Vitamin A supplementation for postpartum women
Abstract
Background
In vitamin A deficient populations, the amount of vitamin A may be insufficient for maintenance of maternal health and levels in breast milk may be insufficient for breastfeeding infants' needs.
Objectives
To assess the effects of postpartum maternal vitamin A supplementation on maternal and infant health.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2010), LILACS (1982 to July 2010), Web of Science (1945 to July 2010) and Biological Abstracts (1998 to July 2010).
Selection criteria
Randomised controlled trials evaluating the effects of postpartum maternal vitamin A supplementation.
Data collection and analysis
Two review authors assessed the studies independently.
Main results
We included 12 trials at moderate risk of bias, enrolling 25,465 mother‐baby pairs and comparing several postpartum doses (200,000‐400,000 IU) of vitamin A or 7.8 mg daily beta‐carotene, with placebo, iron or no supplement; or higher (400,000 IU) versus lower dose (200,000 IU). The majority of infants in all studies were at least partially breastfed for six months.
Maternal: we observed no impact of vitamin A on maternal mortality (two trials of 9,126 women), morbidity (one trial of 50 women) or adverse effects (subset of 786 women in one trial). Vitamin A enhanced serum and breast milk retinol at three months in five trials, but these improvements were generally not sustained.
Infant: we observed no significant differences for infant mortality RR 1.14 95% CI 0.84 to 1.57 (five trials (6,170 infants) or morbidity (three trials) except for fewer episodes of fever with vitamin A in one small trial. No significant differences in infant vitamin A status were seen with maternal vitamin A supplementation (five trials).
No beneficial effects for maternal or infant health were associated with higher compared to lower doses of vitamin A in two trials.
Authors' conclusions
The lack of effect on maternal and infant mortality and morbidity, with exception of some improved infant morbidity in one small study, and the improvement in maternal vitamin A status, suggest that maternal postpartum vitamin A supplementation offers limited benefits.
PICOs
Plain language summary
Vitamin A supplementation for breastfeeding mothers
While the amount of vitamin A in well‐nourished mothers' breast milk is sufficient to meet the needs of their infants, this may not be the case for mothers from populations with vitamin A deficiency. Therefore, trials have tested whether giving mothers vitamin A supplements as single doses soon after birth or beta‐carotene for long periods can improve the health and survival of these mothers and their babies. Ten of the 12 trials in this review compared a single dose of vitamin A and placebo, with one trial supplementing women with beta‐carotene for nine months after birth. Two studies compared a higher dose with a lower dose of vitamin A. None of the trials was able to show an effect on infant death and only one small study showed improved infant health. None of the trials was able to show an effect on maternal death or morbidity. A significant improvement was seen for maternal serum retinol, breast milk retinol and vitamin A liver stores after single dose of vitamin A supplementation. Vitamin A did not show any adverse effects in these trials, but this may not apply for women and babies from well nourished populations.
