(P12-01-26) Evaluation of Trimester-Specific Usual Micronutrient Inadequacy Among Pregnant Women in Ethiopia and Kenya Using Multivariate Usual Intake Modeling

Objectives: Limited information exists on trimester-specific usual nutrient intakes and inadequacy among pregnant women in Kenya and Ethiopia. We aimed to estimate usual nutrient intakes and prevalence of inadequacy by trimester using data from the ARM-CHAMPS pregnancy cohort.

Methods: A longitudinal dietary study was conducted in Ethiopia and Kenya among 400 pregnant women ( < 20 weeks gestation; n=200 per site). Participants completed one 24-hour dietary recall per trimester (up to three during pregnancy), with replicate recalls in a random subset to estimate within-person variation. Trimester-specific usual nutrient intakes from diet and supplements were estimated using the National Cancer Institute multivariate Markov Chain Monte Carlo method. Nutrient intakes were energy-adjusted for Ethiopia. Nutrient inadequacy was defined as percent below the estimated average requirement. Misreporting was assessed by comparing reported energy intake with predicted total energy expenditure using pregnancy-specific energy corrections.

Results: Estimated usual energy intake was 1,792 kcal/day in Ethiopia and 2,373 kcal/day in Kenya. Micronutrient supplement use was 79% in Ethiopia and 71% in Kenya. After energy adjustment, iron inadequacy was low in Ethiopia ( < 10%) but remained higher in Kenya, declining from 46.2% (T1) to 24.3% (T3). Folate inadequacy decreased in Ethiopia (30.6% to 17.8%) with a similar decline in Kenya (5.3% to 0.5%). In Ethiopia, inadequacy of vitamin A, niacin, and riboflavin remained high ( >60%). In Kenya, vitamin A inadequacy was also high (76.9% in T3), while niacin and riboflavin remained < 20%. Zinc inadequacy in T3 was 60.3% in Kenya versus 19.7% in Ethiopia. Calcium inadequacy was nearly universal in Ethiopia (~99%) but < 11% in Kenya.

Conclusions: Micronutrient inadequacies are common among pregnant women in Ethiopia and Kenya across trimesters, indicating the need for targeted strategies beyond standard iron-folic acid supplements.

Funding Sources: Gates Foundation