Antenatal Vitamin A Supplementation

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Christian et al*212Nepal; rural setting; DBPRCTSee Katz et al219 (below)Compared to offspring of non–night-blind women, risk of infant mortality during the first 6 mo of life was increased the least among offspring of night-blind mothers supplemented with vitamin A (OR: 1.14; CI: 0.67–1.93), was intermediate for those whose night-blind mother had received β-carotene (OR: 1.50; CI: 0.97–2.33), and was highest for those born to placebo-control night-blind women (OR: 1.63; CI: 1.09–2.38).
Katz et al*219Nepal; rural setting; RPCTAll married women of child-bearing age in each of the 9 study wards (n = 43 559) were assigned randomly to (1) a weekly dose of 7000 μg of retinol equivalent as retinyl palmitate (vitamin A), (2) 42 mg all-trans β-carotene (7000 μg of retinol equivalent), or (3) placebo (n = 15 832 women who contributed data; during the study period, 17 373 were pregnant, and there were 15 987 live-born infants).There was no effect of either supplement (vitamin A or β-carotene) on fetal loss, neonatal mortality, or prevalence of preterm births.
Coutsoudis et al222South Africa; urban hospital setting; DBRPCTPregnant HIV-infected women (n = 728) were randomized to receive either vitamin A (n = 368) or placebo (n = 360); the vitamin A treatment consisted of a daily dose of 5000 IU of retinyl palmitate and 30 mg of β-carotene during the third trimester of pregnancy and 200 000 IU of retinyl palmitate at delivery.Women receiving the vitamin A supplement were less likely to have a preterm delivery (11.4% in the vitamin A group and 17.4% in the placebo group, P = .03).HIV-infection results were available on 632 children who were included in the Kaplan-Meier transmission analysis. There was no difference in the risk of HIV infection by 3 mo of age between the vitamin A (20.3%; CI: 15.7–24.9) and placebo (22.3%; CI: 17.5–27.1) groups, nor were there differences in fetal mortality rate or IMR between the 2 groups; among the 80 preterm deliveries, those assigned to the vitamin A group were 50% less likely to be HIV infected (17.9%; CI: 3.5–32.2) than those assigned to the placebo group (33.8%; CI: 19.8–47.8).
West et al*218Nepal; rural setting; DBRPCTSee Katz et al (above) (n = 44 646 married women, of whom 22 119 were pregnant).Maternal mortality was reduced 44% (OR: 0.56; CI: 0.37–0.84; P < .005) among women supplemented with vitamin A or β-carotene compared to placebo.
Fawzi et al220Tanzania; urban setting; DBRCTHIV-infected women (n = 1075) were randomized into 4 groups: group 1 (n = 269) received a daily dose of vitamin A, group 2 (n = 269) was given multivitamins excluding vitamin A, group 3 (n = 270) received multivitamins including vitamin A, and group 4 (the control group, n = 267) was given placebo.Risk of LBW (<2500 g) was decreased by 44% (OR: 0.56; CI: 0.38–0.82; P = .003); risk of severe preterm birth (<34 wk) was reduced by 39% (OR: 0.61; CI: 0.38–0.96; P = .03), and risk of SGA was reduced by 43% (OR: 0.57; CI: 0.39–0.82; P = .002) in groups 2 and 3 (multivitamin-supplemented groups with and without vitamin A); vitamin A given alone had no effect on incidence of fetal deaths (OR: 0.89; CI: 0.58–1.36; P = .59), LBW (OR: 1.14; CI: 0.68–1.94; P = .62), VLBW, preterm births, or SGA births (OR: 0.83; CI: 0.58–1.18; P = .29).
Kumwenda et al224Malawi; urban hospital setting; RCTHIV-infected women (n = 697) were randomized to receive daily doses of iron and folate either alone (control group) or combined with vitamin A (3 mg of retinol equivalent), from 18 to 28 wk of gestation until delivery.In the vitamin A and control groups, the mean birth weight was 2895 ± 31 and 2805 ± 32 g, respectively (P = .05), and the proportion of LBW infants was 14.0% and 21.1% (P = .03) in vitamin A-supplemented and control groups, respectively; the proportion of anemic infants at 6 wk postpartum was 23.4% and 40.6% in the 2 groups, respectively (P < .001).
Suharno et al168See Table 7
  • * Data are from the same trial