Researchers working in an impoverished region of Nepal may have found a simple, low-cost way to sharply reduce the risk of death among childbearing women -- weekly vitamin supplements.
Capsules containing vitamin A and beta carotene were effective in reducing maternal death by 40 percent or more, according to scientists at the Johns Hopkins School of Public Health who collaborated with Nepalese health agencies.
Beta carotene, a chemical that the body turns into vitamin A, is normally supplied by vegetables such as carrots and beets.
Dr. Keith West, who supervised a study among 44,000 women in 270 rural villages, said the supplements lowered the death rates among women in the latter stages of pregnancy, during childbirth and in weeks that followed. The supplements appear to have prevented deaths by various causes -- including infection, hemorrhage and obstructed labor.
"When a woman starts to bleed to death, there's only one thing to do: treat her and get good obstetrical care," said West, the lead author of an article appearing in the British Medical Journal. "But if good nutrition can prevent this from happening, through proper diet or supplementation before and during pregnancy, it serves as a very effective way to reduce maternal mortality."
Maternal death rates are 50 to 100 times higher in rural South Asia than in the developed world, in part because of poor diet and the lack of prenatal or obstetric care. Ninety-seven percent of the women in rural Nepal deliver their babies at home and without medical assistance, according to West.
For the study, researchers trained local women to distribute capsules and take records of pregnancies, births and deaths. The death rates were 47 percent lower among women taking beta carotene and 40 percent lower among those taking vitamin A than among women taking placebos.
Groundbreaking research by Dr. Alfred Somer, dean of the Hopkins School of Public Health, has shown that vitamin A supplements prevent deaths from measles, diarrheal disease and other infections.
The Nepal study was the first to demonstrate the benefits among pregnant women. It was funded by the U.S. Agency for International Development.
Duff Gillespie, an official with the agency's population, health and nutrition program, called the finding "one of the most important that relates to maternal health in the last decade."
"What makes it so exciting besides the dramatic decrease in mortality is that it offers an intervention that will allow us to cover very large populations of women in a cost-effective manner," he said. "The programs we have now are quite expensive and difficult to reach people outside urban areas."
Those programs, he said, bring emergency obstetric care to women suffering the complications of pregnancy and unsafe abortions. Before funding a wide-scale program of vitamin A supplementation, the agency wants to see if the results of the Nepal experiment can be duplicated elsewhere.
The supplements cost only a penny or two apiece.
Pub Date: 2/27/99