Night blindness of pregnancy in rural Nepal--nutritional and health risks

Christian, Parul; West, Keith P.; Khatry, Subarna K.; Katz, Joanne; Shrestha, S. R.; Pradhan, Elizabeth Kimbrough; LeClerq, Steven C.; Pokhrel, Ram Prasad

doi:10.1093/ije/27.2.231

Cited by 165 publications

(140 citation statements)

References 25 publications

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“…Women were asked to recall the number of times they had consumed 38 different types of vitamin A-and carotenoid-rich foods from a list that was developed using formative research on commonly consumed sources of vitamin A and b-carotene in this area of Nepal. Previously, we have shown that vitamin A and b-carotene food intakes, using the 7-day food frequency recall, were significantly associated with functional and biochemical indicators of vitamin A status such as maternal night blindness (Christian et al, 1998b) and low serum retinol (West et al, 1999) and carotenoid concentrations (Yamini et al, 2001). Mid-upper-arm circumference (MUAC), as a measure of nutritional status, was measured at both times.…”

Section: Methodsmentioning

confidence: 99%

Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of β-carotene and vitamin A supplementation

et al. 2004

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Objective: We examined risk factors of smoking and the association between smoking and pregnancy-related and 6-month infant mortality in rural Nepal, where 30% women reported smoking during pregnancy. Design: Cross-sectional analysis of risk factors associated with smoking status and health consequences of smoking, using prospective data collected as part of a randomized community trial to examine the effect of maternal vitamin A or b-carotene supplementation on maternal mortality. Setting: Rural, southeastern plains of Nepal. Subjects and methods: A total of 17 767 women contributed at least one pregnancy during 3.5 y of the study. Data on cigarette or bidi (rolled tobacco) smoking were collected using a 7-day recall, twice during pregnancy. Associations between smoking status and maternal diet, morbidity profile, household socioeconomic status and serum concentration of retinol, carotenoids and tocopherols were examined. Further, relative risk (RR) and 95% confidence intervals (CI) were calculated to estimate supplement effects on pregnancy-related mortality, stratified by smoking status during pregnancy. Results: Smokers were more likely to be older, illiterate and poor compared to nonsmokers. Fruit and vegetable consumption among smokers and nonsmokers did not vary. However, smokers were more likely to consume meat/fish/eggs and less likely to consume milk than nonsmokers. They were also more likely to report symptoms of vaginal bleeding, edema, severe headache and convulsions during pregnancy relative to nonsmokers. Mortality per 100 000 pregnancies appeared to be higher among smokers than nonsmokers in the placebo group (915 vs 584, RR ¼ 1.57, 95% CI: 0.80-3.08). b-Carotene supplementation reduced pregnancy-related mortality both among smokers (RR ¼ 0.31 95% CI: 0.11-0.89) and nonsmokers (RR ¼ 0.41, 95% CI: 0.19-0.89). Similar results obtained with vitamin A supplementation were not statistically significant. Infant mortality up to 6 months was B30% higher among smokers compared to nonsmokers in the placebo group both before and after adjusting for confounding factors. Neither supplement given to women reduced infant mortality. Conclusions: Cigarette smoking during pregnancy is associated with an increased risk of maternal and infant mortality in rural Nepal. b-Carotene and to some extent vitamin A may reduce the risk of pregnancy-related mortality, but not infant mortality, among both smokers and nonsmokers.

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Section: Methodsmentioning

confidence: 99%

Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of β-carotene and vitamin A supplementation

et al. 2004

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“…VAD has adverse effects on health, particularly during infancy, childhood and pregnancy because of the rapid growth, proliferation and tissue development that happen in these phases of life. Vitamin A deficient women were found to be more susceptible to illnesses of both infectious such as frequent infection of mucous surface of hallow viscera (Christian et al, 1998) and non-infectious (eclampsia, pre-eclampsia, premature rupture of membrane) nature (Mikhail et al, 1994;Barrett et al, 1994;Ziari et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

Dark adaptation pattern of pregnant women as an indicator of functional disturbance at acceptable serum vitamin A levels

Wondmikun

2002

Eur J Clin Nutr

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Background: As a result of lack of precise guidelines, nutritional surveys on adults and high-risk groups are using diverse reference values as a dividing line between normal and deficient vitamin A status. Objective: To investigate whether pregnant women at marginally normal serum retinol status exhibit functional alteration that are characteristic of a deficiency state. Setting: Antenatal clinic, Gondar teaching hospital. Subjects: Ninety-six healthy pregnant women were recruited for the study at the antenatal clinic. Intervention: The dark adaptation time was tested in 48 pregnant women with marginal serum retinol level. The time lapse to see successive light stimuli of diminishing luminescence grade and change in retinal sensitivity pattern was measured using dark adaptometer. Results were compared with the results of a control group of women of similar age, parity and gestational period but with serum retinol values above 35 mg=dl. Results: The mean serum retinol levels of cases and controls were 23.35 mg=dl and 40.47 mg=dl respectively (P < 0.008). Cases have a lower dark adaptation than their controls, shown by their remarkably reduced sensitivity to light. For instance at mean final light threshold was 72.20 AE 0.11 log cd=m 2 in cases as compared to 72.88 AE 0.1 log cd=m 2 in the normal group (P < 0.001). Conclusion: During pregnancy, dark adaptation was strongly associated with serum retinol concentration and women with marginal vitamin A concentration had lower dark adaptation. Hence marginally normal serum retinol levels should be categorized as a deficiency state, at least in pregnant women.

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“…Tal valor está sendo aplicado com freqüência crescente para definir a deficiência da vitamina A em gestantes, puérperas, recém-nascidos, pré-escolares e escolares (3,10,13,14) . Ressalta-se que esse ponto de corte já foi inter-validado com o teste terapêutico (+S30DR) e com o RDR (28) , além de apresentar associação com alterações funcionais da visão (11,12,27,30,31) . O International Vitamin A Consultive Group também registrou diversos estudos que reforçam a utilização do referido ponto de corte para diagnosticar a deficiência da vitamina A em variados grupos populacionais (32) .…”

Section: Discussionunclassified

Análise crítica de estudos brasileiros sobre deficiência de vitamina A no grupo materno-infantil

Ramalho

Padilha

Saunders

2008

Rev. paul. pediatr.

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OBJETIVO: Apresentar uma análise crítica de estudos da literatura sobre a deficiência de vitamina A (DVA) no Brasil, segundo o indicador bioquímico retinol sérico, considerando-se o impacto negativo da DVA na saúde reprodutiva e no desenvolvimento infantil. FONTES DE DADOS: os bancos de dados Medline e BVS, no período de 1994 a 2007, foram rastreados com a combinação de descritores: "vitamin A deficiency", "Brazil", "pregnant", "children" e "retinol serum level". A inclusão dos artigos foi realizada com base em critérios de elegibilidade referentes à população, desenho do estudo e idioma, enfatizando-se estudos com gestantes, puérperas, nutrizes, lactentes e pré-escolares que não apresentassem doenças crônicas não-transmissíveis ou infecciosas. SÍNTESE DOS DADOS: dos 27 artigos selecionados, 25 eram estudos transversais, um era caso-controle e um estudo longitudinal. Identificou-se que 71% e 25% dos trabalhos com gestantes e crianças, respectivamente, adotaram valores de retinol sérico <1,05µmol/L como ponto de corte. Todos os estudos apontaram a DVA como um problema de proporção preocupante. Reconhece-se a emergente inserção dos adolescentes no grupo de risco potencial para DVA e da antropometria como variável independente para tal deficiência nutricional. CONCLUSÕES: Aponta-se uma necessidade de incluir estratégias de intervenção adicionais à suplementação, reavaliar pontos de corte na interpretação do diagnóstico da DVA e refletir sobre a pertinência da inclusão de novas áreas e grupos com risco potencial para DVA em programas de intervenção.

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Night blindness of pregnancy in rural Nepal--nutritional and health risks

Cited by 165 publications

References 25 publications

Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of β-carotene and vitamin A supplementation

Cigarette smoking during pregnancy in rural Nepal. Risk factors and effects of β-carotene and vitamin A supplementation

Dark adaptation pattern of pregnant women as an indicator of functional disturbance at acceptable serum vitamin A levels

Análise crítica de estudos brasileiros sobre deficiência de vitamina A no grupo materno-infantil

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