Effect of Vitamin A status during pregnancy on maternal anemia and newborn birth weight: results from a cohort study in the Western Brazilian Amazon



Inadequate Vitamin A (VA) status during pregnancy has been associated with maternal anemia and suboptimal newborn birth weight (BW). We assessed the effect of gestational serum retinol and β-carotene (µmol/L), in different moments during pregnancy, on maternal hemoglobin (Hb, g/L) and anemia (Hb < 110.0 g/L) at delivery, and newborn BW (kg).


In a prospective cohort study in Cruzeiro do Sul, Western Brazilian Amazon, biomarkers of the VA status were assessed in the second and third trimesters in pregnancy. Serum retinol and β-carotene were analyzed considering their effects in each and in both assessments (combined VA status), and the difference of serum values between assessments. Multiple linear and Poisson regression models were used with a hierarchical selection of covariates.


A total of 488 mother–newborn pairs were surveyed. Combined VA deficiency status increased the risk for maternal anemia (adjusted prevalence ratio: 1.39; 95% CI 1.05–1.84), and was negatively associated with maternal Hb (β − 3.30 g/L; 95% CI − 6.4, − 0.20) and newborn BW (β − 0.10 kg; 95% CI − 0.20, − 0.00), adjusted for socioeconomic, environmental, obstetric, and antenatal characteristics, and nutritional indicators. However, the association for newborn BW was no longer significant after further adjustment for plasma ferritin. There were no significant associations between serum β-carotene and the outcomes studied.


Poor serum retinol status throughout pregnancy was associated with maternal anemia at delivery in Amazonian women. The current World Health Organization protocols for supplementation during antenatal care should consider VA status for planning recommendations in different scenarios.

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We are thankful to all participants and professional health workers involved in this study, as well as the State Health Secretariat of Acre, the Municipal Health Secretariat, the Primary Health Care Units, and the maternity hospital of Cruzeiro do Sul. The MINA-Brazil Study was supported by the Brazilian National Council for Scientific and Technological Development (CNPq, grant number 407.255/2013-3); the Maria Cecília Souto Vidigal Foundation; and the São Paulo Research Foundation (FAPESP, grant number 2016/00270-6). PARN received scholarships from the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES, grant number PDSE-88881.133704/2016-01). The funders had no role in the design of the study, the data collection and analyses, the interpretation of the data, the preparation and review of the manuscript, or the decision to submit it. Members of the MINA-Brazil Study Group: Marly Augusto Cardoso (Principal Investigator), Alicia Matijasevich Manitto, Bárbara Hatzlhoffer Lourenço, Maíra Barreto Malta, Paulo Augusto Ribeiro Neves (University of São Paulo, São Paulo, Brazil); Bruno Pereira da Silva, Rodrigo Medeiros de Souza (Federal University of Acre, Cruzeiro do Sul, Brazil); Marcia Caldas de Castro (Harvard T.H. Chan School of Public Health, Boston, USA).

Author information





PARN participated in the data collection and field overseen. PARN, CVRO, and MBM performed the statistical analysis. MCC, BHL, and MAC conceived the study design and methods. PARN wrote the first draft of the article, with critical appraisal by MCC and MAC. PARN and MAC had primary responsibility for final content. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Marly A. Cardoso.

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The authors declare that they have no conflict of interest.

Ethical standards

The MINA-Brazil Study was approved by the School of Public Health, University of São Paulo Ethical Review Board (Number 872.613, Nov 13th, 2014), in accordance with the ethical aspects described by the 1964 Declaration of Helsinki. Written informed consent was introduced to the potential participants and approval obtained by their signatures or from the caregivers for teenage pregnancies.

Additional information

A full list of the MINA-Brazil Study Group members can be found in the Acknowledgements.

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Neves, P.A.R., Castro, M.C., Oliveira, C.V.R. et al. Effect of Vitamin A status during pregnancy on maternal anemia and newborn birth weight: results from a cohort study in the Western Brazilian Amazon. Eur J Nutr 59, 45–56 (2020). https://doi.org/10.1007/s00394-018-1880-1

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  • Vitamin A
  • Pregnancy
  • Hemoglobin
  • Anemia
  • Birth weight
  • Amazon