title: Effects of vitamin A and β-carotene supplementation on birth size and length of gestation in rural Bangladesh: a cluster-randomized trial.
abstract: BACKGROUND
  Micronutrient deficiencies may be related to poor fetal growth and short gestation. Few studies have investigated the contribution of maternal vitamin A deficiency to these outcomes.
  
  
  OBJECTIVE
  In rural northwestern Bangladesh, we examined the effects of weekly antenatal vitamin A and β-carotene supplementation on birth weight, length, circumferential body measures, and length of gestation.
  
  
  METHODS
  With the use of a cluster-randomized, placebo-controlled trial design, pregnant women were enrolled in the first trimester and began receiving their allocated supplements (vitamin A, β-carotene, or placebo) weekly until 3 mo postpartum. Birth anthropometric measures were made at home.
  
  
  RESULTS
  Of 13,709 newborns whose birth weight was measured within 72 h of birth, mean (±SD) weight was 2.44 ± 0.42 kg, the prevalence of low birth weight (LBW) was 54.4%, and that of small-for-gestational age (SGA) was 70.5%. Birth weight, length, and chest, head, and arm circumferences did not differ between supplementation and placebo groups nor did rates of LBW and SGA. Mean gestational age at birth was 38.3 ± 2.9 wk, and 25.6% of births occurred before 37 wk. Neither gestational age nor preterm birth rate differed with vitamin A or β-carotene supplementation.
  
  
  CONCLUSIONS
  In this rural South Asian population with a high burden of LBW and preterm birth but modest levels of maternal vitamin A deficiency, antenatal vitamin A or β-carotene supplementation did not benefit these birth outcomes. Other nutritional and nonnutritional interventions should be examined to reduce risks of these adverse outcomes in rural South Asia. This trial was registered at clinicaltrials.gov as NCT00198822.
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. pchristi@jhsph.edu
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
authors.forename: Rolf
authors.initials: R
authors.lastname: Klemm
authors.forename: Abu Ahmed
authors.initials: AA
authors.lastname: Shamim
authors.forename: Hasmot
authors.initials: H
authors.lastname: Ali
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rashid
authors.forename: Saijuddin
authors.initials: S
authors.lastname: Shaikh
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.forename: Alain
authors.initials: A
authors.lastname: Labrique
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001724:Birth Weight / Q000187:drug effects; D016000:Cluster Analysis; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D039382:Maternal Nutritional Physiological Phenomena; D018977:Micronutrients / Q000008:administration & dosage / Q000172:deficiency; D049590:Postpartum Period / Q000187:drug effects; D011247:Pregnancy; D047928:Premature Birth / Q000178:diet therapy / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000150:complications / Q000188:drug therapy; D055815:Young Adult; D019207:beta Carotene / Q000008:administration & dosage*
chemical_list: D018977:Micronutrients; D019207:beta Carotene; D014801:Vitamin A