, MMN = 7.50, LNS = 8.08, p = 0.13). Conclusions: Younger women, but not older women, receiving LNS had lower salivary cortisol compared with women receiving either IFA or MMN in semi-urban Ghana. Nutritionally related physical stress may be reduced by improving maternal nutrition.


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