Effect of neonatal vitamin A supplementation on mortality in infants in Tanzania (Neovita): a randomised, double-blind, placebo-controlled trial

Postpartum vitamin A supplementation of mothers and infants is recommended, but the efficacy has been questioned. In this double-blind, placebo-controlled trial, Kenyan mother–infant pairs were randomised to maternal vitamin A (400 000 IU) or placebo < 24 h postpartum, and infant vitamin A (100 000 IU) or placebo at 14 weeks. Milk retinol was determined at weeks 4, 14 and 26, and maternal and infant serum retinol at weeks 14 and 26. Infant retinol stores were assessed at week 26, using a modified relative dose response (MRDR) test. Among 564 women, serum retinol at 36 weeks gestation was 0·81 (sd 0·21) μmol/l, and 33·3 % were < 0·7 μmol/l. Maternal serum retinol was not different between groups, but milk retinol was higher in the vitamin A group: (0·67 v. 0·60 μmol/l; 0·52 v. 0·44 μmol/l; 0·50 v. 0·44 μmol/l at 4, 14 and 26 weeks, respectively). When expressed per gram fat, milk retinol was higher in the vitamin A group only at 4 weeks. Infant serum retinol was not different between groups. However, although most infants had deficient vitamin A stores (MRDR>0·06 %) at 26 weeks, vitamin A to infants, but not mothers, resulted in a lower proportion of infants with deficient vitamin A stores (69 v. 78 %). High-dose postpartum vitamin A supplementation failed to increase serum retinol and infant stores, despite modest effects on milk retinol. Infant supplementation, however, increased stores. There is a need for a better understanding of factors affecting absorption and metabolism of vitamin A.

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The Impact of Prenatal Vitamin A and Zinc Supplementation on Birth Size and Neonatal Survival - a Double-Blind, Randomized Controlled Trial in a Rural Area of Indonesia

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000141 ◽

2013 ◽

Vol 83 (1) ◽

pp. 14-25 ◽

Cited By ~ 11

Author(s):

Endy P. Prawirohartono ◽

Lennarth Nyström ◽

Detty S. Nurdiati ◽

Mohammad Hakimi ◽

Torbjörn Lind

Keyword(s):

Randomized Controlled Trial ◽

Birth Weight ◽

Vitamin A ◽

Zinc Supplementation ◽

Controlled Trial ◽

Neonatal Morbidity ◽

Birth Length ◽

Double Blind ◽

Vitamin A Supplementation ◽

Randomized Controlled

Background: Prenatal supplementation with micronutrients may increase birth weight and thus improve infant health and survival in settings where infants and children are at risk of micronutrient deficiencies. Objective: To assess whether vitamin A and/or zinc supplementation given during pregnancy can improve birth weight, birth length, neonatal morbidity, or infant mortality. Methods: A double-blind, randomized controlled trial supplementing women (n = 2173) in Central Java, Indonesia throughout pregnancy with vitamin A, zinc, combined vitamin A+zinc, or placebo. Results: Out of 2173 supplemented pregnant women, 1956 neonates could be evaluated. Overall, zinc supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.8 vs. 48.5 cm, p = 0.04); vitamin A supplementation improved birth length compared to placebo or combined vitamin A+zinc (48.7 vs. 48.2 cm, p = 0.04). These effects remained after adjusting for maternal height, pre-pregnancy weight, and parity. There was no effect of supplementation on birth weight, the proportion of low birth weight, neonatal morbidity, or mortality. Conclusions: Prenatal zinc or vitamin A supplementation demonstrates a small but significant effect on birth length, but supplementation with zinc, vitamin A or a combination of zinc and vitamin A, have no effect on birth weight, neonatal morbidity, or mortality.

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Vitamin A and Zinc Supplementation among Pregnant Women to Prevent Placental Malaria: A Randomized, Double-Blind, Placebo-Controlled Trial in Tanzania

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.16-0599 ◽

2017 ◽

pp. 16-0599 ◽

Cited By ~ 5

Author(s):

Anne Marie Darling ◽

Ferdinand M. Mugusi ◽

Analee J. Etheredge ◽

Nilupa S. Gunaratna ◽

Ajibola Ibraheem Abioye ◽

...

Keyword(s):

Vitamin A ◽

Pregnant Women ◽

Zinc Supplementation ◽

Controlled Trial ◽

Placental Malaria ◽

Double Blind ◽

Double Blind Placebo

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Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial

BMJ ◽

10.1136/bmj.323.7308.314 ◽

2001 ◽

Vol 323 (7308) ◽

pp. 314-318 ◽

Cited By ~ 94

Author(s):

M. M Rahman ◽

S. H Vermund ◽

M. A Wahed ◽

G. J Fuchs ◽

A. H Baqui ◽

...

Keyword(s):

Vitamin A ◽

Controlled Trial ◽

Double Blind ◽

Vitamin A Supplementation

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Faculty Opinions recommendation of Simultaneous zinc and vitamin A supplementation in Bangladeshi children: randomised double blind controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726147458.793514628 ◽

2016 ◽

Author(s):

Alfredo Guarino ◽

Andrea Lo Vecchio

Keyword(s):

Vitamin A ◽

Controlled Trial ◽

Double Blind ◽

Vitamin A Supplementation

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A double blind randomized controlled trial in neonates to determine the effect of vitamin A supplementation on immune responses: The Gambia protocol

BMC Pediatrics ◽

10.1186/1471-2431-14-92 ◽

2014 ◽

Vol 14 (1) ◽

Cited By ~ 8

Author(s):

Suzanna LR McDonald ◽

Mathilde Savy ◽

Anthony JC Fulford ◽

Lindsay Kendall ◽

Katie L Flanagan ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Vitamin A ◽

Immune Responses ◽

Controlled Trial ◽

The Gambia ◽

Double Blind ◽

Vitamin A Supplementation ◽

Randomized Controlled

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The Effects of Two Maternal Vitamin A Supplementation Regimens on Serum Retinol in Postpartum Mothers: A Randomised Controlled Trial in Brazil

ISRN Public Health ◽

10.5402/2012/121697 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Luciana Marques Andreto ◽

Ilma Kruze Grande de Arruda ◽

Ariani Impieri Souza ◽

José Natal Figueiroa ◽

Alcides da Silva Diniz

Keyword(s):

Randomised Controlled Trial ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Controlled Trial ◽

Serum Retinol ◽

Double Blind ◽

Vitamin A Supplementation ◽

Treatment Groups ◽

Randomised Controlled ◽

Postpartum Mothers

Objective. To test whether the serum retinol level in mothers supplemented with 400,000 IU of vitamin A is higher than in those supplemented with 200,000 IU and to estimate duration of the protective effect of vitamin A supplementation in the serum retinol level. Methods. Double-blind, randomised controlled trial performed in two hospitals in the state of Pernambuco in northeast Brazil. Three hundred twelve mothers were recruited immediately postpartum. All women received a capsule containing 200,000 IU of vitamin A, and 10 days after delivery, they were randomly assigned to one of two treatment groups. One group received a second capsule containing vitamin A and the other group received a placebo. Each group was invited back after 2, 4, and 6 months for serum retinol analyses. Results. No difference was found between the two groups in serum maternal retinol concentration at 2 months (2.13 versus 2.03 μmol/L), 4 months (2.20 versus 2.24 μmol/L) or 6 months (2.29 versus 2.31 μmol/L). Because there was no further effect and because this population has a level of vitamin A deficiency considered mild, our results do not support a proposal to increase the dosing schedule for vitamin A in postpartum women as recommended by the IVACG.

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