Maternal postpartum vitamin A supplementation for the prevention of mortality and morbidity in infancy: a systematic review of randomized controlled trials.
BACKGROUND
Maternal postpartum vitamin A supplementation (VAS) provides an opportunity to improve vitamin A nutriture of breast fed infants in developing countries and can possibly prevent infant mortality and morbidity attributable to vitamin A deficiency.


OBJECTIVE
To evaluate the effect of maternal postpartum VAS on infant mortality, morbidity and adverse effects.


METHODS
Systematic review, meta-analysis and meta-regression of randomized controlled trials.


METHODS
Electronic databases and abstracts and proceedings of micronutrient conferences.


METHODS
Randomized or quasi-randomized, placebo-controlled trials evaluating the effect of postpartum, maternal synthetic VAS on mortality or morbidity within infancy (<1 year), or adverse effects.


RESULTS
The seven included trials were from developing countries. There was no evidence of a reduced risk of mortality during infancy [relative risk (RR) 1.05, 95% confidence interval (CI) 0.92-1.20, P = 0.438; I² = 0%, P = 0.940]. No variable emerged as a significant predictor of mortality but data for high-risk groups (high maternal night blindness prevalence and low birth weights) was restricted. Neonatal mortality data was available from a single study, (RR 1.09, 95% CI 0.88-1.35; P = 0.422). In two trials, there was no evidence of a reduced risk of cause-specific mortality. In one trial, there was no evidence of a decrease in either diarrhoea or acute respiratory infection. No adverse effects were reported in the single relevant trial.


CONCLUSIONS
There is no evidence of a mortality or morbidity benefit to the infant following postpartum maternal VAS. Only prevention of infant morbidity or mortality would be sufficient justification for initiating this intervention in public health programmes.
Gogia
Siddhartha
S
Max Hospital, Gurgaon, Haryana, India. gogiasiddhartha@gmail.com
Sachdev
Harshpal S
HS
D001724:Birth Weight; D001942:Breast Feeding; D015984:Causality; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D009755:Night Blindness / Q000453:epidemiology; D049590:Postpartum Period; D016032:Randomized Controlled Trials as Topic; D014801:Vitamin A / Q000008:administration & dosage*; D014815:Vitamins / Q000008:administration & dosage*
D014815:Vitamins; D014801:Vitamin A