Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study.
BACKGROUND
Anemia is prevalent in infants in developing countries. Its etiology is multifactorial and includes vitamin A deficiency.


OBJECTIVE
Our primary aim was to measure the effect of maternal or neonatal vitamin A supplementation (or both) on hemoglobin and anemia in Zimbabwean infants. Our secondary aim was to identify the underlying causes of postnatal anemia.


METHODS
A randomized, placebo-controlled trial was conducted in 14 110 mothers and their infants; 2854 infants were randomly selected for the anemia substudy, of whom 1592 were successfully observed for 8-14 mo and formed the study sample. Infants were randomly assigned within 96 h of delivery to 1 of 4 treatment groups: mothers and infants received vitamin A; mothers received vitamin A and infants received placebo; mothers received placebo and infants received vitamin A; and mothers and infants received placebo. The vitamin A doses were 400,000 and 50,000 IU in the mothers and infants, respectively.


RESULTS
Vitamin A supplementation had no effect on hemoglobin or anemia (hemoglobin <105 g/L) in unadjusted or adjusted analyses. Infant HIV infection independently increased anemia risk >6-fold. Additional predictors of anemia in HIV-negative and -positive infants were male sex and lower total body iron at birth. In addition, in HIV-positive infants, the risk of anemia increased with early infection, low maternal CD4+ lymphocyte count at recruitment, and frequent morbidity. Six-month plasma ferritin concentrations <12 microg/L were a risk factor in HIV-negative but not in HIV-positive infants. Maternal HIV infection alone did not cause anemia.


CONCLUSIONS
Prevention of infantile anemia should include efforts to increase the birth endowment of iron and prevent HIV infection.
Miller
Melissa F
MF
Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA. millermeli@mail.nih.gov
Stoltzfus
Rebecca J
RJ
Iliff
Peter J
PJ
Malaba
Lucie C
LC
Mbuya
Nkosinathi V
NV
Humphrey
Jean H
JH
D000328:Adult; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005293:Ferritins / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D009752:Nutritional Status; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014801:Vitamin A / Q000008:administration & dosage* / Q000097:blood; D014802:Vitamin A Deficiency / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D014815:Vitamins / Q000008:administration & dosage / Q000097:blood; D015030:Zimbabwe / Q000453:epidemiology
D006454:Hemoglobins; D014815:Vitamins; D014801:Vitamin A; D005293:Ferritins