Maternal vitamin A or beta-carotene supplementation in lactating Bangladeshi women benefits mothers and infants but does not prevent subclinical deficiency

The effects of maternal postpartum vitamin A or beta-carotene supplementati on on maternal and infant serum retinol concentrations, modified relative d ose-response (MRDR) ratios and breast milk vitamin A concentrations were as sessed during a community-based trial in Matlab, Bangladesh. At 1-3 wk post partum, women were randomly assigned to receive either (1) a single dose of 200,000 international units [60,000 retinol equivalents (RE)] vitamin A fo llowed by daily placebos (n = 74), (2) daily doses of beta-carotene [7.8 mg (1300 RE)] (n = 73) or (3) daily placebos (n = 73) until 9 mo postpartum. Compared to placebos, vitamin A supplementation resulted in lower maternal MRDR ratios (i.e., increased liver stores) and higher milk vitamin A concen trations at 3 mo, but these improvements were not sustained. The beta-carot ene supplementation acted more slowly, resulting in milk vitamin A concentr ations higher than the placebo group only at 9 mo. Irrespective of treatmen t group, over 50% of women produced milk with low vitamin A concentrations (less than or equal to 1.05 mu mol/L or less than or equal to 0.28 mu mol/g fat) throughout the study. Overall, mean maternal serum retinol concentrat ions were not affected by supplementation. Compared to the placebo group, t he mean MRDR ratio of 6-mo-old infants was higher in the vitamin A group, I nfants (33%) had serum retinol concentrations <0.70 mu mol/L and 88% had MR DR ratios greater than or equal to 0.06. We conclude that while both interv entions were beneficial, neither was sufficient to correct the underlying s ubclinical vitamin A deficiency in these women nor to bring their infants i nto adequate vitamin A status.