Maternal medicine: Randomised trial of vitamin A supplementation in pregnant women in rural Malawi found to be anaemic on screening by HemoCue

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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Prenatal Zinc and Vitamin A Reduce the Benefit of Iron on Maternal Hematologic and Micronutrient Status at Delivery in Tanzania

Journal of Nutrition ◽

10.1093/jn/nxz242 ◽

2019 ◽

Vol 150 (2) ◽

pp. 240-248 ◽

Cited By ~ 1

Author(s):

Ramadhani A Noor ◽

Ajibola I Abioye ◽

Anne Marie Darling ◽

Ellen Hertzmark ◽

Said Aboud ◽

...

Keyword(s):

Vitamin A ◽

Pregnant Women ◽

Iron Supplementation ◽

Iron Status ◽

Zinc Protoporphyrin ◽

Plasma Zinc ◽

Vitamin A Supplementation ◽

Iron Supplements ◽

Micronutrient Status ◽

Increased Risk

ABSTRACT Background Zinc and vitamin A supplementation have both been shown to affect iron status, hemoglobin (Hb) concentration, and anemia in animal and human studies. However, evidence on their combined use in pregnancy, in the context of iron–folic acid (IFA) supplementation, remains limited. Objective This study determined the effects of prenatal zinc, vitamin A, and iron supplementation on maternal hematologic and micronutrient status at delivery in Tanzania. Methods We analyzed 2 large randomized controlled trials, using generalized estimating equations, and examined the effect of daily zinc (25 mg) and vitamin A (2500 IU) supplementation starting in the first trimester of pregnancy compared with placebo (n = 2500), and separately evaluated the safety and efficacy of daily iron (60 mg) supplementation among iron-replete pregnant women (n = 1500). Blood samples from baseline and delivery were tested for Hb, serum ferritin, soluble transferrin receptor, plasma zinc, and zinc protoporphyrin. Results Zinc and vitamin A supplementation were associated with lower Hb concentrations at delivery of −0.26 g/dL (95% CI: −0.50, −0.02 g/dL) and −0.25 g/dL (95% CI: −0.49, −0.01 g/dL), respectively. Vitamin A increased mean ferritin concentrations at delivery (14.3 μg/L, 95% CI: 1.84, 29.11 μg/L), but was associated with increased risk of severe anemia (RR: 1.41; 95% CI: 1.06, 1.88). Among women who were iron replete at baseline, iron supplementation reduced the risk of iron depletion at delivery by 47% (RR: 0.53; 95% CI: 0.43, 0.65). There was no effect of zinc or iron supplements on plasma zinc concentrations. Conclusions Our findings support existing WHO guidelines on prenatal iron, vitamin A, and zinc supplementation among pregnant women. In this setting, scaling uptake of prenatal iron supplements is warranted, but prenatal zinc and vitamin A supplementation did not benefit maternal hematologic status at delivery. In settings where vitamin A deficiency is endemic, the efficacy and safety of the WHO recommended prenatal vitamin A supplementation require further evaluation.

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WHO Guideline: Vitamin A Supplementation in Pregnant Women. Geneva: WHO, 2011; WHO Guideline: Vitamin A Supplementation in Postpartum Women. Geneva: WHO, 2011

Advances in Nutrition ◽

10.3945/an.111.001701 ◽

2012 ◽

Vol 3 (2) ◽

pp. 215-216 ◽

Cited By ~ 8

Author(s):

Shelley McGuire

Keyword(s):

Vitamin A ◽

Pregnant Women ◽

Postpartum Women ◽

Vitamin A Supplementation ◽

Who Guideline

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Effects of Vitamin A Supplementation on Viral Load in HIV-1-Infected Pregnant Women

Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology ◽

10.1097/00042560-199705010-00015 ◽

1997 ◽

Vol 15 (1) ◽

pp. 86-87 ◽

Cited By ~ 36

Author(s):

&NA;

Keyword(s):

Viral Load ◽

Vitamin A ◽

Pregnant Women ◽

Vitamin A Supplementation ◽

Hiv 1

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Effect of vitamin A supplementation on morbidity due to Plasmodium falciparum in young children in Papua New Guinea: a randomised trial

The Lancet ◽

10.1016/s0140-6736(98)08293-2 ◽

1999 ◽

Vol 354 (9174) ◽

pp. 203-209 ◽

Cited By ~ 143

Author(s):

Anuraj H Shankar ◽

Blaise Genton ◽

Richard D Semba ◽

Moses Baisor ◽

Joseph Paino ◽

...

Keyword(s):

Plasmodium Falciparum ◽

Young Children ◽

Vitamin A ◽

Papua New Guinea ◽

Randomised Trial ◽

New Guinea ◽

Vitamin A Supplementation

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Randomised trial to assess benefits and safety of vitamin A supplementation linked to immunisation in early infancy

The Lancet ◽

10.1016/s0140-6736(98)02487-8 ◽

1998 ◽

Vol 352 (9136) ◽

pp. 1257-1263 ◽

Cited By ~ 126

Keyword(s):

Vitamin A ◽

Randomised Trial ◽

Early Infancy ◽

Vitamin A Supplementation

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Impact of vitamin A supplementation in anaemia during pregnancy: a randomized double blind controlled clinical trial

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182332 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2262

Author(s):

Shakun Singh ◽

Rachna Chaudhary ◽

Vandana Dhama ◽

Anu Singh ◽

Urmila Karya

Keyword(s):

Clinical Trial ◽

Vitamin A ◽

Pregnant Women ◽

Controlled Clinical Trial ◽

Double Blind ◽

Vitamin A Supplementation ◽

Elemental Iron ◽

Group A ◽

Group B ◽

The Impact

Background: To study the impact of Vitamin A supplementation in anaemia during Pregnancy and thus improving maternal and fetal outcome a Randomized double blind controlled clinical trial was conducted in Department of Obstetrics and Gynaecology, L.L.R.M. Medical college Meerut involving 250 pregnant women in late pregnancy 18-28 weeks with haemoglobin levels <11 g% (7-11 g%)..Methods: The study subjects were divided into two groups: Group A (n=125): Received daily supplement containing Iron (60 mg elemental iron) + Folate (500 mcg) + Vitamin A 20,000 IU weekly for a minimum of 12 weeks. Group B (n=125): Received daily supplement containing iron (60 mg elemental iron) + Folate (500 mcg) for a minimum of 12 weeks.Results: Maximum patients were uneducated belonging to low socioeconomic status. The mean haemoglobin values in Group A and Group B increased from 9.674±1.05 and 9.53±1.04 to 12.2±0.89 and 10.82±1.06 respectively after supplementation. Similarily Serum Ferritin levels increased from 15.96±2.94 and 15.70±2.83 to 78.40±17.82 and 58.64±11.93. Mean corpuscular volume, packed cell volume and red blood cell counts also increased significantly. Maximum haemoglobin levels were achieved with both vitamin A and iron supplementation. The proportion of women who became non anaemic was 97.17% in Group A vs 68.69% in Group B.Conclusions: Vitamin A supplementation improves anaemia and also dramatically improves iron stores in anaemic pregnant women.

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