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PRISMA flow diagram
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Figure 1

PRISMA flow diagram

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ʽRisk of bias' graph: review authors' judgements about each ʽRisk of bias' item presented as percentages across all included trials
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Figure 2

ʽRisk of bias' graph: review authors' judgements about each ʽRisk of bias' item presented as percentages across all included trials

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ʽRisk of bias' summary: review authors' judgements about each ʽRisk of bias' item for each included trial
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Figure 3

ʽRisk of bias' summary: review authors' judgements about each ʽRisk of bias' item for each included trial

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 1 HIV infection status of the child.
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Analysis 1.1

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 1 HIV infection status of the child.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 2 Mean birthweight.
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Analysis 1.2

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 2 Mean birthweight.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 3 Low birthweight.
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Analysis 1.3

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 3 Low birthweight.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 4 Child death by two years of age.
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Analysis 1.4

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 4 Child death by two years of age.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 5 Preterm delivery.
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Analysis 1.5

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 5 Preterm delivery.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 6 Stillbirth.
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Analysis 1.6

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 6 Stillbirth.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 7 Maternal death.
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Analysis 1.7

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 7 Maternal death.

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Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 8 Postpartum CD4 count.
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Analysis 1.8

Comparison 1 Vitamin A supplementation versus no vitamin A supplementation, Outcome 8 Postpartum CD4 count.

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Summary of findings for the main comparison. Effects of giving vitamin A supplements to HIV‐positive women during pregnancy or after delivery

Population: HIV‐positive women during pregnancy and immediate postpartum period
Settings: any setting
Intervention: vitamin A supplements

Comparison: placebo or no intervention

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(trials)

Certainty of the evidence
(GRADE)

Comments

Assumed risk with no vitamin A

Corresponding risk with vitamin A supplements

HIV infection status of the child

27 per 100

29 per 100
(24 to 34)

RR 1.07

(0.91 to 1.26)

4428
(5 trials)

⊕⊕⊕⊝
moderate1

due to imprecision

Vitamin A supplements probably have little or no effect on mother‐to‐child transmission of HIV.

Mean birthweight

2964 g

34 g higher
(13 g lower to 81 g higher)

MD 34.12

(−12.79 to 81.02)

2181
(3 trials)

⊕⊕⊝⊝
low2

due to imprecision

Vitamin A supplements may increase the mean birthweight

Low birthweight

17 per 100

13 per 100
(11 to 17)

RR 0.78
(0.63 to 0.97)

1819
(3 trials)

⊕⊕⊕⊝
moderate3

due to imprecision

Vitamin A supplements probably reduce the incidence of low birthweight babies.

Child death by two years of age

14 per 100

15 per 100
(13 to 18)

RR 1.06
(0.92 to 1.22)

3883
(3 trials)

⊕⊕⊝⊝
low2

due to imprecision

Vitamin A supplements may have little or no effect on child death by two years of age.

Preterm delivery

20 per 100

17 per 100
(10 to 28)

RR 0.84
(0.52 to 1.37)

1577
(2 trials)

⊕⊝⊝⊝
very low2,4

due to imprecision and selective reporting

It is uncertain whether or not vitamin A supplements have an effect on preterm deliveries.

Stillbirth

3 per 100

3 per 100
(2 to 5)

RR 1.13
(0.72 to 1.77)

2335
(3 trials)

⊕⊝⊝⊝
very low2,4

due to imprecision and selective reporting

It is uncertain whether or not vitamin A supplements have an effect on stillbirths.

Maternal death

3 per 100

2 per 100
(1 to 4)

RR 0.71
(0.35 to 1.43)

1267
(2 trials)

⊕⊝⊝⊝
very low2,4

due to imprecision and selective reporting

It is uncertain whether or not vitamin A supplements have an effect on maternal deaths.

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
Abbreviations: CI: confidence interval; g: gram; MD: mean difference; RR: risk ratio.

GRADE Working Group grades of evidence
High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

1We downgraded by 1 for imprecision, as the CI ranges from small benefits to a clinically important increase in harm.
2We downgraded by 2 for imprecision, as the CI ranges from clinically important benefits to a substantial increase in harm.
3We downgraded by 1 for imprecision, as the CI ranges from substantial benefits to no effect.
4We downgraded by 1 for possibility of selective reporting, because 1 or more eligible studies did not report this outcome.

Figuras y tablas -
Summary of findings for the main comparison. Effects of giving vitamin A supplements to HIV‐positive women during pregnancy or after delivery
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Table 1. Search strategy used on 25 August 2017

Search set

CENTRAL

PubMed

Embase

WHO ICTRP

ClinicalTrials.gov

#1

MeSH descriptor: [HIV Infections] explode all trees

Search ((HIV Infections[MeSH] OR HIV[MeSH] OR hiv[tiab] OR hiv‐1*[tiab] OR hiv‐2*[tiab] OR hiv1[tiab] OR hiv2[tiab] OR hiv infect*[tiab] OR human immunodeficiency virus[tiab] OR human immunedeficiency virus[tiab] OR human immuno‐deficiency virus[tiab] OR human immune‐deficiency virus[tiab] OR ((human immun*[tiab]) AND (deficiency virus[tiab])) OR acquired immunodeficiency syndrome[tiab] OR acquired immunedeficiency syndrome[tiab] OR acquired immuno‐deficiency syndrome[tiab] OR acquired immune‐deficiency syndrome[tiab] OR ((acquired immun*[tiab]) AND (deficiency syndrome[tiab])) OR "sexually transmitted diseases, Viral"[MeSH:NoExp]))

'human immunodeficiency virus infection'/exp OR 'human immunodeficiency virus infection'/de OR 'human immunodeficiency virus infection' OR 'human immunodeficiency virus'/exp OR 'human immunodeficiency virus'/de OR 'human immunodeficiency virus' OR 'human immunodeficiency virus:ab,ti' OR hiv:ab,ti OR 'hiv‐1':ab,ti OR 'hiv‐2':ab,ti OR 'human immunodeficiency virus':ab,ti OR 'human immunedeficiency virus':ab,ti OR 'human immune‐deficiency virus':ab,ti OR 'human immuno‐deficiency virus':ab,ti OR 'acquired immunodeficiency syndrome':ab,ti OR 'acquired immuno‐deficiency syndrome':ab,ti OR 'acquired immune‐deficiency syndrome':ab,ti OR 'acquired immunedeficiency syndrome':ab,ti

hiv AND vitamin A OR hiv AND retinol OR hiv AND retinoic OR hiv AND micronutrients OR hiv AND carotene

HIV and "VITAMIN A" | Interventional Studies | Studies received from 05/20/2016 to 08/25/2017

#2

MeSH descriptor: [HIV] explode all trees

Search (randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized [tiab] OR placebo [tiab] OR "clinical trials as topic"[mesh: noexp] OR randomly [tiab] OR trial [tiab]) NOT (animals [mh] NOT humans [mh])

'randomized controlled trial'/de OR 'randomized controlled trial' OR random*:ab,ti OR trial:ti OR allocat*:ab,ti OR factorial*:ab,ti OR placebo*:ab,ti OR assign*:ab,ti OR volunteer*:ab,ti OR 'crossover procedure'/de OR 'crossover procedure' OR 'double‐blind procedure'/de OR 'double‐blind procedure' OR 'single‐blind procedure'/de OR 'single‐blind procedure' OR ((doubl* NEAR/3 blind*):ab,ti) OR (singl*:ab,ti AND blind*:ab,ti) OR crossover*:ab,ti OR cross+over*:ab,ti OR ((cross NEXT/1 over*):ab,ti)

—

—

#3

hiv or hiv‐1* or hiv‐2* or hiv1 or hiv2 or (hiv near infect*) or (human immunodeficiency virus) or (human immunedeficiency virus) or (human immune‐deficiency virus) or (human immuno‐deficiency virus) or (human immune deficiency virus) or (human immuno deficiency virus) or (acquired immunodeficiency syndrome) or (acquired immunedeficiency syndrome) or (acquired immuno‐deficiency syndrome) or (acquired immune‐deficiency syndrome) or (acquired immun* deficiency syndrome) (Word variations have been searched)

Search (infectious disease transmission, vertical[mh] OR vertical transmission[tiab] OR vertical infect*[tiab] OR infection transmission[tiab] OR mother‐to‐child transmission[tiab] OR MTCT[tiab])

'animal'/de OR 'animal experiment'/de OR 'invertebrate'/de OR 'animal tissue'/de OR 'animal cell'/de OR 'nonhuman'/de

—

—

#4

MeSH descriptor: [Lymphoma, AIDS‐Related] this term only

Search (vitamin A[mh] OR vitamin*[tiab] OR caroten*[tiab] OR retinol[tiab] OR retinoic[tiab] OR micronutrient*[tiab])

'human'/de OR 'normal human'/de OR 'human cell'/de

—

—

#5

MeSH descriptor: [Sexually Transmitted Diseases, Viral] this term only

Search (#1 AND #2 AND #3 AND #4)

#3 AND #4

—

—

#6

#1 or #2 or #3 or #4 or #5

Search (((#1 AND #2 AND #3 AND #4))) AND ("2016/05/20"[Date ‐ Publication] : "2017/08/25"[Date ‐ Publication])

#3 NOT #5

—

—

#7

[mh "infectious disease transmission, vertical"] or "vertical transmission":ti,ab,kw or vertical next infect*:ti,ab,kw or "infection transmission":ti,ab,kw or "mother‐to‐child transmission":ti,ab,kw or MTCT:ti,ab,kw (Word variations have been searched)

—

#2 NOT #6

—

—

#8

[mh "vitamin A"] or vitamin*:ti,ab,kw or caroten*:ti,ab,kw or retinol:ti,ab,kw or retinoic:ti,ab,kw or micronutrient*:ti,ab,kw (Word variations have been searched)

—

'vertical transmission'/de OR 'vertical transmission':ab,ti OR 'infectious disease transmission':ab,ti OR 'mother+to+child transmission':ab,ti OR mtct:ab,ti

—

—

#9

#6 and #7 and #8

—

caroten*:ab,ti OR retinoic:ab,ti OR 'retinol'/de OR retinol:ab,ti OR vitamin*:ab,ti OR 'vitamin a'/de OR micronutrient*:ab,ti

—

—

#10

#6 and #7 and #8 Publication Year from 2016 to 2017

—

#1 AND #7 AND #8 AND #9

—

—

#11

—

—

#1 AND #7 AND #8 AND #9 AND [20‐5‐2016]/sd NOT [25‐8‐2017]/sd

—

—
Figuras y tablas -
Table 1. Search strategy used on 25 August 2017
Ir a la tabla de la revisión
Table 2. Search strategy used on 20 May 2016

Search set

CENTRAL

PubMed

Embase

#1

HIV Infections

HIV Infections OR HIV OR hiv OR hiv‐1* OR hiv‐2* OR hiv1 OR hiv2 OR hiv infect* OR human immunodeficiency virus OR human immunedeficiency virus OR human immuno‐deficiency virus OR human immune‐deficiency virus OR (human immun* AND deficiency virus) OR acquired immunodeficiency syndrome OR acquired immunedeficiency syndrome OR acquired immuno‐deficiency syndrome OR acquired immune‐deficiency syndrome OR (acquired immun* AND deficiency syndrome) OR "sexually transmitted diseases, Viral"

human immunodeficiency virus infection OR human immunodeficiency virus infection OR human immunodeficiency virus infection OR human immunodeficiency virus OR human immunodeficiency virus OR human immunodeficiency virus OR human immunodeficiency virus OR hiv OR hiv‐1 OR hiv‐2 OR human immunodeficiency virus OR human immunedeficiency virus OR human immune‐deficiency virus OR human immuno‐deficiency virus OR acquired immunodeficiency syndrome OR acquired immuno‐deficiency syndrome OR acquired immune‐deficiency syndrome OR acquired immunedeficiency syndrome

#2

HIV

randomized controlled trial OR controlled clinical trial OR randomized OR placebo OR "clinical trials as topic" OR randomly OR trial) NOT (animals NOT humans)

randomized controlled trial OR randomized controlled trial OR random* OR trial OR allocat* OR factorial* OR placebo* OR assign* OR volunteer* OR crossover procedure OR crossover procedure OR double‐blind procedure OR double‐blind procedure OR single‐blind procedure OR single‐blind procedure OR doubl* NEAR/3 blind* OR singl* AND blind* OR crossover* OR cross+over* OR cross NEXT/1 over*

#3

hiv or hiv‐1* or hiv‐2* or hiv1 or hiv2 or hiv near infect* or human immunodeficiency virus or human immunedeficiency virus or human immune‐deficiency virus or human immuno‐deficiency virus or human immune deficiency virus or human immuno deficiency virus or acquired immunodeficiency syndrome or acquired immunedeficiency syndrome or acquired immuno‐deficiency syndrome or acquired immune‐deficiency syndrome or acquired immun* deficiency syndrome

infectious disease transmission, vertical OR vertical transmission OR vertical infect* OR infection transmission OR mother‐to‐child transmission OR MTCT

animal OR animal experiment OR invertebrate OR animal tissue OR animal cell OR nonhuman

#4

Lymphoma, AIDS‐Related

vitamin A OR vitamin* OR caroten* OR retinol OR retinoic OR micronutrient*

human OR normal human OR human cell

#5

Sexually Transmitted Diseases, Viral

1‐4/AND

#3 AND #4

#6

1‐5/OR

5 AND (2010/06/01 NOT 2016/05/20)

#3 NOT #5

#7

infectious disease transmission, vertical or vertical transmission or vertical next infect* or infection transmission or mother‐to‐child transmission or MTCT

—

#2 NOT #6

#8

vitamin A or vitamin* or caroten* or retinol or retinoic or micronutrient*

—

vertical transmission OR vertical transmission OR infectious disease transmission OR mother+to+child transmission OR mtct

#9

6‐8/AND

—

caroten* OR retinoic OR retinol OR retinol OR vitamin* OR vitamin a OR micronutrient*

#10

Limit 9 to publication date 2010‐2016

—

#1 AND #7 AND #8 AND #9

#11

—

—

#10 AND (2010/06/01 NOT 2016/05/20)
Figuras y tablas -
Table 2. Search strategy used on 20 May 2016
Ir a la tabla de la revisión
Table 3. Search strategy used in June 2010

Search set

CENTRAL

PubMed

Embase

#1

MeSH descriptor HIV Infections explode all trees

Search HIV Infections[MeSH] OR HIV[MeSH] OR hiv[tw] OR hiv‐1*[tw] OR hiv‐2*[tw] OR hiv1[tw] OR hiv2[tw] OR hiv infect*[tw] OR human immunodeficiency virus[tw] OR human immunedeficiency virus[tw] OR human immuno‐deficiency virus[tw] OR human immune‐deficiency virus[tw] OR ((human immun*) AND (deficiency virus[tw])) OR acquired immunodeficiency syndrome[tw] OR acquired immunedeficiency syndrome[tw] OR acquired immuno‐deficiency syndrome[tw] OR acquired immune‐deficiency syndrome[tw] OR ((acquired immun*) AND (deficiency syndrome[tw])) OR "sexually transmitted diseases, viral"[MESH:NoExp]

'human immunodeficiency virus infection'/exp OR 'human immunodeficiency virus infection'/de OR 'human immunodeficiency virus infection' OR 'human immunodeficiency virus'/exp OR 'human immunodeficiency virus'/de OR 'human immunodeficiency virus'OR hiv:ti OR hiv:ab OR 'hiv‐1':ti OR 'hiv‐1':ab OR 'hiv‐2':ti OR 'hiv‐2':ab OR 'human immunodeficiency virus':ti OR 'human immunodeficiency virus':ab OR 'human immuno‐deficiency virus':ti OR 'human immuno‐deficiency virus':ab OR 'human immunedeficiency virus':ti OR 'human immunedeficiency virus':ab OR 'human immune‐deficiency virus':ti OR 'human immune‐deficiency virus':ab OR 'acquired immune‐deficiency syndrome':ti OR 'acquired immune‐deficiency syndrome':ab OR 'acquired immunedeficiency syndrome':ti OR 'acquired immunedeficiency syndrome':ab OR 'acquired immunodeficiency syndrome':ti OR 'acquired immunodeficiency syndrome':ab OR 'acquired immuno‐deficiency syndrome':ti OR 'acquired immuno‐deficiency syndrome':ab

#2

MeSH descriptor HIV explode all trees

Search (randomised controlled trial [pt] OR controlled clinical trial [pt] OR randomised [tiab] OR placebo [tiab] OR drug therapy [sh] OR randomly [tiab] OR trial [tiab] OR groups [tiab]) NOT (animals [mh] NOT humans [mh])

random*:ti OR random*:ab OR factorial*:ti OR factorial*:ab OR cross?over*:ti OR cross?over*:ab OR crossover*:ti OR crossover*:ab OR placebo*:ti OR placebo*:ab OR (doubl*:ti AND blind*:ti) OR (doubl*:ab AND blind*:ab) OR (singl*:ti AND blind*:ti) OR (singl*:ab AND blind*:ab) OR assign*:ti OR assign*:ab OR allocat*:ti OR allocat*:ab OR volunteer*:ti OR volunteer*:ab OR 'crossover procedure'/exp OR 'crossover procedure'/de OR 'crossover procedure'OR 'double‐blind procedure'/exp OR 'double‐blind procedure'/de OR 'double‐blind procedure' OR 'single‐blind procedure'/exp OR 'single‐blind procedure'/de OR 'single‐blind procedure' OR 'randomised controlled trial'/exp OR 'randomised controlled trial'/de OR 'randomised controlled trial'

#3

hiv OR hiv‐1* OR hiv‐2* OR hiv1 OR hiv2 OR HIV INFECT* OR HUMAN IMMUNODEFICIENCY VIRUS OR HUMAN IMMUNEDEFICIENCY VIRUS OR HUMAN IMMUNE‐DEFICIENCY VIRUS OR HUMAN IMMUNO‐DEFICIENCY VIRUS OR HUMAN IMMUN* DEFICIENCY VIRUS OR ACQUIRED IMMUNODEFICIENCY SYNDROME OR ACQUIRED IMMUNEDEFICIENCY SYNDROME OR ACQUIRED IMMUNO‐DEFICIENCY SYNDROME OR ACQUIRED IMMUNE‐DEFICIENCY SYNDROME OR ACQUIRED IMMUN* DEFICIENCY SYNDROME

Search mother‐to‐child‐transmission OR MTCT OR infectious disease transmission, vertical

'mother‐to‐child transmission' OR 'mother to child transmission' OR mtct OR 'vertical transmission'/de OR 'vertical transmission'

#4

MeSH descriptor Lymphoma, AIDS‐Related, this term only

Search caroten* OR retinoic OR retinol OR vitamin* OR vitamin A OR micronutrient*

caroten* OR retinoicOR 'retinol'/de OR retinolOR vitamin*OR 'vitamin a'/de OR 'vitamin a'OR micronutrient*

#5

MeSH descriptor Sexually Transmitted Diseases, Viral, this term only

Search #1 AND #2 AND #3 AND #4 Limits: Publication Date from 2007/01/01 to 2010/06/08

#1 AND #2AND #3AND #4

#6

(#1 OR #2 OR #3 OR #4 OR #5)

—

#1 AND #2AND #3AND #4AND [humans]/lim AND [embase]/lim AND [1‐1‐2007]/sd NOT [8‐6‐2010]/sd

#7

mother‐to‐child‐transmission OR MTCT

—

—

#8

MeSH descriptor Infectious Disease Transmission, Vertical, this term only

—

—

#9

(#7 OR #8)

—

—

#10

caroten* OR retinoic OR vitamin* OR vitamin A OR micronutrient*

—

—

#11

(#6 AND #9 AND #10)

—

—

#12

(#6 AND #9 AND #10), from 2007 to 2010

—

—
Figuras y tablas -
Table 3. Search strategy used in June 2010
Ir a la tabla de la revisión
Table 4. Search strategy used in February 2008

Search set

PubMed

Embase

AIDSearch

GATEWAY

#1

Search HIV Infections[MeSH] OR HIV[MeSH] OR hiv[tw] OR hiv‐1*[tw] OR hiv‐2*[tw] OR hiv1[tw] OR hiv2[tw] OR hiv infect*[tw] OR human immunodeficiency virus[tw] OR human immunedeficiency virus[tw] OR human immuno‐deficiency virus[tw] OR human immune‐deficiency virus[tw] OR ((human immun*) AND (deficiency virus[tw])) OR acquired immunodeficiency syndrome[tw] OR acquired immunedeficiency syndrome[tw] OR acquired immuno‐deficiency syndrome[tw] OR acquired immune‐deficiency syndrome[tw] OR ((acquired immun*) AND (deficiency syndrome[tw])) OR "sexually transmitted diseases, viral"[MH]

(('human immunodeficiency virus infection'/exp OR 'human immunodeficiency virus infection') OR ('human immunodeficiency virus infection'/exp OR 'human immunodeficiency virus infection')) OR ((('human immunodeficiency virus'/exp OR 'human immunodeficiency virus') OR ('human immunodeficiency virus'/exp OR 'human immunodeficiency virus'))) OR ((('b cell lymphoma'/exp OR 'b cell lymphoma') OR ('b cell lymphoma'/exp OR 'b cell lymphoma'))) OR (hiv:ti OR hiv:ab) OR ('hiv‐1':ti OR 'hiv‐1':ab) OR ('hiv‐2':ti OR 'hiv‐2':ab) OR ('human immunodeficiency virus':ti OR 'human immunodeficiency virus':ab) OR ('human immunedeficiency virus':ti OR 'human immunedeficiency virus':ab) OR ('human

(HIV INFECTIONS) OR HIV OR HIV OR HIV‐1* OR HIV‐2* OR HIV1 OR HIV2 OR (HIV INFECT*) OR (HUMAN IMMUNODEFICIENCY VIRUS) OR (HUMAN IMMUNEDEFICIENCY VIRUS) OR (HUMAN IMMUNO‐DEFICIENCY VIRUS) OR (HUMAN IMMUNE‐DEFICIENCY VIRUS) OR ((HUMAN IMMUN*) AND (DEFICIENCY VIRUS)) OR (ACQUIRED IMMUNODEFICIENCY SYNDROME) OR (ACQUIRED IMMUNEDEFICIENCY SYNDROME) OR (ACQUIRED IMMUNO‐DEFICIENCY SYNDROME) OR (ACQUIRED IMMUNE‐DEFICIENCY SYNDROME) OR ((ACQUIRED IMMUN*) AND (DEFICIENCY SYNDROME)) OR (SEXUALLY TRANSMITTED DISEASES, VIRAL)

Search: (HIV Infections[MeSH] OR HIV[MeSH] OR hiv[tw] OR hiv‐1*[tw] OR hiv‐2*[tw] OR hiv1[tw] OR hiv2[tw] OR hiv infect*[tw] OR human immunodeficiency virus[tw] OR human immunedeficiency virus[tw] OR human immuno‐deficiency virus[tw] OR human immune‐deficiency virus[tw] OR ((human immun*) AND (deficiency virus[tw])) OR acquired immunodeficiency syndrome[tw]) AND (acquired immunedeficiency syndrome[tw] OR acquired immuno‐deficiency syndrome[tw] OR acquired immune‐deficiency syndrome[tw] OR ((acquired immun*) AND (deficiency syndrome[tw])) OR "sexually transmitted diseases, viral"[MH])

#2

Search randomised controlled trial [pt] OR controlled clinical trial [pt] OR randomised controlled trials [mh] OR random allocation [mh] OR double‐blind method [mh] OR single‐blind method [mh] OR clinical trial [pt] OR clinical trials [mh] OR ("clinical trial" [tw]) OR ((singl* [tw] OR doubl* [tw] OR trebl* [tw] OR tripl* [tw]) AND (mask* [tw] OR blind* [tw])) OR ( placebos [mh] OR placebo* [tw] OR random* [tw] OR research design [mh:noexp] OR (comparative study) OR (comparative studies) OR (evaluation studies) OR follow‐up studies [mh] OR prospective studies [mh] OR control* [tw] OR prospectiv* [tw] OR volunteer* [tw]) NOT (animals [mh] NOT human [mh])

(random*:ti OR random*:ab) OR (factorial*:ti OR factorial*:ab) OR (cross?over*:ti OR cross?over:ab OR crossover*:ti OR crossover*:ab) OR (placebo*:ti OR placebo*:ab) OR (((doubl*:ti AND blind*:ti) OR (doubl*:ab AND blind*:ab))) OR (((singl*:ti AND blind*:ti) OR (singl*:ab AND blind*:ab))) OR (assign*:ti OR assign*:ab) OR (volunteer*:ti OR volunteer*:ab) OR (((('crossover procedure'/exp OR 'crossover procedure') OR ('crossover procedure'/exp OR 'crossover procedure')) OR (('crossover procedure'/exp OR 'crossover procedure') OR ('crossover procedure'/exp OR 'crossover procedure')))) OR (((('double‐blind procedure'/exp OR 'double‐blind procedure') OR ('double‐blind procedure'/exp OR 'double‐blind procedure')) OR (('double‐blind procedure'/exp OR 'double‐blind procedure') OR ('double‐blind procedure'/exp OR 'double‐blind procedure')))) OR (((('single‐blind procedure'/exp OR 'single‐blind procedure') OR ('single‐blind procedure'/exp OR 'single‐blind procedure')) OR (('single‐blind procedure'/exp OR 'single‐blind procedure') OR ('single‐blind procedure'/exp OR 'single‐blind procedure')))) OR (((('randomised controlled trial'/exp OR 'randomised controlled trial') OR ('randomised controlled trial'/exp OR 'randomised controlled trial')) OR (('randomised controlled trial'/exp OR 'randomised controlled trial') OR ('randomised controlled trial'/exp OR 'randomised controlled trial')))) OR (allocat*:ti OR allocat*:ab) AND [2003‐2008]/py

((RANDOMIZED CONTROLLED TRIAL) OR (CONTROLLED CLINICAL TRIAL) OR (RANDOMIZED CONTROLLED TRIALS) OR (RANDOM ALLOCATION) OR (DOUBLE‐BLIND METHOD) OR (SINGLE‐BLIND METHOD) OR (CLINICAL TRIAL) OR (CLINICAL TRIALS) OR ("CLINICAL TRIAL") OR ((SINGL* OR DOUBL* OR TREBL* OR TRIPL* AND (MASK* OR BLIND* )) OR PLACEBOS OR PLACEBO* OR RANDOM* OR (COMPARATIVE STUDY) OR (EVALUATION STUDIES) OR (FOLLOW‐UP STUDIES) OR (PROSPECTIVE STUDIES) OR CONTROL* OR PROSPECTIV* OR VOLUNTEER*)) NOT (ANIMALS NOT HUMAN )

Search: (randomised controlled trial [pt] OR controlled clinical trial [pt] OR randomised controlled trials [mh] OR random allocation [mh] OR double‐blind method [mh] OR single‐blind method [mh] OR clinical trial [pt] OR clinical trials [mh] OR ("clinical trial" [tw]) OR ((singl* [tw] OR doubl* [tw] OR trebl* [tw] OR tripl* [tw]) AND (mask* [tw] OR blind* [tw]))) OR (( placebos [mh] OR placebo* [tw] OR random* [tw] OR research design [mh:noexp] OR (comparative study) OR (comparative studies) OR (evaluation studies) OR follow‐up studies [mh] OR prospective studies [mh] OR control* [tw] OR prospectiv* [tw] OR volunteer* [tw]) NOT (animals [mh] NOT human [mh]))

#3

Search (DISEASE TRANSMISSION, VERTICAL) OR MTCT OR (MOTHER‐TO‐CHILD TRANSMISSION)

'mother‐to‐child transmission' OR mtct OR 'vertical disease transmission' AND [2003‐2008]/py

(MOTHER‐TO‐CHILD TRANSMISSION) OR MTCT OR (VERTICAL DISEASE TRANSMISSION)

Search: (DISEASE TRANSMISSION, VERTICAL) OR MTCT OR (MOTHER‐TO‐CHILD TRANSMISSION)

#4

Search CAROTEN* OR RETINOIC OR RETINOL OR VITAMIN* OR MICRONUTRIENT*

caroten* OR retinoic OR ('retinol'/exp OR 'retinol') OR vitamin* OR micronutrient* AND [2003‐2008]/py

CAROTEN* OR RETINOIC OR RETINOL OR VITAMIN* OR MICRONUTRIENT*

Search: CAROTEN* OR RETINOIC OR RETINOL OR VITAMIN* OR MICRONUTRIENT*

#5

Search PREGNANT OR PREGNANCY OR ANTEPARTUM OR PRENATAL OR ANTE‐PARTUM OR PRE‐NATAL OR PREPART*

pregnant OR ('pregnancy'/exp OR 'pregnancy') OR antepartum OR ('ante partum') OR antenatal OR ('ante natal') OR prenatal OR ('pre natal') AND [2003‐2008]/py

PREGNANT OR PREGNANCY OR ANTEPARTUM OR (ANTE‐PARTUM) OR ANTENATAL OR (ANTE‐NATAL) OR PRENATAL OR (PRE‐NATAL)

Search: PREGNANT OR PREGNANCY OR ANTEPARTUM OR PRENATAL OR ANTE‐PARTUM OR PRE‐NATAL OR PREPART*

#6

Search #1 AND #2 AND #3 AND #4 AND #5 Limits: Publication Date from 2003 to 2008

#1 AND #2 AND #3 AND #4 AND #5

#1 AND #2 AND #3 AND #4 AND #5

#1 and #2 and #3 and #4 and #5 Limit: 2003:2008
Figuras y tablas -
Table 4. Search strategy used in February 2008
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Table 5. Optimal information size calculation

Outcome

Assumed risk

Source

Clinically important relative improvement

Sample size required

HIV infection in child

27/100

Analysis 1.1

25%

1236

Mean birthweight

2964

Analysis 1.2

25%

6178

Low birthweight

17/100

Analysis 1.3

25%

2194

Still birth

3/100

Analysis 1.4

25%

14,264

Preterm birth

20/100

Analysis 1.5

25%

1806

Child death

14/100

Analysis 1.6

25%

2748

Maternal death

3/100

Analysis 1.7

25%

14,264

We based the sample size calculations: 2‐sided tests, with ratio of 1:1, power of 0.8 and confidence level of 0.05.
We performed the sample size calculations using http://www.sealedenvelope.com/power/binary‐superiority/

Figuras y tablas -
Table 5. Optimal information size calculation
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Comparison 1. Vitamin A supplementation versus no vitamin A supplementation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 HIV infection status of the child Show forest plot

5

4428

Risk Ratio (M‐H, Random, 95% CI)

1.07 [0.91, 1.26]

1.1 Antepartum supplementation

2

650

Risk Ratio (M‐H, Random, 95% CI)

0.85 [0.67, 1.09]

1.2 Postpartum supplementation

1

2248

Risk Ratio (M‐H, Random, 95% CI)

1.11 [0.98, 1.27]

1.3 Antepartum and postpartum supplementation

2

1530

Risk Ratio (M‐H, Random, 95% CI)

1.17 [0.86, 1.59]

2 Mean birthweight Show forest plot

3

2181

Mean Difference (IV, Random, 95% CI)

34.12 [‐12.79, 81.02]

3 Low birthweight Show forest plot

3

1819

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.63, 0.97]

4 Child death by two years of age Show forest plot

3

3883

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.92, 1.22]

5 Preterm delivery Show forest plot

2

1577

Risk Ratio (M‐H, Random, 95% CI)

0.84 [0.52, 1.37]

6 Stillbirth Show forest plot

3

2335

Risk Ratio (M‐H, Random, 95% CI)

1.13 [0.72, 1.77]

7 Maternal death Show forest plot

2

1267

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.35, 1.43]

8 Postpartum CD4 count Show forest plot

1

511

Mean Difference (IV, Random, 95% CI)

‐13.0 [‐60.46, 34.46]
Figuras y tablas -
Comparison 1. Vitamin A supplementation versus no vitamin A supplementation
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