Impact of lipid-based nutritional supplementation on cardio metabolic risk factors in underweight pre-eclamptic primigravidas: A randomized controlled trial

Pre-eclampsia is a major cause of maternal and fetal complications in Pakistan, particularly among primigravidas, where poor nutritional status further increases risk. Emerging evidence suggests that underweight pre-eclamptic women may have distinct cardio metabolic adaptations, higher susceptibility to adverse pregnancy outcomes, and increased long-term cardiovascular risk. Lipid-based nutritional supplementation provides essential energy and micronutrients and may help improve maternal metabolic status and pregnancy outcomes in pre-eclamptic women. To determine the effect of lipid-based micronutrient supplementation on lipid profile, Insulin resistance and blood pressure in underweight pre-eclamptic primigravidas at delivery, six months and twelve months postnatal. An open label randomized controlled trial was undertaken to explore the effects of supplementation on the cardio metabolic risk factors in the tertiary care hospitals of KPK, Pakistan. A total of sixty primigravidas were randomized equally into two groups; Group A: control group and Group B; supplement group. At delivery, 26 and 28 participants in Groups A and B, respectively and at 6 and 12 months, 23 and 25 participants were analyzed. In addition to their prescribed antenatal treatment of preeclampsia and IFA (60 mg iron and 400ug FA) daily, the Group B also received one 75gm of lipid-based nutrition supplement (LNS) sachet (MAAMTA) daily from their first antenatal visit after enrollment till one year postnatally. The IFA was stopped 6 weeks after delivery. There was no discernable difference among the baseline cardio-metabolic parameters like insulin, glucose & HOMA-IR of two groups at delivery. Also, the difference in BP (systolic) was non-significant while BP (diastolic) was decreased in group B ( p = 0.025). Similarly, at delivery the significant declined were observed in triglyceride (TGs) levels with LNS supplementation ( p = 0.007), Total cholesterol ( p = 0.01), LDL ( p = 0.02) and VLDL ( p = 0.005). At 6 months follow-up systolic ( p = 0.002) and diastolic blood pressure ( p = 0.013) were decreased significantly in group B & also a significant decline in TGs ( p = 0.05), cholesterol ( p < 0.001), LDL ( p < 0.001) and VLDL levels ( p = 0.04) observed in group B. A significant decrease was seen in cholesterol levels ( p < 0.001) and LDL levels ( p < 0.001) in group B at 12 months postnatal. This study concludes that long term LNS supplementation can cause a decrease in cholesterol, TGs, LDL and VLDL in underweight pre-eclamptic primigravidas and thus may contribute to a more favorable cardio metabolic risk profile. ClinicalTrials.gov Identifier: ISRCTN 15485068. Registered on April 21, 2018: https://doi.org/10.1186/ISRCTN15485068 .