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Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes

Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes

Published on: June 28, 2024

The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: a randomized trial

Emily R Smith¹, Alfa Muhihi², Salum Mshamu²

¹Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

International Journal of Epidemiology

|October 30, 2016

Insights

Neonatal vitamin A supplementation (NVAS) did not reduce infant mortality or morbidity. However, maternal vitamin A intake influenced NVAS effectiveness, suggesting a need for further research into this heterogeneity.

Area of Science:

Public Health
Pediatrics
Nutritional Science

Background:

Neonatal vitamin A supplementation (NVAS) is investigated for its potential to decrease infant mortality and illness.
Understanding the efficacy and variability of NVAS is crucial for public health interventions.

Purpose of the Study:

To evaluate the effectiveness of neonatal vitamin A supplementation in reducing infant morbidity and mortality.
To identify factors contributing to the heterogeneity in NVAS effects.

Main Methods:

A randomized, double-blind, placebo-controlled trial was conducted in Tanzania involving 31,999 infants.
Infants received a single dose of vitamin A or placebo within 3 days of birth.
Outcomes including mortality, hospitalization, and morbidity were assessed up to 12 months post-supplementation.

Main Results:

Neonatal vitamin A supplementation did not significantly reduce all-cause infant mortality (RR 1.04; 95% CI 0.92-1.16) or hospitalization rates (RR 1.09; 95% CI 0.97-1.22).
No significant effect on all-cause morbidity was observed (RR 1.00; 95% CI 0.96-1.05).
Maternal postpartum vitamin A supplementation significantly modified the effect of NVAS on infant mortality (P=0.04), increasing risk in infants whose mothers received a mega-dose postpartum.

Conclusions:

Neonatal vitamin A supplementation did not demonstrate efficacy in reducing infant mortality or common morbidities in this trial.
Maternal vitamin A status appears to be a key factor influencing NVAS outcomes, warranting further investigation in pooled analyses.

Read full analysis

Abstract

Background:

: Neonatal vitamin A supplementation (NVAS) is an intervention hypothesized to reduce infant morbidity and mortality. The objective of this study was to assess the efficacy of neonatal vitamin A supplementation in reducing infant morbidity and mortality and assess potential sources of heterogeneity of the effect of NVAS.

Methods:

: We completed an individually randomized, double-blind, placebo-controlled trial in Tanzania. Infants were randomized within 3 days of birth to a single dose of vitamin A (50 000 IU) or placebo. We assessed infants at 1 and 3 days after supplementation, as well as 1, 3, 6 and 12 months after supplementation. We included all live births in the analysis and used relative risks (RR) and 95% confidence intervals (CI) to assess the risks of mortality and hospitalization by 12 months. We used general estimating equations to assess the incidence of morbidities during infancy.

Results:

: A total of 31 999 infants were enrolled in the study between August 2010 and March 2013. At 12 months, vitamin A did not reduce all-cause infant mortality (RR 1.04; 95% CI 0.92-1.16), nor affect hospitalization (RR 1.09; 95% CI 0.97-1.22) or all-cause morbidity (RR 1.00; 95% CI 0.96-1.05). Postpartum maternal vitamin A supplementation modified the effect of neonatal vitamin A supplementation on mortality at 12 months ( P -value, test for interaction = 0.04). Among infants born to women who received a mega-dose of vitamin A after delivery, NVAS appeared to increase the risk of death (RR 1.12; 95% CI 0.98-1.29), whereas the risk of death among infants born to women who did not receive a mega-dose was reduced (RR 0.86; 95% CI 0.70-1.06). We noted no modification of the effect of NVAS by infant gender, birthweight or maternal HIV status.

Conclusion:

: NVAS did not affect the risk of death or incidence of common childhood morbidities. However, this study sheds light on potential sources of heterogeneity of the effect of neonatal vitamin A supplementation which should be further examined in a pooled analysis of all NVAS trials.

Keywords:

Neonatal vitamin A supplementation Tanzania hospitalization infant mortality morbidity

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