Publisher's Synopsis
Micronutrient malnutrition and DDT exposure remain prevalent in the displaced population on the north-western border of Thailand. Overall aims of this thesis was to examine effects of antenatal supplementation, introduced micronutrient enriched flour and DDT exposure on biochemical status during pregnancy and post partum and on pregnancy outcomes in Maela refugee camp. Between 2004 and 2007, 2 cross-sectional studies where iron, thiamine, micronutrients and DDT residues were measured have enrolled more than 1,000 refugee camp women and prospectively followed their pregnancies. Sampling in the 3 month post partum period on more than 600 women for blood and breast milk has allowed comparison of the pregnancy and post-partum results. These studies have confirmed that iron status and serum levels of retinol, zinc, and beta-carotene decreased whereas alpha-tocopherol, copper and DDT increased concurrently with serum cholesterol and triglycerides during pregnancy. Breast milk concentrations of iron, thiamine, DDT and micronutrients except zinc were positively correlated to their respective blood levels in post partum. Provision of thiamine improved whole blood indices during pregnancy and post partum reflecting good compliance to the supplement being able to compensate thiamine deficient diet in the camp. The high prevalence of iron and zinc deficiency suggests inadequate dietary sources and a low acceptance to iron supplements. The introduction of micronutrient enriched flour in the camp showed a sustainable positive effect on zinc and iron status in pregnant and lactating women. Four to six years after the last DDT residual house spraying its residues were still highly prevalent and found in the blood of all pregnant and post partum women. Multivariate regression analysis on pregnancy outcomes controlled for significant covariates revealed that blood levels of alpha-tocopherol were positively whereas high iron status, highest hematocrit levels and DDT residues during pregnancy were found to be negatively associated with newborn's weight. Whole blood thiamine had a significant positive impact on infant's length, and serum beta-carotene and alpha-tocopherol were positively while DDT residues were negatively associated with newborn's head circumference.
