Post-partum High-dose Vitamin A Supplementation to Improve Vitamin A Status of Mother and Infant: The Role of Timing and Inflammation
Nguyen Song Tu *
National Institute of Nutrition, Hanoi, Vietnam.
Tran Thuy Nga
National Institute of Nutrition, Hanoi, Vietnam.
Marjoleine Amma Dijkhuizen
Copenhagen University, Copenhagen, Denmark.
Jacques Berger
Institute de Recherche pour le Développement, Montpellier, France.
Henrik Friis
Copenhagen University, Copenhagen, Denmark.
Frank Tammo Wieringa
Institute de Recherche pour le Développement, Montpellier, France.
*Author to whom correspondence should be addressed.
Abstract
Objectives: Vitamin A deficiency (VAD) in infancy remains an important health problem. Post-partum maternal high-dose vitamin A supplementation (MHDVAS) was recommended but recently cancelled by WHO as efficacy was unclear. We investigated effects of inflammation and timing of MHDVAS on VA status in mothers and newborns.
Methods: In a randomized, double-blinded placebo-controlled trial, 400 pregnant women were randomly assigned at 28–32 weeks gestation, to receive MHDVAS within 1 week after delivery (WK1) or 6 weeks post-partum (WK6). Breastmilk, plasma VA and inflammation markers were measured at several time-points during the first 6 months post-partum.
Results: Retinol concentrations during pregnancy and 6 months post-partum were strongly correlated (R=0.53, P<0.001). Prevalence of VAD(<0.70 μmol/L) in mothers 6 months post-partum was low (2.7%), but high in infants (33.6%), regardless of intervention. 77.6% of infants had retinol concentrations <1.05 μmol/L. Breastmilk vitamin A concentrations (<1.05 μmol/L) were deficient in only 5% of the women first week post-partum, but increased to 28% of the women 6 months post-partum and tended to be higher in the WK1 compared to the WK6 (31.4% and 24.5%,P<0.10). Retinol liver stores were significantly higher in children from mothers receiving MHDVAS at WK6 as compared to WK1 (P<0.001), with 27% and 46.9% of the infants having insufficient VA liver stores respectively.
Conclusions: Lactation caused depletion of vitamin A stores in mothers. Delaying the high-dose VAS post-partum from WK1 to WK6 did not affect circulating retinol, but did significantly increased VA liver stores in infants 6 months after birth. Health-benefits should be evaluated in a larger trial.