Vitamin A supplementation for postpartum women.

Systematic review and meta-analysis of randomized trials in postpartum women from low- and middle-income settings, including multiple countries in Asia, Africa, and Latin America. Most participants were breastfeeding, and some studies also reported infant outcomes alongside maternal outcomes.

Postpartum women received high-dose vitamin A, most commonly as retinyl palmitate, given as single oral doses of 200,000 IU to 400,000 IU soon after delivery or within the first few postpartum weeks. Several trials also tested maternal vitamin A plus infant vitamin A, and one trial compared maternal vitamin A with maternal beta-carotene for up to 9 months postpartum.

Postpartum vitamin A supplementation did not improve maternal or infant mortality or morbidity compared with placebo or lower-dose regimens. In the largest mortality analyses, maternal mortality was RR 1.01 (0.44 to 2.21) at 12 months in 8577 participants from 1 RCT and RR 0.50 (0.09 to 2.71) at 6 months in 564 participants from 1 RCT. Biochemical markers improved modestly, including breast milk retinol, which increased by MD 0.20 µmol/L at 3 to 3.5 months in 837 participants from 6 RCTs, but these changes did not translate into clear clinical benefit. No consistent adverse effects were reported, although safety data were limited.

Evidence quality was generally low to very low. Few trials reported mortality or morbidity, follow-up was limited for many outcomes, and there was substantial heterogeneity across doses, regimens, and populations. Safety reporting was limited, and some trials combined maternal and infant supplementation, which adds complexity and indirectness.