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Changes in the concentrations of biochemical indicators of diet and nutritional status of pregnant women across pregnancy trimesters in Trujillo, Peru, 2004–2005

D Kevin Horton2, Olorunfemi Adetona1, Manuel Aguilar-Villalobos3, Brandon E Cassidy1, Christine M Pfeiffer4, Rosemary L Schleicher4, Kathleen L Caldwell4, Larry L Needham4, Stephen L Rathbun5, John E Vena5 and Luke P Naeher1*

Author Affiliations

1 The University of Georgia, College of Public Health, 150 Environmental Health Science Bldg, Athens, Georgia 30602-2102, USA

2 Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA

3 Asociacion del Aire Ambiental, Lima, Peru

4 National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, 30341, USA

5 Department of Biostatistics and Epidemiology, The University of Georgia, College of Public Health, Paul D. Coverdell Center for Biomedical and Health Sciences, Athens, Georgia, 30602-7396, USA

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Nutrition Journal 2013, 12:80  doi:10.1186/1475-2891-12-80

Published: 11 June 2013



In developing countries, deficiencies in essential micronutrients are common, particularly in pregnant women. Although, biochemical indicators of diet and nutrition are useful to assess nutritional status, few studies have examined such indicators throughout pregnancy in women in developing countries.


The primary objective of this study was to assess the nutritional status of 78 Peruvian women throughout pregnancy for 16 different nutritional indicators including fat-soluble vitamins and carotenoids, iron-status indicators, and selenium. Venous blood samples from which serum was prepared were collected during trimesters one (n = 78), two (n = 65), three (n = 62), and at term via the umbilical cord (n = 52). Questionnaires were completed to determine the demographic characteristics of subjects. Linear mixed effects models were used to study the associations between each maternal indicator and the demographic characteristics.


None of the women were vitamin A and E deficient at any stage of pregnancy and only 1/62 women (1.6%) was selenium deficient during the third trimester. However, 6.4%, 44% and 64% of women had ferritin levels indicative of iron deficiency during the first, second and third trimester, respectively. Statistically significant changes (p ≤ 0.05) throughout pregnancy were noted for 15/16 nutritional indicators for this Peruvian cohort, with little-to-no association with demographic characteristics. Three carotenoids (beta-carotene, beta-cryptoxanthin and trans-lycopene) were significantly associated with education status, while trans-lycopene was associated with age and beta-cryptoxanthin with SES (p < 0.05). Concentrations of retinol, tocopherol, beta-cryptoxanthin, lutein + zeaxanthin and selenium were lower in cord serum compared with maternal serum (p < 0.05). Conversely, levels of iron status indicators (ferritin, transferrin saturation and iron) were higher in cord serum (p < 0.05).


The increasing prevalence of iron deficiency throughout pregnancy in these Peruvian women was expected. It was surprising though not to find deficiencies in other nutrients. The results highlight the importance of continual monitoring of women throughout pregnancy for iron deficiency which could be caused by increasing fetal needs and/or inadequate iron intake as pregnancy progresses.

Micronutrients; Pregnant women; Trimester; Serum; Cord blood; Peru