Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal.
OBJECTIVE
To examine the effect of supplemental prenatal folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrients on maternal morbidity in rural Nepal.


METHODS
A cluster-randomized double-masked controlled trial of pregnant women who received daily supplements from early pregnancy through 3 months post partum as per the treatment allocation. Women were interviewed at birth about labor and delivery complications and for 9 days post partum to obtain 24-hour histories of morbidity.


RESULTS
A total of 3986 (97.3%) women completed an interview regarding labor and delivery; morbidity history was available for 3564 (87.0%) women. Folic acid-iron reduced the risk of postpartum hemorrhage (relative risk [RR] 0.59; 95% confidence interval [CI] 0.35-0.98). Risk of dysfunctional labor increased with multiple micronutrient supplementation (RR 1.28; 95% CI, 1.01-1.60), although preterm premature rupture of membrane decreased (RR 0.40; 95% CI, 0.21-0.79). Puerperal sepsis was lower in those receiving folic acid-iron, folic acid-iron-zinc, and multiple micronutrients compared with controls (P<0.05).


CONCLUSIONS
Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting.
Christian
Parul
P
Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Baltimore, MD 21205, USA. pchristi@jhsph.edu
Khatry
Subarna K
SK
LeClerq
Steven C
SC
Dali
Sanu Maiya
SM
D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000517:prevention & control; D005492:Folic Acid / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007501:Iron / Q000008:administration & dosage; D018977:Micronutrients / Q000008:administration & dosage; D009390:Nepal / Q000453:epidemiology; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D006473:Postpartum Hemorrhage / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods; D011644:Puerperal Disorders / Q000517:prevention & control*; D012424:Rural Population; D018805:Sepsis / Q000517:prevention & control; D014803:Vitamin B Complex / Q000008:administration & dosage; D015032:Zinc / Q000008:administration & dosage
D018977:Micronutrients; D014803:Vitamin B Complex; D005492:Folic Acid; D007501:Iron; D015032:Zinc