Effects of vitamin A deficiency during pregnancy on maternal and child health

Abstract

Objective To examine the association between biochemical vitamin A deficiency in pregnancy and maternal and fetal health. Design A cross sectional clinical study.Setting Antenatal clinic of nutrition unit of Niloufer Hospital catering for a low socio-economic population, and a private nursing home (Swapna nursing home) catering for a high socio-economic population. Population 736 pregnant women in their third trimester of pregnancy belonging to low (n ¼ 522) and high socio-economic groups (n ¼ 214). Methods All the women were subjected to a detailed clinical, anthropometric and obstetric examination. Night blindness was assessed by administering the standard WHO questionnaire. Birthweight and gestational age of the infants, maternal anaemia and development of pregnancy-induced hypertension in the mother were recorded. Haemoglobin and serum retinol were estimated at the time of recruitment to the study. Main outcome measures Serum retinol levels, anaemia, pregnancy-induced hypertension, birthweight and gestational age of the infant. Results Night blindness was observed in 2.9% of the women and subclincal vitamin A deficiency (serum retinol <20 Ag/dL with no clinical signs) in 27% of the women. Moderate to severe anaemia was observed in 41.2% of the women, and 15.8% of the women developed pregnancy-induced hypertension. Sixty-one (9.4%) women delivered preterm. Univariate analysis identified a significant association between serum retinol <20 Ag/dL and preterm delivery (OR ¼ 1.74, 95% CI 1.03 -2.96), maternal anaemia (OR ¼ 1.82, 95% CI 1.28-2.60) and pregnancy-induced hypertension (OR ¼ 1.56, 95% CI 1.02-2.83). After adjusting for the confounding variables (body mass index, parity, age and socio-economic status) in a multivariate analysis, the significant associations between serum retinol <20 Ag/dL and preterm delivery ( P ¼ 0.02) and anaemia ( P ¼ 0.003) persisted, while that for pregnancy-induced hypertension disappeared ( P ¼ 0.71). Conclusion The study suggests that subclinical vitamin A deficiency is a problem during the third trimester of pregnancy. Serum concentration of retinol <20 Ag/dL appears to indicate a deficient status, and is associated with an increased risk of preterm delivery and maternal anaemia.

Scientific Opinion on Dietary Reference Values for vitamin A

“…In a systematic review, vitamin A supplementation during pregnancy was found to reduce anaemia risk (haemoglobin < 11.0 g/dL) among both anaemic and non-anaemic women (Thorne-Lyman and Fawzi, 2012). This is consistent with observational and intervention studies in women and children which showed correlations between anaemia and vitamin A deficiency and the amelioration of anaemia by improving vitamin A status in deficient populations (Radhika et al, 2002;Semba and Bloem, 2002;Al-Mekhlafi et al, 2013). In non-anaemic subjects, a test meal containing 1 000 µg retinol did not enhance iron absorption (Walczyk et al, 2003).…”

Deficiencia de vitamina A en adolescentes no gestantes y gestantes de Maracaibo, Venezuela

“…La deficiencia de vitamina A (DVA) es un problema de salud pública en el mundo, que durante el embarazo se ha asociado con incremento en la morbilidad y mortalidad materna e infantil (16,17). Estudios en humanos y animales gestantes con concentraciones anormales de retinol sérico, han descrito la aparición de anormalidades obstétricas como malformaciones fetales, retardo del crecimiento intrauterino y abortos espontáneos durante la gestación (16,17).…”

“…Estudios en humanos y animales gestantes con concentraciones anormales de retinol sérico, han descrito la aparición de anormalidades obstétricas como malformaciones fetales, retardo del crecimiento intrauterino y abortos espontáneos durante la gestación (16,17). En estudios de mujeres gestantes con bajos niveles séricos de vitamina A se han reportado un mayor riesgo de infecciones puerperales y genitourinarias (18), pre-eclampsia (19), bajo peso neonatal o parto prematuro (20).…”

Relación Entre Los Niveles De Ácido Todo Trans-Retinoico en Sangre De Cordón Umbilical Y Medidas Antropométricas Del Recién Nacido

“…Algunos autores han señalado que una concentración sérica menor a 30 µg/dL podría definirse como deficiente durante el embarazo (21). Adicionalmente, se ha descrito que probablemente la baja ingesta de vitamina A contribuya a la aparición de la anemia durante el embarazo, de alta prevalencia en Sudamérica, ya que esta vitamina contribuye a la absorción y utilización del hierro, factor que no fue determinado en el presente estudio (22,23).…”