Peripartum outcomes after combined myo-inositol, probiotics, and micronutrient supplementation from preconception: the NiPPeR randomized controlled trial

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Peripartum outcomes after combined myo-inositol, probiotics, and micronutrient supplementation from preconception: the NiPPeR randomized controlled trial
Title:
Peripartum outcomes after combined myo-inositol, probiotics, and micronutrient supplementation from preconception: the NiPPeR randomized controlled trial
Journal Title:
American Journal of Obstetrics & Gynecology MFM
Publication Date:
12 August 2022
Citation:
Chan, S.-Y., Yong, H. E. J., Chang, H. F., Barton, S. J., Galani, S., Zhang, H., Wong, J.-T., Ong, J., Ebreo, M., El-Heis, S., Kenealy, T., Nield, H., Baker, P. N., Chong, Y. S., Cutfield, W. S., & Godfrey, K. M. (2022). Peripartum outcomes after combined myo-inositol, probiotics, and micronutrient supplementation from preconception: the NiPPeR randomized controlled trial. American Journal of Obstetrics & Gynecology MFM, 4(6), 100714. https://doi.org/10.1016/j.ajogmf.2022.100714
Abstract:
Background: Evidence that nutritional supplementation before and during pregnancy improves peripartum outcomes is sparse. In the Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health (NiPPeR) trial we previously reported that a combined myo-inositol, probiotics and micronutrient supplement starting preconception showed no difference in the primary outcome of gestational glycemia, but did reduce the risk of preterm delivery, preterm pre-labor rupture of membranes and major postpartum hemorrhage. Objective: To examine the hypothesis that a reduction in major postpartum hemorrhage following a combined nutritional (myo-inositol, probiotics and micronutrient) intervention is linked with promotion of labor progress and reduced operative delivery. Study Design: This double-blind randomized controlled trial recruited from the community 1729 UK, Singapore and New Zealand women aged 18-38 years planning conception between 2015-2017. Here, the effects of the nutritional intervention compared with a standard micronutrient supplement (control), taken preconception and throughout pregnancy, on the secondary outcomes of peripartum events were examined using multinomial, Poisson and linear regression adjusting for site, ethnicity and important covariates. Results: Of the women who conceived and progressed beyond 24 weeks’ gestation with a singleton pregnancy (n=589), 583 (99%) provided peripartum data. Between women in the intervention (n=293) and control (n=290) groups, there were no differences in rates of labor induction, oxytocin augmentation during labor, instrumental delivery, perineal trauma and intrapartum cesarean section. While duration of the first stage of labor was similar, the second-stage duration was 20% shorter in the intervention group compared with controls [adjusted mean difference -12.0 (95%CI -22.2, -1.2) minutes, p=0.029], accompanied by a reduction in operative delivery for delayed second-stage progress [adjusted risk ratio 0.61 (0.48, 0.95); p=0.022]. Estimated blood loss was 10% less with intervention compared with control [adjusted mean difference -35.0 (-70.0, -3.5) ml, p=0.047], consistent with previous findings of reduced postpartum hemorrhage. Conclusion: Supplementation with a specific combination of myo-inositol, probiotics and micronutrients starting preconception and continued in pregnancy reduced both the duration of the second stage of labor and the risk of operative delivery for delay in the second stage, and reduced blood loss at delivery.
License type:
Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Funding Info:
This research / project is supported by the National Medical Research Council - Translational and Clinical Research (TCR) Flagship Programme
Grant Reference no. : NMRC/TCR/012-NUHS/2014

This research / project is supported by the National University of Singapore / Agency of Science, Technology and Research - Growth, Development and Metabolism program of the Singapore Institute for Clinical Sciences
Grant Reference no. : H17/01/a0/005

This research / project is supported by the National Institute for Health Research - NIHR Senior Investigator
Grant Reference no. : NF-SI-0515-10042

This research / project is supported by the National Medical Research Council - Clinician Scientist Award
Grant Reference no. : NMRC/CSA-INV/0010/2016

This research / project is supported by the National Medical Research Council - Clinician Scientist Award
Grant Reference no. : MOH-CSAINV19nov-0002

Public-good funding for this investigator-led study was received from the UK Medical Research Council (as part of a Medical Research Council [MRC] award to the MRC Lifecourse Epidemiology Unit [MC_UU_12011/4]) and Gravida: National Centre for Growth and Development (Centre of Research Excellence). Funding for provision of the intervention and control drinks and covering aspects of the fieldwork for the study was provided by Societe des Produits Nestle S.A under a Research Agreement with the University of Southampton, Auckland UniServices Ltd, NIHR Southampton 1000 DaysPlus Global Nutrition Research Group (17/63/154), and NIHR Southampton Biomedical Research Centre [IS-BRC-1215-20004]), British Heart Foundation (RG/15/17/3174), and the European Union (Erasmus+ program ImpENSA [598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP]).
Description:
ISSN:
2589-9333
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