title: Plasma and breast milk vitamin A as indicators of vitamin A status in pregnant women.
abstract: Breast milk vitamin A is not well characterized as an indicator of vitamin A status in women with infections. A controlled trial of vitamin A, 3 mg retinol equivalent/day, was conducted among 697 pregnant women with human immunodeficiency virus (HIV) infection in Malawi which allowed comparison of plasma versus breast milk vitamin A as indicators of vitamin A status. Retinol concentrations were measured in plasma at baseline (18-28 weeks) and 38 weeks gestation and breast milk at 6 weeks post-partum. Plasma alpha 1-acid glycoprotein (AGP) and C-reactive protein (CRP) were measured at baseline. Plasma retinol (geometric mean, SD) at 38 weeks was 0.72 (0.44, 1.18) and 0.61 (0.38, 0.98) mumol/L (P < 0.0002) and breast milk retinol was 1.32 (0.71, 2.43) and 0.95 (0.49, 1.82) mumol/L (P < 0.0001) in vitamin A and placebo groups, respectively. Women with elevated acute phase protein (AGP > 1 gm/L and/or CRP > 5 mg/L) at baseline who received vitamin A had significantly higher plasma and breast milk vitamin A at follow-up compared with placebo. Elevated acute phase proteins did not distinguish women with low body stores of vitamin A. Breast milk retinol appears to be a better indicator of vitamin A status than plasma retinol in women with infections.
authors.affiliation: Departments of Ophthalmology and Epidemiology, Johns Hopkins University Schools of Medicine and Hygiene and Public Health, Baltimore, Maryland, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Semba
authors.forename: N
authors.initials: N
authors.lastname: Kumwenda
authors.forename: T E
authors.initials: TE
authors.lastname: Taha
authors.forename: L
authors.initials: L
authors.lastname: Mtimavalye
authors.forename: R
authors.initials: R
authors.lastname: Broadhead
authors.forename: P G
authors.initials: PG
authors.lastname: Miotti
authors.forename: W
authors.initials: W
authors.lastname: Eisinger
authors.forename: D
authors.initials: D
authors.lastname: Hoover
authors.forename: J D
authors.initials: JD
authors.lastname: Chiphangwi
mesh_terms: D000328:Adult; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000378:metabolism*; D006801:Humans; D008295:Malawi; D008895:Milk, Human / Q000737:chemistry*; D009752:Nutritional Status; D009961:Orosomucoid / Q000032:analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000378:metabolism*; D014801:Vitamin A / Q000008:administration & dosage / Q000032:analysis* / Q000097:blood; D014802:Vitamin A Deficiency / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D015415:Biomarkers; D009961:Orosomucoid; D014801:Vitamin A; D002097:C-Reactive Protein