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BMJ. 1999 Feb 27;318(7183):570-5.

Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta carotene on mortality related to pregnancy in Nepal. The NNIPS-2 Study Group.

Author information

1
Johns Hopkins School of Hygiene and Public Health, Division of Human Nutrition, Room 2041, 615 N Wolfe Street, Baltimore, MD 21205, USA. kwest@jhsph.edu

Abstract

OBJECTIVE:

To assess the impact on mortality related to pregnancy of supplementing women of reproductive age each week with a recommended dietary allowance of vitamin A, either preformed or as beta carotene.

DESIGN:

Double blind, cluster randomised, placebo controlled field trial.

SETTING:

Rural southeast central plains of Nepal (Sarlahi district).

SUBJECTS:

44 646 married women, of whom 20 119 became pregnant 22 189 times.

INTERVENTION:

270 wards randomised to 3 groups of 90 each for women to receive weekly a single oral supplement of placebo, vitamin A (7000 micrograms retinol equivalents) or beta carotene (42 mg, or 7000 micrograms retinol equivalents) for over 31/2 years.

MAIN OUTCOME MEASURES:

All cause mortality in women during pregnancy up to 12 weeks post partum (pregnancy related mortality) and mortality during pregnancy to 6 weeks postpartum, excluding deaths apparently related to injury (maternal mortality).

RESULTS:

Mortality related to pregnancy in the placebo, vitamin A, and beta carotene groups was 704, 426, and 361 deaths per 100 000 pregnancies, yielding relative risks (95% confidence intervals) of 0. 60 (0.37 to 0.97) and 0.51 (0.30 to 0.86). This represented reductions of 40% (P<0.04) and 49% (P<0.01) among those who received vitamin A and beta carotene. Combined, vitamin A or beta carotene lowered mortality by 44% (0.56 (0.37 to 0.84), P<0.005) and reduced the maternal mortality ratio from 645 to 385 deaths per 100 000 live births, or by 40% (P<0.02). Differences in cause of death could not be reliably distinguished between supplemented and placebo groups.

CONCLUSION:

Supplementation of women with either vitamin A or beta carotene at recommended dietary amounts during childbearing years can lower mortality related to pregnancy in rural, undernourished populations of south Asia.

PMID:
10037634
PMCID:
PMC27760
[Indexed for MEDLINE]
Free PMC Article

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