Multivitamin Supplementation and Maternal-fetal Disproportion among HIV-negative Women in Tanzania.
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Date
2015
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Abstract
Objectives: We evaluated the effect of multivitamin supplementation on delivery complications
that can arise from maternal-fetal disproportion.
Methods: We used data from a double-blind, randomized controlled trial among 8286 HIVnegative
pregnant women in Dar es Salaam, Tanzania. From August 2001 to July 2004, eligible
women were randomly assigned to receive daily multivitamins or placebo between 12 and 27
gestational weeks. All women received prenatal iron and folic acid supplementation.
Results: Women in the multivitamin group experienced a 50% higher risk of prolonged labor
requiring cesarean section or forceps delivery compared to the women in the placebo group
(relative risk 1.52, 95% CI: 1.12-2.07; p=0.007). There was also a non-significant increase in the
incidence of vaginal tear (RR-1.11 95% CI 0.99-1.24, p=0.06 ) in the multivitamin group. We found
no difference in the risks of need for newborn resuscitation, low APGAR score and signs of fetal
distress among the infants born to women receiving multivitamin and placebo. Increases in birth
weight and head circumference of the newborn mediated 63% (95% CI- 33- 85%; P <0.0001) of
the effect of the multivitamins on prolonged labor. In addition, maternal short stature (height <150
cm) and obesity (BMI≥30) were independently associated with significantly increased risks of
prolonged labor. Conclusions: Multivitamin supplementation increased the risk of prolonged labor among HIVnegative
pregnant women in Dar es Salaam. However, this risk did not result in any increased
adverse fetal outcome. Routine multivitamin supplementation is best integrated in programs that
provide emergency obstetric care for women at high risk for prolonged labor.
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Sania Ayesha, Spiegelman Donna, Rich-Edwards Janet, Hertzmark Ellen, Kisenge Rodrick, Msamanga Gernard, Urassa Willy, Fawzi Wafaie. Multivitamin Supplementation and Maternal-fetal Disproportion among HIV-negative Women in Tanzania. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 1001-1002.