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

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Abstract
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).Conclusion: Prenatal folic acid–iron supplementation reduced the risk of obstetric complications in this South Asian setting.