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Int J Gynaecol Obstet. 2009 Jul;106(1):3-7. doi: 10.1016/j.ijgo.2009.03.040. Epub 2009 Apr 15.

Effects of prenatal micronutrient supplementation on complications of labor and delivery and puerperal morbidity in rural Nepal.

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  • 1Department of International Health, Center for Human Nutrition, Bloomberg School of Public Health, Baltimore, MD 21205, USA.



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.


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.


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).


Prenatal folic acid-iron supplementation reduced the risk of obstetric complications in this South Asian setting.

[PubMed - indexed for MEDLINE]
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