title: Sex differences in the effects of maternal vitamin supplements on mortality and morbidity among children born to HIV-infected women in Tanzania.
abstract: We examined whether there are sex differences in the effect of vitamin supplements on birth outcomes, mortality and morbidity by 2 years of age among children born to HIV-infected women in Tanzania. A randomised placebo-controlled trial was conducted among 959 mother-infant pairs. HIV-infected pregnant women were randomly assigned to receive a daily oral dose of one of four regimens: multivitamins (vitamins B-complex, C and E), vitamin A plus beta-carotene, multivitamins including vitamin A plus beta-carotene or placebo. Supplements were administered during pregnancy and continued after delivery. The beneficial effect of multivitamins on decreasing the risk of low birth weight was stronger among girls (relative risks (RR) = 0.39, 95 % CI 0.22, 0.67) than among boys (RR = 0.81, 95 % CI 0.44, 1.49; P for interaction = 0.08). Maternal multivitamin supplements resulted in 32 % reduction in mortality among girls (RR = 0.68, 95 % CI 0.47, 0.97), whereas no effect was found among boys (RR = 1.20, 95 % CI 0.80, 1.78; P for interaction = 0.04). Multivitamins had beneficial effects on the overall risks of diarrhoea that did not differ by sex. Vitamin A plus beta-carotene alone increased the risk of HIV transmission, but had no effects on mortality, and we found no sex differences in these effects. Sex differential effects of multivitamins on mortality may be due to sex-related differences in the immunological or genetic factors. More research is warranted to examine the effect of vitamins by sex and better understand biological mechanisms mediating such effects.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. kkawai@hsph.harvard.edu
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kawai
authors.forename: Gernard
authors.initials: G
authors.lastname: Msamanga
authors.forename: Karim
authors.initials: K
authors.lastname: Manji
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villamor
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000209:etiology; D019587:Dietary Supplements; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007226:Infant Mortality; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012307:Risk Factors; D012737:Sex Factors; D013636:Tanzania / Q000453:epidemiology; D014815:Vitamins / Q000494:pharmacology / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014815:Vitamins