Trial of Pre-Pregnancy Supplements

Globally, more than half a million women die from pregnancy or childbirth-related complications, most of them in developing countries. The global community committed to reducing the maternal mortality ratio by three quarters between 1990 and 2015 (MDG5). Women die from a range of complications in pregnancy, childbirth or the postpartum period. 80% of maternal deaths are due to severe bleeding (mostly bleeding postpartum), infections, hypertensive disorders in pregnancy and obstructed labor. Additionally, low birth weight and neonatal mortality are common problems in developing countries. The benefit of periconceptual folate on preventing congenital anomalies has been established in randomized trials; however, the role of other nutrients needs to be examined further. Anemia is strongly associated with adverse perinatal outcomes including maternal mortality and low birthweight.

Inclusion criteria

• Girls aged > =15 years and <= 29 years
• Have not missed a menstrual period during recruitment (no amenorrhea)
• Has not been pregnant or given birth within the last 6 months
• Intend to stay in the study area for at least 6 months after enrollment
• Have provided written informed consent

Exclusion criteria

• Amenorrhea or confirmed pregnancy at screening or enrollment.
• Has given birth within 6 months
• Already taking long-term vitamin supplementation.
• Any severe illness requiring hospitalization at screening or enrollment (women who have been deemed to have recovered will be eligible once they return home).