(P27-010-25) Multiple Micronutrient Versus Iron and Folic Acid Supplementation on Maternal Morbidity in Late Pregnancy: The JiVitA-3 Cluster-Randomized Trial

Objectives: The JiVitA-3 cluster-randomized trial, comparing antenatal multiple micronutrient supplements (MMS) to iron and folic acid (IFA), revealed a lower risk of adverse birth outcomes. Here, we aim to determine the effects of MMS versus IFA supplementation on the prevalence and relative odds (ORs) of morbidity symptoms among rural Bangladeshi women in late pregnancy.

Methods: Thirty-day histories of 33 morbidity symptoms were assessed both in early pregnancy prior to supplementation (baseline), and early in the 3^rd trimester, among 11,681 and 11,252 MMS and IFA recipients, respectively. Prevalence (per 1,000 women) and ORs for each morbidity symptom were analyzed by supplement assignment using generalized estimating equations to account for a clustered design effect. Certainty of estimates was evaluated by 99% confidence intervals (CI) to account for multiple comparisons.

Results: Morbidity histories were virtually identical prior to supplementation. Later in pregnancy (median: 32; IQR 32-33 weeks gestation), ~ 50% in both groups reported any days of one or more symptoms in the previous month. ORs among MMS versus IFA recipients were < 1 for 26 of 33 symptoms; 95% CI for symptoms with ORs >1 included unity. The most prevalent symptoms (per 1,000 women) in IFA recipients were stress-related incontinence (355), lower abdominal pain (325), low-grade fever (281), nausea (237), productive cough (235), poor appetite (192), vaginal itching (153), and vomiting (146). Among these, ORs favoring MMS with associated 99% CI < 1 were observed for nausea [0.86 (0.77-0.95)], productive cough [0.89 (0.80-0.98)], poor appetite [0.88 (0.78-0.99)], vaginal itching [0.88 (0.78-0.99)], and vomiting [0.82 (0.74-0.92)].

Conclusions: During a trial in Bangladesh where antenatal MMS versus IFA reduced adverse birth outcomes, fewer MMS recipients also reported morbidity symptoms, suggesting micronutrient supplementation may result in improved maternal health during pregnancy.

Funding Sources: Cancer Prevention Fellowship Program, National Cancer Institute, Division of Cancer Prevention; The Bill and Melinda Gates Foundation; Sight and Life Global Nutrition Research Institute; DSM; Beximco Pharmaceuticals