Peripartum Outcomes After Combined Myo-inositol, Probiotics, Micronutrient Supplementation from Preconception: NiPPeR RCT.

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.