(OR03-01-26) The Impact of Prenatal Nutrition Interventions Including Balanced Energy Protein Supplementation on Maternal and Infant Metabolomic Profiles in Rural Amhara, Ethiopia

Objectives: Determine the impact of a maternal enhanced nutrition package (ENP) during pregnancy on maternal and infant metabolomics.

Methods: In a cluster randomized clinical effectiveness trial in Amhara, Ethiopia, we randomized 12 health centers to provide ENP (iodized salt, iron folic acid, and for women with mid-upper arm circumference < 23cm, a micronutrient fortified balanced-energy protein [BEP]) or routine care (iron folic acid only). We enrolled pregnant women at < 24 weeks gestation and collected maternal whole blood at enrollment and a 3rd-trimester follow-up visit via volumetric absorptive microsampling, and from their infants, dried blood spots (DBS) at birth and 1 month postnatally. We conducted untargeted metabolomics analysis via rapid liquid chromatography-mass spectroscopy. Using logistic regression models, we identified the metabolites that differed between women on ENP vs. non-ENP in trimester 3, post-intervention and at infant birth or postnatally. Non-singleton births were excluded from these analyses.

Results: From 277 pregnant women, we collected 448 samples (63 in trimester 1, 212 in trimester 2, 173 in trimester 3) and from 142 infants, 153 samples (122 at birth, 31 postnatal) and conducted complete case analysis on the post-intervention trimester 3 and birth/postnatal samples. From 38,668 metabolites found in women, 487 were identified and matched to known metabolites in trimester 3 of which 1 - n-acetylglutamine - was significantly negatively associated with ENP and 3 - (Iso)Valerycarnitine, PFC_C7H2F12O2, and guanidinosuccinic acid - were significantly positively associated with ENP compared to routine care (FDR < 0.1). From 31,131 metabolites found in infants, 544 were identified, and 32 overlapped with maternal metabolites. Of identified infant metabolites, 44 were associated with ENP at birth, including 22 triacylglycerols, polyunsaturated fatty acids, essential fatty acids, and caffeine, among others. Compared to women not taking BEP, 11 unidentified maternal metabolites were associated with BEP consumption. There were no significant results for BEP among infants.

Conclusions: The identified maternal and infant metabolites indicate the nutrition intervention may play a role in mediating renal and metabolic stress during pregnancy and within infants at birth.

Funding Sources: Bill & Melinda Gates Foundation