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The impact of maternal micronutrient supplementation on early neonatal morbidity in rural Nepal: a randomized, controlled, community trial.
  1. Parul S Christian (pchristi{at}
  1. Johns Hopkins University, United States
    1. Gary L Darmstadt (gdarmsta{at}
    1. Johns Hopkins University, United States
      1. Lee Wu (lwu{at}
      1. Johns Hopkins University, United States
        1. Subarna K Khatry (skk{at}
        1. Nepal Nutrition Intervention Project, Nepal
          1. Steven C LeClerq (sleclerq{at}
          1. Johns Hopkins University Bloomberg School of Public Health, United States
            1. Joanne Katz (jkatz{at}
            1. Johns Hopkins University, United States
              1. Keith P West, Jr (kwest{at}
              1. School of Public Health, Johns Hopkins University, United States
                1. Ramesh K Adhikari
                1. Institute of Medicine, Tribhuvan University, Nepal


                  Objective: Micronutrient deficiencies during pregnancy may be linked to poor newborn health and host defenses against infection. We assessed newborn morbidity to determine the impact of four combinations of antenatal micronutrient supplements.

                  Design: Cluster-randomized, double-masked, controlled trial.

                  Setting: Rural community in Nepal.

                  Interventions: Women received daily supplements from early pregnancy through 3 months postpartum of vitamin A alone (control) or vitamin A with folic acid, folic acid + iron, folic acid + iron + zinc or a multiple micronutrient supplement containing these and 11 other nutrients.

                  Main outcome measures: Infants were visited in their home at birth (n=3927) and for each of 9 days thereafter to elicit a 24-h history of 9 infant morbidity symptoms, measure infant respiratory rate and axial temperature, and assess the infant for chest indrawing. At 6 weeks of age, infants were visited again in their homes to elicit a 30-day and 7-day history of 10 morbidity symptoms using parental recall.

                  Results: Maternal micronutrient supplementation had no impact on 10-d morbidity or morbidity 30-d and 7-d morbidity assessed at 6 wk of age; all relative risks were close to 1. Symptoms of birth asphyxia increased by about 60% (p<0.05) in infants of women who received the multiple micronutrient supplement compared to the control. Symptoms of combinations of sepsis, preterm, and birth asphyxia were associated with 8-14-fold increased odds of 6-mo infant mortality.

                  Conclusions: None of the combinations of antenatal micronutrient supplements tested improved symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age. Further research is needed to elucidate the association and mechanism of increased risk of birth asphyxia following maternal multiple micronutrient supplementation.

                  • Nepal
                  • micronutrients
                  • mortality
                  • neonatal morbidity
                  • pregnancy

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                    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health