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).
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.
Available from: Steven C Leclerq
- "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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ABSTRACT: The purpose of this study was to examine whether changes in the mid-upper arm circumference (MUAC) in pregnancy and early post-partum varied by maternal age. The MUAC of 3359 nulliparous pregnant women ≤25 years of age in rural Nepal was measured in early pregnancy and at 3 months post-delivery of a live-born infant. Regression was used to model the change in MUAC and prevalence of MUAC < 20 cm by maternal age, adjusted for confounders. A total of 5.2% of the pregnant women were under 16 years of age. The prevalence of MUAC measurements <20 cm was 11.3% in early pregnancy and did not differ by maternal age. The prevalence of low MUAC was 17.7% at post-partum, but those <16 years of age had a significantly higher prevalence of low post-partum MUAC [odds ratio: 2.47, 95% confidence interval (CI) 1.49, 4.10] compared with women 20-25 years of age, adjusted for maternal literacy, caste, meat consumption in early pregnancy and timing of measurements. All women reduced their MUAC from early pregnancy through post-partum. The adjusted loss of the MUAC among those under 16 years of age was 0.97 cm (95% CI: -1.33, -0.60), compared with 0.40 cm (95% CI: -0.70, -0.10) among women 20-25 years of age. In an energy-restricted environment, girls under 16 years contributed to a half centimetre more loss of MUAC than older women of the same parity. Such a loss of fat, muscle or both may put younger women and their breastfed offspring at greater risk of other adverse health and nutritional outcomes.
Available from: Makhan Maharjan
- "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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ABSTRACT: To elucidate gender differences in dietary intake among adults in lowland Nepalese communities.
For 122 male and 195 female subjects aged 20 years and over from 94 randomly selected households, interviews using a 19-item food frequency questionnaire were conducted. To determine the portion sizes of these foods, the samples consumed by 56 subjects in a full 1-day period were weighed. Energy expenditure was estimated by time spent on daily activities.
Gender differences in per-day energy and protein intakes were related to sex differences in body size and energy expenditure. Apparent gender differences in the crude intakes disappeared when they were expressed by nutrient density (mg or microg/MJ) since micronutrient intakes were significantly correlated with energy intake. However, males' iron intake was larger even after adjustment for energy intake, attributing to their larger portion sizes of commonly consumed staple foods and higher frequencies of consuming luxury foods (fish and tea).
The intrahousehold unequal distribution of food incurs risk of iron deficiency among female subjects.
This study was financially supported by the Ajinomoto Foundation for Dietary Culture and the Alliance for Global Sustainability Program.
Available from: Steven C Leclerq
- "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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ABSTRACT: We examined risk factors of smoking and the association between smoking and pregnancy-related and 6-month infant mortality in rural Nepal, where 30% women reported smoking during pregnancy.
Cross-sectional analysis of risk factors associated with smoking status and health consequences of smoking, using prospective data collected as part of a randomized community trial to examine the effect of maternal vitamin A or beta-carotene supplementation on maternal mortality.
Rural, southeastern plains of Nepal.
A total of 17 767 women contributed at least one pregnancy during 3.5 y of the study. Data on cigarette or bidi (rolled tobacco) smoking were collected using a 7-day recall, twice during pregnancy. Associations between smoking status and maternal diet, morbidity profile, household socioeconomic status and serum concentration of retinol, carotenoids and tocopherols were examined. Further, relative risk (RR) and 95% confidence intervals (CI) were calculated to estimate supplement effects on pregnancy-related mortality, stratified by smoking status during pregnancy.
Smokers were more likely to be older, illiterate and poor compared to nonsmokers. Fruit and vegetable consumption among smokers and nonsmokers did not vary. However, smokers were more likely to consume meat/fish/eggs and less likely to consume milk than nonsmokers. They were also more likely to report symptoms of vaginal bleeding, edema, severe headache and convulsions during pregnancy relative to nonsmokers. Mortality per 100,000 pregnancies appeared to be higher among smokers than nonsmokers in the placebo group (915 vs 584, RR=1.57, 95% CI: 0.80-3.08). beta-Carotene supplementation reduced pregnancy-related mortality both among smokers (RR=0.31 95% CI: 0.11-0.89) and nonsmokers (RR=0.41, 95% CI: 0.19-0.89). Similar results obtained with vitamin A supplementation were not statistically significant. Infant mortality up to 6 months was approximately 30% higher among smokers compared to nonsmokers in the placebo group both before and after adjusting for confounding factors. Neither supplement given to women reduced infant mortality.
Cigarette smoking during pregnancy is associated with an increased risk of maternal and infant mortality in rural Nepal. beta-Carotene and to some extent vitamin A may reduce the risk of pregnancy-related mortality, but not infant mortality, among both smokers and nonsmokers.
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