Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women.
OBJECTIVE
The effect of daily prenatal and postnatal vitamin supplementation on concentrations of breast milk nutrients is not well characterized in HIV-infected women. We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women.


METHODS
We conducted a randomized, double-blind, placebo-controlled trial. Women were assigned to one of four daily oral supplements: vitamin A+beta-carotene (VA+BC); multivitamins (MV; B, C and E); MV+VA+BC or placebo. Concentrations of breast milk nutrients were determined by high-performance liquid chromatography at birth and every 3 months thereafter.


RESULTS
Supplementation with VA+BC increased concentrations of retinol, beta-carotene and alpha-carotene at delivery by 4799, 1791 and 84 nmol l(-1), respectively, compared to no VA+BC (all P<0.0001). MV supplementation did not increase concentrations of alpha-tocopherol or delta-tocopherol at delivery but significantly decreased concentrations of breast milk gamma-tocopherol and retinol. Although concentrations of all nutrients decreased significantly by 3 months postpartum, retinol, alpha-carotene and beta-carotene concentrations were significantly higher among those receiving VA+BC at 3, 6 and 12 months compared to no VA+BC. alpha-Tocopherol was significantly higher, while gamma-tocopherol concentrations were significantly lower, among women receiving MV compared to no MV at 3, 6 and 12 months postpartum.


CONCLUSIONS
Sustained supplementation of HIV-infected breastfeeding mothers with MV could be a safe and effective intervention to improve vitamin E concentrations in breast milk. VA+BC supplementation increases concentrations of breast milk retinol but it is not recommended in HIV-infected mothers due to the elevated risk of vertical transmission.
Webb
A L
AL
Department of Nutrition, Harvard School of Public Health, Boston, MA 2115, USA.
Aboud
S
S
Furtado
J
J
Murrin
C
C
Campos
H
H
Fawzi
W W
WW
Villamor
E
E
D000328:Adult; D001942:Breast Feeding; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007774:Lactation; D008895:Milk, Human / Q000737:chemistry*; D011247:Pregnancy; D011295:Prenatal Care; D013636:Tanzania; D024505:Tocopherols / Q000032:analysis; D014801:Vitamin A / Q000032:analysis; D014803:Vitamin B Complex / Q000494:pharmacology; D014815:Vitamins / Q000032:analysis* / Q000494:pharmacology*; D055815:Young Adult; D019207:beta Carotene / Q000032:analysis
D014815:Vitamins; D019207:beta Carotene; D014801:Vitamin A; D014803:Vitamin B Complex; D024505:Tocopherols