Pregnant women need vitamins and minerals to stay healthy and help their babies develop properly. Scientists in Nepal are testing whether pregnant women will actually take their vitamins if they’re given a larger mix of nutrients instead of just iron and folic acid. They’re also testing whether the way vitamins are packaged (in blister packs or bottles) makes a difference in whether women remember to take them. This study will help the government decide if they should give all pregnant women these extra vitamins. The research involves 2,640 pregnant women across 120 health clinics in one region of Nepal.

The Quick Take

  • What they studied: Whether pregnant women will consistently take a multi-vitamin supplement (containing many nutrients) compared to the standard iron and folic acid supplement, and whether the type of packaging affects how often women take their vitamins.
  • Who participated: 2,640 pregnant women in Nepal, divided into three groups: one group received iron and folic acid in blister packs, another received multiple vitamins in blister packs, and a third received multiple vitamins in bottles.
  • Key finding: This is a study protocol (a plan for research), not yet completed results. The researchers will measure success by whether women take at least 180 supplements during their pregnancy, with a goal that the multi-vitamin groups perform almost as well as the standard supplement group.
  • What it means for you: If you’re pregnant or planning pregnancy in Nepal or similar countries, this research may eventually show whether taking more complete vitamins is practical and helpful. Results aren’t available yet, but this study will provide important information for health programs.

The Research Details

This is a carefully designed research study called a cluster-randomized controlled trial. Instead of randomly assigning individual women, the researchers randomly assigned entire health clinics to give one of three types of supplements. This approach is practical because it’s easier to train clinic staff to give one type of supplement consistently. The study takes place across 120 health clinics in Lumbini Province in Nepal, one of the country’s seven provinces. Women are followed throughout their pregnancy and after their baby is born to see how well they stick with taking their supplements.

The researchers will track adherence (whether women actually take their vitamins) by counting the remaining tablets at clinic visits. They’re testing whether the multi-vitamin supplement works just as well as the standard iron and folic acid supplement in terms of how often women take it. They’re also comparing whether blister packs (individual compartments) versus bottles make a difference in whether women remember to take their vitamins.

This is a non-inferiority study, which means the researchers are asking: ‘Does the new supplement work at least almost as well as the old one?’ rather than ‘Is it better?’ This is a practical question for governments deciding whether to switch all pregnant women to the new supplement.

Knowing whether women will actually take their vitamins is just as important as knowing whether the vitamins are healthy. A supplement only works if women remember to take it consistently. This study design is important because it tests real-world conditions in actual health clinics, not in a laboratory. The researchers also looked at whether packaging style matters, which is a practical detail that could affect whether women stick with their vitamins.

This study has several strengths: it involves a large number of women (2,640), uses a randomized design to reduce bias, and follows women throughout pregnancy and after birth. The study is registered with ClinicalTrials.gov, which means the researchers committed to their plan before starting. However, this is a protocol paper (the research plan), not the actual results, so we cannot yet evaluate whether the study was successfully completed or what the findings show.

What the Results Show

This paper describes the research plan, not the actual results. The study is currently being conducted in Nepal. The primary goal is to measure how many of the 180 recommended supplements pregnant women actually take during their pregnancy. The researchers will consider the multi-vitamin supplement successful if women take at least 87% of their supplements (a 13% non-inferiority margin), meaning it performs almost as well as the standard iron and folic acid supplement.

The study will compare three groups: women receiving iron and folic acid in blister packs (the current standard), women receiving multiple vitamins in blister packs, and women receiving multiple vitamins in bottles. By comparing these groups, researchers can answer two important questions: Does the multi-vitamin supplement work as well as the standard supplement in terms of how often women take it? And does the type of packaging affect whether women remember to take their vitamins?

Beyond the main question about adherence, the researchers will also look at whether women actually attend their prenatal care appointments and whether the type of supplement or packaging affects clinic visits. They’ll also explore whether women find the supplements acceptable and easy to take, both during early pregnancy, mid-pregnancy, and after the baby is born. These secondary questions help paint a complete picture of whether switching to the multi-vitamin supplement would be practical for Nepal’s health system.

Previous research has shown that multi-vitamin supplements (containing iron, folic acid, and other nutrients) appear to be better for pregnant women’s health and baby outcomes compared to just iron and folic acid alone. However, most of that research was done in controlled settings. This study is important because it tests whether these benefits hold up in real-world conditions in Nepal, where health systems and resources are different from wealthy countries. It also addresses a gap in knowledge: we know multi-vitamins might be better, but we don’t know if pregnant women will actually take them consistently.

Since this is a protocol paper (the research plan), we cannot yet identify limitations in the actual results. However, the study design has some considerations: it only takes place in one province of Nepal (Lumbini), so results may not apply to other regions. The study measures adherence by counting pills, which is reliable but doesn’t capture whether women took the pills at the right times or with food. Additionally, the study doesn’t measure whether the multi-vitamin supplement actually improves baby health outcomes—it only measures whether women take the supplements consistently.

The Bottom Line

This study is still in progress, so no final recommendations can be made yet. However, the research is designed to help Nepal’s government decide whether to provide multi-vitamin supplements to all pregnant women instead of just iron and folic acid. Once results are available, they may show that multi-vitamins are practical and acceptable for pregnant women in Nepal. Current evidence suggests multi-vitamins are beneficial, but this study will answer the important question of whether women will actually take them.

Pregnant women in Nepal and similar countries should care about this research, as it may affect what supplements their health clinics offer. Health officials and government programs should care because they need to know whether switching to multi-vitamins is practical before making that change nationwide. Healthcare workers should care because the results may change what they recommend to pregnant women. Women planning pregnancy should care because this research may eventually improve the supplements available to them.

This study is currently being conducted and results are not yet available. Once completed, it will take additional time for the results to be analyzed and published. Typically, such studies take 2-3 years from start to finish. Once results are published, it may take another 1-2 years for health programs to review the evidence and make decisions about changing supplement recommendations.

Want to Apply This Research?

  • Users could track daily supplement intake by logging each dose taken. For example: ‘Took multi-vitamin supplement today: Yes/No’ with a running count toward the goal of 180 supplements during pregnancy (approximately one per day for 6 months).
  • Set a daily reminder at the same time each day (such as with breakfast) to take the supplement. Users could also track which packaging style (blister pack vs. bottle) they find easier to remember, helping them understand their own adherence patterns.
  • Track weekly adherence rates (number of days supplements were taken divided by 7) to identify patterns. For example, if adherence drops on weekends, the user could set a special weekend reminder. Over time, users could see whether their adherence improves with consistent reminders or changes in routine.

This article describes a research study protocol that is currently in progress. Results are not yet available. This information is for educational purposes only and should not replace advice from your healthcare provider. If you are pregnant or planning pregnancy, consult with your doctor or midwife about what supplements are appropriate for you. The findings from this study, once available, should be discussed with your healthcare provider to determine how they apply to your individual situation. Different countries and regions may have different supplement recommendations based on local nutritional needs and health conditions.