The effects of maternal and infant vitamin A supplementation on vitamin A status: a randomised trial in Kenya
What this study found
Maternal vitamin A did not meaningfully improve maternal serum retinol, but it modestly increased breast milk retinol; infant vitamin A improved infant vitamin A stores by MRDR, yet did not increase infant serum retinol, and combining maternal plus infant supplementation did not show a clear added benefit. In mothers, the serum retinol difference for vitamin A versus placebo was 0.04 (95% CI 0.01 to 0.09; P=0.13) at week 14 postpartum and -0.02 (95% CI -0.08 to 0.04; P=0.50) at week 26 postpartum. Infant supplementation reduced MRDR ratios by -0.012 (95% CI -0.019 to -0.005) and lowered the…
- Study & population
- Randomized, double-blind, placebo-controlled 2x2 factorial trial in postpartum mother-infant pairs from rural western Kenya (Bondo District, Lake Victoria shore).
- Intervention
- Mothers in the active arms received 400,000 IU vitamin A orally as two 200,000 IU oily capsules within 24 hours postpartum.
- Key limitation
- The main findings rely on surrogate biomarkers rather than clinical deficiency outcomes or morbidity benefits.
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Open PDFOriginal abstract
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.