title: HIV and other predictors of serum beta-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe.
abstract: BACKGROUND
  Vitamin A status during pregnancy is important to maternal and infant health.
  
  
  OBJECTIVE
  Our goal was to identify predictors of serum beta-carotene and retinol.
  
  
  METHODS
  This was a cross-sectional study of 1669 women (22-35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum alpha1-antichymotrypsin (ACT) on serum beta-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses.
  
  
  RESULTS
  HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum beta-carotene concentrations (geometric x: 0.19 micromol/L) were lower in HIV-infected women than in uninfected women (10beta = 0.78; 95% CI: 0.72, 0.84) and increased with age (10beta = 1.05; 1.02, 1.07) in gravida 1 but not in gravida > or =2 (P for interaction = 0.00002). Serum retinol (x: 0.92 micromol/L) increased with age (beta = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-micromol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum beta-carotene. Serum retinol was lower in women carrying male (beta = -0.04; -0.08, -0.00005) and multiple (beta = -0.21; -0.35, -0.08) fetuses. Serum ACT concentrations of 0.3-0.4, 0.4-0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum beta-carotene and 0.04-, 0.15-, and 0.41-micromol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (beta = 0.10; 0.03, 0.16) and in gravida 1 than in gravida > or =2 (beta = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (beta = 0.001; -0.008, 0.011).
  
  
  CONCLUSIONS
  HIV infection, malaria, gravidity, and gestational age were predictors of serum beta-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.
authors.affiliation: Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark. hfr@kvl.dk
authors.forename: H
authors.initials: H
authors.lastname: Friis
authors.forename: E
authors.initials: E
authors.lastname: Gomo
authors.forename: P
authors.initials: P
authors.lastname: Koestel
authors.forename: P
authors.initials: P
authors.lastname: Ndhlovu
authors.forename: N
authors.initials: N
authors.lastname: Nyazema
authors.forename: H
authors.initials: H
authors.lastname: Krarup
authors.forename: K F
authors.initials: KF
authors.lastname: Michaelsen
mesh_terms: D000210:Acute-Phase Reaction; D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000378:metabolism*; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000097:blood*; D006801:Humans; D016014:Linear Models; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood*; D012621:Seasons; D015842:Serine Proteinase Inhibitors / Q000097:blood; D014801:Vitamin A / Q000097:blood*; D015030:Zimbabwe; D000514:alpha 1-Antichymotrypsin / Q000097:blood; D019207:beta Carotene / Q000097:blood*
chemical_list: D000975:Antioxidants; D015842:Serine Proteinase Inhibitors; D000514:alpha 1-Antichymotrypsin; D019207:beta Carotene; D014801:Vitamin A