The State of the World's Children 1998: Focus on Nutrition

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Vitamin A supplements save pregnant women's lives

Photo: A mother and child in Nepal, where a recent study showed that weekly vitamin A supplements given to pregnant women substantially reduced maternal deaths.

Each year, nearly 600,000 women die worldwide from pregnancy-related causes. Prenatal vitamin A supplements will help reduce this massive toll, according to preliminary results from a major new study. By measuring the impact of low weekly doses of the vitamin on the health and survival of pregnant women in southern Nepal, the study found that deaths among women receiving either low-dose vitamin A or beta-carotene supplements dropped dramatically, by an average 44 per cent.

Like many parts of the developing world, Nepal has a notoriously high maternal mortality rate - 125 times that of the United States - and vitamin A deficiency is common, par ticularly among pregnant women. Night-blindness, long ignored by the medical establishment and viewed by women as a routine consequence of pregnancy, but in reality a worrying sign of vitamin A deficiency, develops in 10 to 20 per cent of pregnant women.

Researchers from Johns Hopkins University in the United States and the National Society for Eye Health and Blindness Prevention in Nepal, supported by the United States Agency for International De vel op ment (USAID) and Task Force Sight and Life, based in Switzerland, conducted the study to see whether maternal, foetal or infant mortality could be lowered by providing wo men of childbearing age one low-dose vitamin A capsule each week. Night-blindness and anaemia in wo men in the study and birth defects in their infants were also care fully investigated.

Approximately 44,000 young married women, nearly half of whom became pregnant during the study, were given either vitamin A supplements or placebos. The supplements were in the form of either pure vitamin A or beta-carotene, the vitamin A-active ingredient found in fruits and vegetables that the body converts to vitamin A.

Among the women receiving pure vitamin A there were 38 per cent fewer deaths and among those receiving beta-carotene there were 50 per cent fewer deaths, during pregnancy and the three months following childbirth, than among women receiving no supplements.b Anaemia, which is usually associated with iron deficiency and which is known to be a contributing cause of maternal deaths, was a surprising 45 per cent lower in the women receiving supplements who were not infected with hookworm.

Women suffering from night-blindness (an inability to see at dusk or in dim light) were found to be more likely to get infections, to be anaemic and underweight and to be at greater risk of death. Night-blindness was reduced by 38 per cent and 16 per cent, respectively, in the vitamin A and beta-carotene groups, leaving questions about the most appropriate mix of nutrients, and the amounts needed, to prevent the condition. No reduction in foetal or infant mortality through six months of age was apparent in children born to women in the study.

The scientists have not yet completed analysing the effects of supplements on the different causes of maternal deaths. However, deaths from infection are one important cause of high maternal mortality rates, and vitamin A is known to be essential for the effective functioning of the immune system that reduces the severity of infection.

The results of this study indicate that where vitamin A deficiency is common, the regular and adequate intake of vitamin Ac or beta-carotene by women during their reproductive years can markedly reduce their risk of pregnancy-related mortality. Adequate intake of vitamin A may also dramatically reduce anaemia in pregnant wo men if combined with deworming.

This study helps highlight the urgent need to improve the nutrition of girls and women as part of a multi-pronged approach to reduce the tragedy of maternal mortality in the developing world and opens the way to new prevention strategies that can be widely implemented in the near future.

NOTES

a. The low-dose supplements contained 7,000 micrograms of retinol equivalents (RE) (23,300 IU) of vitamin A, or a similar amount of beta-carotene, which is approximately equivalent to a woman's weekly requirement.

b. Deaths were reduced from 713 per 100,000 pregnancies in the group of women not receiving supplements to 443 and 354 deaths per 100,000 respectively in women receiving the weekly vi tamin A and beta-carotene supplements.

c. Although found in many foods, vitamin A has powerful biological effects and care is essential to prevent the misuse of supplements, especially by pregnant women. High-dose (200,000 IU) vitamin A supplements of the type routinely provided at four to six monthly intervals to young children in developing countries should never be taken by women of childbearing age because of the risk of possible harm to a developing foetus. High-dose supplements may, however, be safely given to women within eight weeks following childbirth. Low-dose weekly vitamin A supplements, like those given in this study, and even lower-dose daily supplements can be taken by women during their reproductive years with little risk to mother or foetus and with considerable benefit wherever deficiency is likely.

 

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