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Multiple infections, nutrient deficiencies and inflammation (MINDI) occur in indigenous communities, but their associations with perinatal outcomes have not been described.


To assess maternal and cord blood micronutrient and inflammation status in peripartum mothers from the Ngäbe-Buglé comarca in Panama, and their associations with placental and infant outcomes.


In 34 mother-newborn dyads, placental weight and diameter were measured, and maternal and cord blood were processed for complete cell counts, serum C-reactive protein, ferritin, serum transferrin receptor (sTfR), vitamins A and D. Blood volumes were calculated using Nadler’s formula.


Mothers had low plasma volume (<2.8 L, 96%), vitamin A (52.9%), vitamin D (29.4%), iron (58.8%) and hemoglobin (23.5%), but high hematocrit (>40%, 17.6%) and inflammation (C-reactive protein >8.1 mg/L, 85.3%). Birthweights were normal, but the low placental weight (35.3%), low head circumference Z-scores (17.6%), and low cord hemoglobin (5.9%), iron (79.4%), vitamin A (14.7%) and vitamin D (82.3%) were identified. Maternal and cord vitamin D were highly correlated. Higher maternal plasma volume was associated with heavier placentae (β= 0.57), and higher cord D (β= 0.43) and eosinophils (β= 0.43) with larger placentae. Hemoconcentration (higher cord hematocrit) was associated with lower newborn weight (β= -0.48) and head circumference (β= -0.56). Inflammation [higher maternal neutrophils (β= -0.50), and cord platelets (β= -0.32)] was associated with the lower newborn length and head circumference.


Maternal-newborn hemoconcentration, subclinical inflammation and multiple nutrient deficiencies, particularly neonatal vitamin D deficiency, were identified as potential targets for interventions to improve pregnancy outcomes in vulnerable communities.

Doris González-Fernández, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada


Yining An, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada


Hugues Plourde, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada


Emérita del Carmen Pons, Ministerio de Salud, Departamento de Salud Nutricional, Ciudad de Panamá, Panamá


Odalis Teresa Sinisterra, Ministerio de Salud, Región de Salud “Panamá Norte”, Ciudad de Panamá, Panamá


Delfina Rueda, Ministerio de Salud, Región de Salud “Comarca Ngäbe-Buglé” San Félix, provincia de Chiriquí, Panamá


Enrique Murillo, Universidad de Panamá, Departamento de Bioquímica, Ciudad de Panamá, Panamá


Marilyn E Scott, McGill University (Macdonald Campus), Institute of Parasitology, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada


Kristine G Koski, McGill University (Macdonald Campus), School of Human Nutrition, Faculty of Agricultural and Environmental Sciences. Ste-Anne-de-Bellevue, Canada


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Received 2020-10-26
Accepted 2021-05-09
Published 2024-04-18