1.
Impact of Vitamin A Supplementation on Pregnant Women and on Women Who Have Just Given Birth: A Systematic Review.
Cruz, S, da Cruz, SP, Ramalho, A
Journal of the American College of Nutrition. 2018;(3):243-250
Abstract
BACKGROUND The aim of this review was to evaluate the impact of vitamin A supplementation on adult pregnant women and women who have just given birth in studies examining serum concentrations of vitamin A in breast milk and in maternal/child morbidity and mortality. METHODS This review followed the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). In November 2014, an electronic search was independently performed by two authors on the Medline, Scopus, Web of Science, and LILACS databases on studies published from January 2004 to November 2014. The methodological quality of the studies was assessed in accordance with the Jadad scale, which determines the exclusion of studies with scores lower than 3. RESULTS It was observed that when supplementation was provided only in the immediate postpartum period, it increased the liver stores of vitamin A. On the other hand, when supplementation was provided during pregnancy and puerperium5, the propensity for depleting the stores of vitamin A at the end of pregnancy decreased, the immune system improved, and cases of gestational night blindness decreased, but there were no changes in the outcomes at childbirth or in maternal, fetal, and child mortality. When supplementation was provided before and during pregnancy and in the immediate postpartum period, an additional improvement of lung function evaluated in preschool-aged children was found, but no significant changes in cognitive and motor development were noted. CONCLUSIONS Studies show the benefits of vitamin A supplementation, not just in the immediate postpartum period but, above all, when it is provided before and/or during pregnancy. Considering the positive repercussions observed, we suggest supplementation both in the gestational period and in the immediate postpartum period as a way to enhance the safety of mother-child care.
2.
Vitamin A supplements for reducing mother-to-child HIV transmission.
Wiysonge, CS, Ndze, VN, Kongnyuy, EJ, Shey, MS
The Cochrane database of systematic reviews. 2017;(9):CD003648
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Abstract
BACKGROUND Strategies to reduce the risk of mother-to-child transmission of the human immunodeficiency virus (HIV) include lifelong antiretroviral therapy (ART) for HIV-positive women, exclusive breastfeeding from birth for six weeks plus nevirapine or replacement feeding plus nevirapine from birth for four to six weeks, elective Caesarean section delivery, and avoiding giving children chewed food. In some settings, these interventions may not be practical, feasible, or affordable. Simple, inexpensive, and effective interventions (that could potentially be implemented even in the absence of prenatal HIV testing programmes) would be valuable. Vitamin A, which plays a role in immune function, is one low-cost intervention that has been suggested in such settings. OBJECTIVES To summarize the effects of giving vitamin A supplements to HIV-positive women during pregnancy and after delivery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) up to 25 August 2017, and checked the reference lists of relevant articles for eligible studies. SELECTION CRITERIA We included randomized controlled trials conducted in any setting that compared vitamin A supplements to placebo or no intervention among HIV-positive women during pregnancy or after delivery, or both. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and extracted data. We expressed study results as risk ratios (RR) or mean differences (MD) as appropriate, with their 95% confidence intervals (CI), and conducted random-effects meta-analyses. This is an update of a review last published in 2011. MAIN RESULTS Five trials met the inclusion criteria. These were conducted in Malawi, South Africa, Tanzania, and Zimbabwe between 1995 and 2005 and none of the participants received ART. Women allocated to intervention arms received vitamin A supplements at a variety of doses (daily during pregnancy; a single dose immediately after delivery, or daily doses during pregnancy plus a single dose after delivery). Women allocated to comparison arms received identical placebo (6601 women, 4 trials) or no intervention (697 women, 1 trial). Four trials (with 6995 women) had low risk of bias and one trial (with 303 women) had high risk of attrition bias.The trials show that giving vitamin A supplements to HIV-positive women during pregnancy, the immediate postpartum period, or both, probably has little or no effect on mother-to-child transmission of HIV (RR 1.07, 95% CI 0.91 to 1.26; 4428 women, 5 trials, moderate certainty evidence) and may have little or no effect on child death by two years of age (RR 1.06, 95% CI 0.92 to 1.22; 3883 women, 3 trials, low certainty evidence). However, giving vitamin A supplements during pregnancy may increase the mean birthweight (MD 34.12 g, 95% CI -12.79 to 81.02; 2181 women, 3 trials, low certainty evidence) and probably reduces the incidence of low birthweight (RR 0.78, 95% CI 0.63 to 0.97; 1819 women, 3 trials, moderate certainty evidence); but we do not know whether vitamin A supplements affect the risk of preterm delivery (1577 women, 2 trials), stillbirth (2335 women, 3 trials), or maternal death (1267 women, 2 trials). AUTHORS' CONCLUSIONS Antepartum or postpartum vitamin A supplementation, or both, probably has little or no effect on mother-to-child transmission of HIV in women living with HIV infection and not on antiretroviral drugs. The intervention has largely been superseded by ART which is widely available and effective in preventing vertical transmission.