Maternal low-dose vitamin A or β-carotene supplementation has no effect on fetal loss and early infant mortality: a randomized cluster trial in Nepal

Katz, Joanne; West, Keith P.; Khatry, Subarna K.; Pradhan, Elizabeth Kimbrough; LeClerq, Steven C.; Christian, Parul; Wu, Lee; Adhikari, Ramesh; Shrestha, Sharada Ram; Sommer, Alfred

doi:10.1093/ajcn/71.6.1570

Cited by 107 publications

(69 citation statements)

References 36 publications

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“…This is in line with the findings of Katz et al, (2000), who found that foetal loss and early infant mortality were not reduced when Nepalese women were supplemented weekly with vitamin A during pregnancy. However vitamin A supplementation was beneficial in terms of reducing mortality in pregnant women (West et al, 1999).…”

Section: Discussionsupporting

confidence: 91%

“…Inadequate maternal nutrition during pregnancy is thought to be one of the contributors to this (Frongillo, 1999;Waterlow & Schürch, 1994;Kusin et al, 1992). Vitamin A supplementation of women before and during pregnancy has been shown to reduce maternal nightblindness and mortality (West et al, 1999;Christian et al, 1998) and improve serum retinol levels in infants (Katz et al, 2000;Schmidt et al, 2001). However it did not reduce foetal loss or early infant mortality (Katz et al, 2000) and other outcomes of infants have not been reported so far.…”

Section: Introductionmentioning

confidence: 99%

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Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

et al. 2002

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OBJECTIVE:To investigate whether supplementation with vitamin A together with iron of Indonesian pregnant women decreases morbidity and improves growth of their infants during the first year of life. DESIGN: Women from a rural area in West Java, Indonesia, were randomly assigned on an individual basis to double-blind supplementation once weekly from $ 18 weeks of pregnancy until delivery. Supplementation comprised 120 mg iron and 500 mg folic acid with or without 4800 RE vitamin A. Their newborn infants were followed up during the first year of life: weight, length, morbidity and food intake were assessed monthly. RESULTS: Infants whose mothers had taken vitamin A supplements during pregnancy had similar weight, length, weight gain and growth as their counterparts during the follow-up period. The proportions of infants with reported symptoms of morbidity were similar in the vitamin A plus iron group and the iron group. In addition immunisation coverage and feeding mode did not differ between the groups. All infants were breast-fed, but exclusive breast-feeding rapidly declined at 4 months of age. Infants with serum retinol concentrations > 0.70 mmol=l increased their weight and length more during the first 6 months of life and had higher weight-for-age Z-scores during the first year of life than infants with serum retinol concentrations 0.70 mmol=l. Serum retinol concentrations were not associated with morbidity. CONCLUSION: In this study, vitamin A supplementation in conjunction with iron supplementation of pregnant women did not improve growth or reduce morbidity of their infants during the first year of life.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

et al. 2002

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“…In the low-lying plains of Nepal, called 'Terai,' mortality related to pregnancy was as high as 704 deaths per 100 000 live births (West et al, 1999), being 100 times higher than that of Japan, that is, 7.3 in 2002 (Health andWelfare Statistics Association, 2004). The 24-week infant mortality rate in this area was 70.8 per 1000 live births (Katz et al, 2000), more than 10 times higher than that in the developed world. Katz et al (2003) pointed out that maternal undernutrition during pregnancy was strongly associated with infant mortality and Christian et al (2004) revealed potential effects of intervention by means of supplementation of micronutrients on improvement of maternal and infant health and survival.…”

Section: Introductionmentioning

confidence: 63%

Gender differences in dietary intake among adults of Hindu communities in lowland Nepal: assessment of portion sizes and food consumption frequencies

Sudo

Sekiyama

Maharjan³

et al. 2005

Eur J Clin Nutr

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Objective: To elucidate gender differences in dietary intake among adults in lowland Nepalese communities. Subjects and methods: For 122 male and 195 female subjects aged 20 years and over from 94 randomly selected households, interviews using a 19-item food frequency questionnaire were conducted. To determine the portion sizes of these foods, the samples consumed by 56 subjects in a full 1-day period were weighed. Energy expenditure was estimated by time spent on daily activities. Results: Gender differences in per-day energy and protein intakes were related to sex differences in body size and energy expenditure. Apparent gender differences in the crude intakes disappeared when they were expressed by nutrient density (mg or mg/MJ) since micronutrient intakes were significantly correlated with energy intake. However, males' iron intake was larger even after adjustment for energy intake, attributing to their larger portion sizes of commonly consumed staple foods and higher frequencies of consuming luxury foods (fish and tea). Conclusion: The intrahousehold unequal distribution of food incurs risk of iron deficiency among female subjects.

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“…27 Maternal vitamin A supplementation significantly reduced maternal mortality in Nepal by 40%, 28 although there was no impact on infant mortality through age 6 months. 29 Vitamin A supplementation early in the newborn period, however, is under evaluation as a potentially promising approach. 30 Several trials suggest calcium supplementation can lower rates of preterm delivery and might be effective in preventing pre-eclampsia.…”

Section: Maternal Nutritionmentioning

confidence: 99%

Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities

et al. 2002

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Despite global declines in under-five and infant mortality rates in recent decades, neonatal mortality rates have remained relatively unchanged.1 Mortality during the first 28 days of life now accounts for two-thirds of deaths in children less than 1 year of age, and nearly four-tenths of all deaths in children less than 5 years of age.2 -4 A recent analysis found that the loss of healthy life from newborn deaths represented 8.2% and 13.6% of the burden of disease in Sub-Saharan Africa and South Asia, respectively, or 27 and 53 million years of life lost in those two respective regions alone. 5 The analysis, however, highlighted the dearth of information available on neonatal outcomes in developing countries, particularly at the community level, and the potential for currently available figures to underestimate the magnitude of the problem. Thus, epidemiological research is needed to make available more accurate data on risk factors and causes of neonatal morbidity and mortality, and improved and validated neonatal verbal autopsy instruments are needed in order to collect accurate data.For every death during the neonatal period, it is estimated that another stillbirth has occurred; when combined with the two-thirds of neonatal deaths that occur during the first week of life, perinatal deaths nearly equal the number of deaths during the entire first year of life. 6,7 Estimates from the World Bank suggest that perinatal deaths account for approximately 7% of the global burden of disease, exceeding that due to malaria and vaccine-preventable infections combined. 8 Worldwide, 98% of all neonatal deaths occur in developing countries, most often at home, outside the formal health care system, and largely due to infections (32%), birth asphyxia and injuries (29%), and consequences of prematurity and congenital anomalies (34%).9 Infections may account for approximately half of newborn deaths at the community level.10 Low birth weight (LBW) is an overriding factor in the majority of the deaths. 1Conditions that affect the neonate, including LBW, impact not only neonatal mortality but also long-term morbidity through effects on neurological and cognitive development and associations with chronic diseases such as diabetes, cardiovascular disease and chronic lung disease.11 Thus, interventions that prevent morbidity during the neonatal period have the potential to be highly cost-effective and impact health far beyond the neonatal period.In this review, we present a conceptual framework for maternal and neonatal health care, and in this context, propose priority research activities to improve perinatal and neonatal health and survival in developing country communities. CONCEPTUAL FRAMEWORK AND CONTEXT OF NEONATAL HEALTH CARE AND RESEARCHImproving newborn health and survival depends in large measure on more effectively implementing what we already know works.Although post -neonatal and child mortality rates have declined dramatically in many developing countries in recent decades, neonatal mortality rates have remained relati...

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Maternal low-dose vitamin A or β-carotene supplementation has no effect on fetal loss and early infant mortality: a randomized cluster trial in Nepal

Cited by 107 publications

References 36 publications

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

Randomised double-blind trial of the effect of vitamin A supplementation of Indonesian pregnant women on morbidity and growth of their infants during the first year of life

Gender differences in dietary intake among adults of Hindu communities in lowland Nepal: assessment of portion sizes and food consumption frequencies

Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities

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