Maternal low-dose vitamin A or β-carotene supplementation has no effect on fetal loss and early infant mortality: a randomized cluster trial in Nepal

Department of International Health, the Center for Human Nutrition, the Sight and Life Institute, and the Dean's Office, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-2103, USA.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 07/2000; 71(6):1570-6.
Source: PubMed


The effect of vitamin A supplementation on the survival of infants aged <6 mo is unclear. Because most infant deaths occur in the first few month of life, maternal supplementation may improve infant survival.
The objective was to assess the effect of maternal vitamin A or beta-carotene supplementation on fetal loss and survival of infants <6 mo of age.
Married women of reproductive age in 270 wards of Sarlahi district, Nepal, were eligible to participate. Wards were randomly assigned to have women receive weekly doses of 7000 microg retinol equivalents as retinyl palmitate (vitamin A), 42 mg all-trans-beta-carotene, or placebo. Pregnancies were followed until miscarriage, stillbirth, maternal death, or live birth of one or more infants, who were followed through 24 wk of age.
A total of 43559 women were enrolled; 15832 contributed 17373 pregnancies and 15987 live born infants to the trial. The rate of fetal loss was 92.0/1000 pregnancies in the placebo group, comparable with rates in the vitamin A and beta-carotene groups, which had relative risks of 1.06 (95% CI: 0.91, 1.25) and 1.03 (95% CI: 0.87, 1.19), respectively. The 24-wk mortality rate was 70.8/1000 live births in the placebo group, comparable with rates in the vitamin A and beta-carotene groups, which had relative risks of 1.05 (95% CI: 0.87, 1.25) and 1.03 (95% CI: 0.86, 1.22), respectively.
Small weekly doses of vitamin A or beta-carotene given to women before conception, during pregnancy, and through 24 wk postpartum did not improve fetal or early infant survival in Nepal.

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    • "The Nepal Nutrition Interventions Project, Sarlahi (NNIPS) studies are a series of populationbased community randomized trials of micronutrient and other interventions undertaken by our research team in rural Nepal from 1989 through the present. The NNIPS-2 study randomized 270 communities to receive weekly vitamin A, beta-carotene or placebo capsules for ∼45,000 women of child-bearing age to examine the impact on maternal and infant survival (West et al. 1999, Katz et al. 2000). NNIPS-3 randomized communities to receive daily vitamin A, folate, iron-folate, iron-folate and zinc, and a multiple micronutrient supplement for ∼5,000 pregnant women to examine the impact on birth weight and infant survival (Christian et al. 2003a, Christian et al. 2003b). "
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    • "In the low-lying plains of Nepal, called 'Terai,' mortality related to pregnancy was as high as 704 deaths per 100 000 live births (West et al., 1999), being 100 times higher than that of Japan, that is, 7.3 in 2002 (Health and Welfare Statistics Association, 2004). The 24-week infant mortality rate in this area was 70.8 per 1000 live births (Katz et al., 2000), more than 10 times higher than that in the developed world. Katz et al. (2003) pointed out that maternal undernutrition during pregnancy was strongly associated with infant mortality and Christian et al. (2004) revealed potential effects of intervention by means of supplementation of micronutrients on improvement of maternal and infant health and survival. "
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    • "European Journal of Clinical Nutrition status, similar to the lack of an overall effect of supplementation that has been described previously (Katz et al, 2000). While cigarette smoking can result in increased oxidative stress (Traber et al, 2000; Zhou et al, 2000), smoking during pregnancy, paradoxically, has been shown to be associated with a lower risk of pre-eclampsia (Conde-Agudelo et al, 1999; Salafia & Shiverick 1999; Conde-Agudelo & Belizan, 2000). "
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