title: Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study.
abstract: 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.
authors.affiliation: Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA. millermeli@mail.nih.gov
authors.forename: Melissa F
authors.initials: MF
authors.lastname: Miller
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Iliff
authors.forename: Lucie C
authors.initials: LC
authors.lastname: Malaba
authors.forename: Nkosinathi V
authors.initials: NV
authors.lastname: Mbuya
authors.forename: Jean H
authors.initials: JH
authors.lastname: Humphrey
mesh_terms: 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
chemical_list: D006454:Hemoglobins; D014815:Vitamins; D014801:Vitamin A; D005293:Ferritins