A COMPARATIVE EVALUATION OF MATERNAL MICRONUTRIENT SUPPLEMENTATION AND NEONATAL OUTCOMES IN URBAN AND RURAL TERTIARY HOSPITALS OF INDIA AND UZBEKISTAN

Introduction: Micronutrient supplementation during pregnancy is critical for optimal fetal growth and maternal health. However, disparities in supplement adherence and clinical outcomes persist between urban and rural healthcare settings. India and Uzbekistan provide free antenatal care services, but the impact of these services on maternal and neonatal outcomes remains inconsistent across regions. Aim: To compare maternal micronutrient supplementation adherence and related neonatal outcomes between urban and rural tertiary care hospitals in India and Uzbekistan. Materials and Methods: A prospective observational study was conducted among 200 pregnant women (50 each from Delhi, Bihar, Tashkent, and Tashkent Region) from January to December 2024. Women enrolled at ≤20 weeks gestation were followed until 6 months postpartum. Clinical data collected included IFA, calcium, vitamin D adherence, maternal haemoglobin levels, antenatal visit frequency, and neonatal outcomes such as birth weight, Apgar scores, gestational age, and Denver Developmental Screening Test (DDST) at 6 months. Data analysis was performed using SPSS v25.0 with p<0.05 considered statistically significant. Results: IFA adherence was highest in Delhi (90%) and Tashkent (84%), while Bihar and Tashkent Region showed lower rates (66% and 60%, respectively; p=0.001). Anaemia prevalence (Hb<10g/dL) was significantly higher in Bihar (40%) and Tashkent Region (38%) compared to Delhi (18%) and Tashkent (22%; p=0.003). Mean birth weights: Delhi – 3.1kg, Bihar – 2.55kg, Tashkent – 3.05kg, Tashkent Region – 2.6kg (p<0.001). Low birth weight (<2.5kg) rates: Bihar – 30%, Tashkent Region – 28%, vs. Delhi – 8%, Tashkent – 10% (p=0.002). Preterm birth rates: Bihar – 18%, Tashkent Region – 16%, vs. Delhi – 6%, Tashkent – 8% (p=0.04). Delayed DDST milestones at 6 months were more prevalent in Bihar (20%) and Tashkent Region (18%) than in Delhi (6%) and Tashkent (8%) (p=0.01). Placental histopathology in LBW/preterm births showed increased villous infarction, syncytial knotting, and calcification in rural populations. Conclusions: Urban centres demonstrated better maternal nutritional compliance and improved neonatal outcomes. Rural settings showed higher anaemia rates and poorer developmental indices despite similar policy frameworks. Strengthening antenatal education, ensuring consistent supplement availability, and region-specific intervention strategies are critical to improving maternal and neonatal health in underserved populations.

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