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.
Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Baltimore, MD 21205, USA. pchristi@jhsph.edu
Parul
P
Christian
Subarna K
SK
Khatry
Steven C
SC
LeClerq
Sanu Maiya
SM
Dali
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