Background: Nightblindness affects 16 -52% of pregnant women in areas of Nepal and in some cases persists after vitamin A treatment. Iron and riboflavin affect vitamin A utilization and photoreceptor function, respectively, and pilot data in the study population showed a high prevalence of iron and riboflavin deficiencies. Objective: The objective was to assess the effect of supplemental iron and riboflavin on pupillary threshold (PT) and plasma retinol in nightblind, pregnant Nepali women given vitamin A-fortified rice. Design: Nightblind pregnant women were randomly assigned to receive, 6 d/wk under supervision for 6 wk, a vitamin A-fortified rice curry dish providing 850 g retinal activity equivalents/d with either a 30-mg Fe and 6-mg riboflavin (FeR ѿ VA) capsule or a placebo control (VA only) capsule. Hemoglobin, erythrocyte riboflavin, and plasma ferritin and retinol were measured before and after the intervention. Dark adaptation was assessed by PT score. Results: Women who were iron deficient at baseline (n ҃ 38) had significantly greater improvement in PT score with iron and riboflavin supplementation than without (P ҃ 0.05). Iron and riboflavin supplements significantly reduced the prevalences of riboflavin deficiency (from 60% to 6%; P 0.0001), iron deficiency anemia (from 35% to 15%; P 0.007), and abnormal PT (from 87% to 30%; P 0.05) from baseline. Mean increases in erythrocyte riboflavin (P 0.0001) and plasma ferritin (P ҃ 0.01) were greater in the FeR ѿ VA group than in the VA only group. Conclusions: Iron deficiency may limit the efficacy of vitamin A to normalize dark adaptation in pregnant Nepali women. Further studies are needed to assess the effect of simultaneous delivery of iron and vitamin A for the treatment of nightblindness.Am J Clin Nutr 2007;85: 1375-84.