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Guideline: Vitamin A Supplementation in Postpartum Women. Geneva: World Health Organization; 2011.

Cover of Guideline: Vitamin A Supplementation in Postpartum Women

Guideline: Vitamin A Supplementation in Postpartum Women.

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Summary of evidence

Three systematic reviews (2022) have addressed the effects and safety of vitamin A supplementation in postpartum women. The first review evaluated the effect of postpartum vitamin A supplements on maternal and infant health (20). It included 12 studies comparing maternal vitamin A supplementation (β-carotene or retinyl palmitate or water miscible formulation) alone or in combination with other micronutrients, with placebo, no intervention, or administration of other micronutrients or a lower dose of vitamin A, commencing at any time during the postpartum period (within 24 hours of giving birth until 6 weeks after giving birth). The studies included mothers residing in low-income settings in India, Bangladesh, Indonesia, Tanzania, the Gambia, Zimbabwe, Kenya, Ghana and Peru. Thus the women were likely to have low vitamin A levels as well as low nutritional status. One study evaluated maternal mortality at 12 months postpartum and reported no significant effect of administration of 400 000 IU vitamin A within 24–96 hours of giving birth (hazard ratio (HR) 1.11; 95% confidence interval (CI) 0.81–1.51). Only one study assessed adverse effects and it found no difference in the incidence of vomiting within 30 hours of administering a single dose of 400 000 IU vitamin A or a placebo (risk ratio (RR) 0.33; 95% CI 0.03–3.14). Four trials reported no difference overall in infant mortality following vitamin A supplementation compared with placebo (RR 1.14; 95% CI 0.84–1.57).

The other reviews (21, 22) evaluated the effect of vitamin A supplementation in postpartum mothers on mortality, morbidity and adverse effects in their infants until the age of 1 year. Seven studies from low- and middle-income countries (three in Asia and four in Africa) were included in the meta-analysis, which revealed no impact on infant mortality (RR 1.00; 95% CI 0.94–1.06). Only two trials documented information on the cause of death and there was no evidence of a reduced risk of death due to respiratory causes (RR 1.59; 95% CI 0.84 to 2.99) or diarrhoea (RR 2.57; 95% CI 0.72 to 9.12). The one trial that reported morbidity found no effect on the risk of diarrhoea (RR 1.10; 95% CI 0.99–1.23) or acute respiratory infection (rate ratio 0.96; 95% CI 0.85–1.08). Two trials reported adverse effects, but in both studies no adverse effects were observed in either the intervention or the control group during the follow-up. These reviews included three studies that were not included in the first review mentioned above (20). These additional studies involved supplementation with smaller, weekly doses of vitamin A before or during pregnancy until delivery or 12–24 weeks' postpartum. The cumulative vitamin A dose received by the mother over this period was reported in one of these studies, as less than or equal to 200 000 IU, and in the remaining six studies it was greater than 200 000 IU. No significant differences were identified with regard to outcomes when the data were stratified based on either the total vitamin A dose (units) received by the mothers (less than or equal to 200 000 IU versus greater than 200 000 IU) or by the number of vitamin A doses received (single versus multiple).

The overall quality of available evidence for maternal mortality, maternal morbidity and adverse effects was graded as low or very low (Annex 1). Data for all-cause infant mortality was graded as high quality, however, the quality of evidence for cause-specific infant mortality and morbidity was graded as very low.

Copyright © World Health Organization 2011.

All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

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Bookshelf ID: NBK185189
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