title: Maternal multivitamin supplementation reduces the risk of diarrhoea among HIV-exposed children through age 5 years.
abstract: BACKGROUND
  The aim of this study was to determine whether maternal vitamin supplementation affects long-term mortality and morbidity of children born to HIV-infected mothers.
  
  
  METHODS
  In total, 1078 HIV-infected pregnant woman were enrolled in a double-blind, 2×2 factorial, randomised, placebo-controlled trial in Tanzania. Data were collected for 874 children at monthly clinic visits through a median age of 51 months.
  
  
  RESULTS
  Maternal receipt of multivitamins (HR=0.93; 95% CI: 0.70-1.22) or vitamin A (HR=1.00; 95% CI: 0.76-1.32) did not affect all-cause child mortality through age 5 years. Among HIV-negative children, maternal multivitamin supplementation was associated with a lower mortality rate up to 5 years (HR=0.60; 95% CI: 0.38-0.95), primarily in children <2 years of age. Maternal vitamin A supplementation did not significantly affect child mortality up to 5 years (HR=0.76; 95% CI: 0.48-1.20). Children born to mothers who received multivitamins had a lower risk of all types of diarrhoea (RR=0.86; 95% CI: 0.75-0.98) through 5 years of age. The reduced risk of watery diarrhoea persisted in children from 2-5 years of age (RR=0.71; 95% CI: 0.54-0.95).
  
  
  CONCLUSIONS
  Maternal vitamin supplementation during pregnancy and lactation may be associated with long-lasting affects in HIV-exposed children [ClinicalTrials.gov Identifier: NCT00197743].
authors.affiliation: Division of GI/Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Pediatrics, Stanford University, Palo Alto, CA 94306, USA.
authors.forename: Nasim
authors.initials: N
authors.lastname: Khavari
authors.affiliation: Division of GI/Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Hongyu
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Departments of Community Medicine and Pediatrics, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania.
authors.forename: Karim
authors.initials: K
authors.lastname: Manji
authors.affiliation: Departments of Community Medicine and Pediatrics, Muhimbili University of Health and Allied Sciences, United Nations Road, Dar es Salaam, Tanzania.
authors.forename: Gernard
authors.initials: G
authors.lastname: Msamanga
authors.affiliation: Departments of Nutrition, Epidemiology, Biostatistics, Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.affiliation: Departments of Nutrition, Epidemiology, Biostatistics, Global Health and Population, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Wafaie
authors.initials: W
authors.lastname: Fawzi
authors.affiliation: Division of GI/Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA Christopher.Duggan@childrens.harvard.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000517:prevention & control*; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D039382:Maternal Nutritional Physiological Phenomena; D011247:Pregnancy; D013636:Tanzania / Q000453:epidemiology; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D014815:Vitamins
keywords: Child mortality; Diarrhoea; HIV; Infection; Maternal nutrition; Respiratory tract