Association between prenatal provision of lipid‐based nutrient supplements and cesarean delivery: Findings from a randomized controlled trial in Malawi

  • Meeri Salenius (Tampere University) (Creator)
  • Juha Pyykkö (Creator)
  • Ulla Ashorn (Creator)
  • Kathryn G Dewey (Creator)
  • Austrida Gondwe (Creator)
  • Ulla Harjunmaa (Creator)
  • Kenneth Maleta (Creator)
  • Minyanga Nkhoma (Creator)
  • Stephen A Vosti (Creator)
  • Per Ashorn (Creator)
  • Laura Adubra (Creator)



Data set for a published manuscript on Maternal & Child Nutrition. ABSTRACT: In populations with a high prevalence of childhood and adolescent undernutrition, supplementation during pregnancy aiming at improving maternal nutritional status and preventing fetal growth restriction might theoretically lead to cephalopelvic disproportion and delivery complications. We investigated whether the prenatal provision of small-quantity lipid-based nutrient supplements (SQ-LNS) was associated with an increased risk of caesarean section (CS) or other delivery complications. Pregnant Malawian women were randomised to receive daily i) iron–folic acid (IFA) capsule (control), ii) multiple micronutrient (MMN) capsule of 18 micronutrients (second control), or iii) SQ-LNS with similar micronutrients as MMN, plus four minerals and macronutrients contributing 118 kcal. We analysed the associations of SQ-LNS, CS, and other delivery complications using log-binomial regressions. Among 1391 women enrolled, 1255 had delivery information available. The incidence of CS and delivery complications was 6.3% and 8.2%, respectively. The incidence of CS was 4.0%, 6.0%, and 8.9% (p = 0.017) in the IFA, MMN, and LNS groups, respectively. Compared to the IFA group, the relative risk (95% confidence interval) of CS was 2.2 (1.3–3.8) (p = 0.006) in the LNS group and 1.5 (0.8–2.7) (p = 0.200) in the MMN group. We found no significant differences for other delivery complications. Provision of SQ-LNS to pregnant women may have increased the incidence of CS. The baseline rate was, however, lower than recommended. It is unclear if the higher CS incidence in the SQ-LNS group resulted from increased obstetric needs or more active health seeking and a better supply of services. Trial registered at, NCT01239693.
Date made available31 Jul 2022

Field of science, Statistics Finland

  • 3142 Public health care science, environmental and occupational health
  • 3123 Gynaecology and paediatrics

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