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Many women throughout the world survive on diets of poor quality, and deficiencies in vitamins, minerals and trace elements are common in many developing countries. The effect of this poor nutritional status is a particular concern when the additional demands of pregnancy and lactation expose both the mother and her newborn infant to increased risk of adverse consequence.1 In response to this, the international community proposed about 10 years ago that a multiple micronutrient supplement be developed for widespread use as a dietary supplement during pregnancy.2 Since that time a number of large-scale randomised controlled trials have been carried out in which maternal supplementation with multiple micronutrients during pregnancy has been assessed for an effect on maternal mortality and morbidity, birth weight and later growth, morbidity and survival.
There have been two large trials of multiple micronutrients in rural Nepal, and each noted previously a concern that the supplementation of mothers with multiple micronutrients might increase neonatal mortality.3–5 Further results from one of these trials is published in this issue of Archives of Disease in Childhood6, and the authors report on the effect supplementation during pregnancy had on early neonatal morbidity. The intervention was carried out in women living in rural Nepal, and there were five arms to the study: vitamin A as the control; vitamin A plus folic acid; folic acid plus iron; folic acid plus iron plus zinc; a multiple micronutrient containing vitamin A, folic acid, iron, zinc and 11 other nutrients. The women received the supplement from early pregnancy until 3 months post-partum. The present paper reports the effect of antenatal supplementation on symptoms of neonatal morbidity in the first 10 days of life or at 6 weeks of age. There was an increase of 60% in symptoms of birth …