Vitamin A or β-Carotene Supplementation Reduces Symptoms of Illness in Pregnant and Lactating Nepali Women

Abstract

The contribution of nutritional interventions to the reduction in maternal morbidity rates in developing countries is not well known. We assessed the impact of weekly vitamin A and beta-carotene supplementation on the prevalence of pregnancy and postpartum illness symptoms among 15,832 Nepali women in a placebo-controlled, double-masked, cluster-randomized trial. There was no impact of either supplement on morbidity rates reported up to 28 wk of gestation, inclusive. However, in late pregnancy (>28 wk), symptoms of nausea, faintness and night blindness were reduced with vitamin A, but not beta-carotene, supplementation. Vitamin A supplementation shortened the length of labor by 1.5 h 50 min among nulliparous and multiparous women, respectively. Both interventions reduced the postpartum prevalence of at least four loose stools and night blindness. beta-Carotene supplementation also reduced symptoms of high fever postpartum. The mean number of days of any reported illness symptoms was 3-4 per wk throughout pregnancy. Among women receiving vitamin A, the total number of days of illness symptoms accrued over the last 12 wk of pregnancy was lower by 5 d compared with the placebo recipients. We found the burden of pregnancy-related illness symptoms to be high in this rural area of Nepal where antenatal care is poor and most deliveries occur at home. Maternal vitamin A or beta-carotene supplementation resulted in a reduction in the prevalence of selected illness symptoms during late pregnancy, at the time of birth and during 6 mo postpartum, suggesting that a diet adequate in vitamin A may be important for improving women's reproductive health.

Vitamin A deficiency and xerophthalmia among school-aged children in Southeastern Asia

“…While blinding xerophthalmia seems to be exceedingly rare, other less apparent or specific health consequences of VA deficiency known to exist in younger children, such as increased severity of diarrhea (Sommer & West, 1996), could contribute to the burden of disease in this age group and should not be assumed to be absent. Furthermore, beyond plausible risk of comorbidity, given that maternal night blindness recurs with repeated pregnancy during the reproductive years in high-risk populations (Katz et al, 1995), it is possible that adolescent VA deficiency antecedes and predicts chronic maternal VA deficiency and its apparent health consequences (Christian et al, , 2000a(Christian et al, , b, 2001West et al, 1999). This latter possibility would confer far greater importance to the need to quantify the prevalence and severity, and understand the epidemiology of VA deficiency in early adolescence.…”

“…There are also an estimated 7.2 million pregnant women with VA deficiency (serum retinol o0.7 mmol/l) at any one time in the developing world, of whom B6 million are night blind (West, 2002), a condition attributable to VA deficiency (Christian, 2002). Gestational and postpartum VA deficiency may increase the risk of maternal morbidity (Christian et al, , 2000a and mortality (West et al, 1999;Christian et al, 200b) and infant mortality (Christian et al, 2001). A high maternal prevalence of low VA status (based on serum retinol o1.05 mmol/l) during pregnancy (eg, 22.0% in Africa and 24.3% in South Asia) (West, 2002), coupled with evidence of recurrent night blindness in repeated pregnancies, suggests that the nutritional problem is likely to be chronic, with antecedent risk possibly starting earlier in childhood and pubescence; that is, 5-15 y of age.…”

Papel da vitamina A na prevenção do estresse oxidativo em recém-nascidos

“…2 A partir da segunda metade dessa década, evidências apontaram que a carência subclínica, sem sinais como xeroftalmia (mancha de Bitot e ceratomalácia), também poderia ter impacto negativo na morbidade e mortalidade de RN, pré-escolares, mulheres em idade fértil, gestantes, puér-peras e nutrizes, os grupos tradicionalmente considerados "de risco nutricional". [4][5][6][7][8][9]31 Estima-se que 150 milhões de mulheres e crianças no mundo apresentam a DVA, 4,4 milhões de pré-escolares apresentam xeroftalmia e 6,2 milhões de mulheres desenvolvam cegueira noturna durante a gestação. 32 Aproximadamente 500.000 crianças evoluem para a cegueira nutricional irreversível anualmente.…”

“…47 Entre esses, o ß-caroteno é o mais potente precursor de retinol1 4,20,47 e durante muito tempo apenas essa função foi estudada. 17 Independente de sua atividade de pró-vitamina A os carotenóides são responsáveis por outros efeitos benéficos para a saúde humana.…”

“…2 Posteriormente, as conseqüências da deficiência de vitamina A (DVA) sobre a função imune, assim como seu reflexo nas taxas de morbimortalidade, em especial no grupo materno-infantil, foram estabelecidas. [3][4][5][6][7][8][9] A VA atua no metabolismo intermediário, na síntese de ácido ribonucléico (RNA) e proteínas, enzimas, globulinas, glicoproteínas, queratina, na permeabilidade celular e nos metabolismos da hemoglobina e do zinco. 1 Blaner,10 revisando os mecanismos moleculares da ação da vitamina A, sugere que esse micronutriente participa dos receptores nucleares e seus ativadores, que regulam a expressão de genes relacionados ao metabolismo da triiodo-tironina, estrogênio, progesterona, cortisol, aldosterona, testosterona, vitamina D, colesterol e ácidos graxos.…”