Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child HIV-1 transmission in Durban, South Africa

Objective: Poor vitamin A status has been associated with a higher risk for mother-to-child transmission of HIV-1 and there is contradictory evidence on the impact of vitamin A on perinatal outcome. We therefore assessed the effect of vitamin A supplementation to mothers on birth outcome and mother- to-child transmission of HIV-1. Design and methods: In Durban, South Africa 728 pregnant HIV infected women received either vitamin A (368) or placebo (360) in a randomized, double-b lind trial. The vitamin A treatment consisted of a daily dose of 5000 IU re tinyl palmitate and 30 mg beta-carotene during the third trimester of pregn ancy and 200 000 IU retinyl palmitate at delivery. HIV infection results we re available on 632 children who were included in the Kaplan-Meier transmis sion analysis. Results are reported on mother-to-child transmission rates u p to 3 months of age. Results: There was no difference in the risk of HIV infection by 3 months o f age between the vitamin A [20.3%; 95% confidence interval (CI), 15.7-24.9 ] and placebo groups (22.3%; 95% CI, 17.5-27.1), nor were there differences in foetal or infant mortality rates between the two groups. Women receivin g vitamin A supplement were, however, less likely to have a preterm deliver y (11.4% in the vitamin A and 17.4% in the placebo group; P = 0.03) and amo ng the 80 preterm deliveries, those assigned to the vitamin A group were le ss likely to be infected (17.9%; 95% CI, 3.5-32.2) than those assigned to t he placebo group (33.8%; 95% CI, 19.8-47.8). Conclusion: Vitamin A supplementation, a low-cost intervention, does not ap pear to be effective in reducing overall mother-to-child transmission of HI V; however, its potential for reducing the incidence of preterm births, and the risk of mother-to-child transmission of HIV in these infants needs fur ther investigation. (C) 1999 Lippincott Williams & Wilkins.