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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
United Nations Children’s Fund and World Health Organization (2004) Low birthweight: country, regional and global estimates. UNICEF. https://www.unicef.org/publications/index_24840.html. Accessed Nov 2017
World Health Organisation (2006) Promoting optimal fetal development: report of a technical consultation. WHO. http://www.who.int/nutrition/publications/fetomaternal/9241594004/en/. Accessed Sep 2017
World Health Organization (2009) Global prevalence of vitamin A deficiency in populations at risk. WHO. http://www.who.int/vmnis/vitamina/prevalence/en/. Accessed Sep 2017
Strobel M, Tinz J, Biesalski H (2007) The importance of β-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women. Eur J Nutr 46(Suppl. 1):I1–I20
Checkley W, West KP, Wise RA et al (2010) Maternal vitamin A supplementation and lung function in offspring. N Engl J Med 362:1784–1794
Cohen JM, Kahn SR, Platt RW et al (2015) Small-for-gestational-age birth and maternal plasma antioxidant levels in mid-gestation: a nested case-control study. BJOG 122:1313–1321
West KP, Shamim AA, Mehra S et al (2014) Effect of maternal multiple micronutrient vs iron-folic acid supplementation on infant mortality and adverse birth outcomes in rural Bangladesh: the JiVitA-3 randomized trial. JAMA 312:2649–2658
World Health Organization (2012) Guideline: daily iron and folic acid supplementation in pregnant women. WHO. http://apps.who.int/iris/handle/10665/77770. Accessed Nov 2017
Mathews F, Youngman L, Neil A (2004) Maternal circulating nutrient concentrations in pregnancy: implications for birth and placental weights of term infants. Am J Clin Nutr 79:103–110
Thorne-Lyman AL, Fawzi WW (2012) Vitamin A and carotenoids during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 26(Suppl. 1):36–54
McCauley ME, van den Broek N, Dou L et al (2015) Vitamin A supplementation during pregnancy for maternal and newborn outcomes. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008666.pub3
Cunha MSB, Hankins CNA, Arruda SF (2018) Effect of vitamin A supplementation on iron status in humans: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. https://doi.org/10.1080/10408398.2018.1427552)
Handel M, Moon RJ, Titcombe P et al (2016) Maternal serum retinol and β-carotene concentrations and neonatal bone mineralization: results from the Southampton Women’ s survey cohort. Am J Clin Nutr 104:1183–1188
Gebremedhin S, Enquselassie F, Umeta M (2012) Independent and joint effects of prenatal zinc and vitamin A deficiencies on birthweight in rural Sidama, Southern Ethiopia: prospective cohort study. PLoS ONE. https://doi.org/10.1371/journal.pone.0050213
Fall CH, Fisher DJ, Osmond C et al (2009) Multiple micronutrient supplementation during pregnancy in low-income countries: a meta-analysis of effects on birth size and length of gestation. Food Nutr Bull 30(Suppl. 4):S533–S546
Instituto Brasileiro de Geografia e Estatística (2017) Cidades. IBGE. https://cidades.ibge.gov.br/v4/brasil/ac/cruzeiro-do-sul/panorama. Accessed Aug 2017
United Nations Development Program (2010) Human Development Report 2010. The real wealth of the nations: pathways to Human Development. UNPD. http://hdr.undp.org/sites/default/files/reports/270/hdr_2010_en_complete_reprint.pdf. Accessed Aug 2017
Pincelli A, Neves PAR, Lourenço BH et al (2018) The hidden burden of Plasmodium vivax malaria in pregnancy in the Amazon: an observational study in Northwestern Brazil. Am J Trop Med Hyg 99:73–83
Ministério da Saúde do Brasil (2010) Guia prático de tratamento da malária no Brasil. MS. http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_malaria.pdf. Accessed Mar 2018
Filmer D, Pritchett LH (2001) Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography 38:115–132
World Health Organization (1995) Physical status: the use and interpretation of anthropometry.WHO. http://www.who.int/childgrowth/publications/physical_status/en/. Accessed Aug 2017
De Onis M, Onyango AW, Borghi E et al (2007) Development of a WHO growth reference for school-aged children and adolescents. Bull World Heal Organ 85:812–819
Institute of Medicine (2013) Implementing guidelines on weight gain and pregnancy. IOM. https://www.nap.edu/catalog/18292/implementing-guidelines-on-weight-gain-and-pregnancy. Accessed Jan 2018
Gomes LF, Alves AF, Sevanian A et al (2004) Role of β2-glycoprotein I, LDL-, and antioxidant levels in hypercholesterolemic elderly subjects. Antioxid Redox Signal 6:237–244
World Health Organization (2017) Nutritional anaemias: tools for effective prevention.WHO. http://www.who.int/nutrition/publications/micronutrients/anaemias-tools-prevention-control/en/. Accessed Mar 2018
World Health Organization (2014) C-reactive protein concentrations as a marker of inflammation or infection for interpreting biomarkers of micronutrient status. WHO. http://www.who.int/nutrition/publications/micronutrients/indicators_c-reactive_protein/en/. Accessed Apr 2018
Villar J, Cheikh Ismail L, Victora CG et al (2014) International standards for newborn weight, length, and head circumference by gestational age and sex: the newborn cross-sectional study of the INTERGROWTH-21st Project. Lancet 384:857–868
Barros AJ, Hirakata VN (2003) Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 3:21
Smith ER, Shankar AH, Wu LS-F et al (2017) Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries. Lancet Glob Health 5(11):e1090–e1100
Michelazzo FB, Oliveira JM, Stefanello J et al (2013) The influence of vitamin A supplementation on iron status. Nutrients 5:4399–4413
Semba RD, Bloem MW (2002) The anemia of vitamin A deficiency: epidemiology and pathogenesis. Eur J Clin Nutr 56:271–281
van Stuijvenberg ME, Schoeman SE, Nel J et al (2017) Serum retinol in post-partum mothers and newborns from an impoverished South African community where liver is frequently eaten and vitamin A deficiency is absent. Matern Child Nutr 13(1). https://doi.org/10.1111/mcn.12223
Instituto Brasileiro de Geografia e Estatística (2016) Síntese de indicadores sociais: uma análise das condições de vida da população brasileira. IBGE. https://biblioteca.ibge.gov.br/visualizacao/livros/liv98965.pdf. Accessed May 2018
Miranda AE, Pinto VM, Szwarcwald CL et al (2012) Prevalence and correlates of preterm labor among young parturient women attending public hospitals in Brazil. Rev Panam Salud Pública 32:330–334
Katona P, Katona-Apte J (2008) The interaction between nutrition and infection. Clin Infect Dis 46:1582–1588
Wiseman EM, Bar-El Dadon S, Reifen R (2017) The vicious cycle of vitamin A deficiency: a review. Crit Rev Food Sci Nutr 57:3703–3714
Haider BA, Bhutta ZA (2017) Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004905.pub5
Garcêz LS, Lima GSP, Paiva AA et al (2016) Serum retinol levels in pregnant adolescents and their relationship with habitual food intake, infection and obstetric, nutritional and socioeconomic variables. Nutrients 8(669). https://doi.org/10.3390/nu8110669
King CJ (2000) Physiology of pregnancy and nutrient metabolism. Am J Clin Nutr 71:1218S–1225S
Augusto RA, Cobayashi F, Cardoso MA (2014) Associations between low consumption of fruits and vegetables and nutritional deficiencies in Brazilian schoolchildren. Publ Health Nutr 18:927–935
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).
Conflict of interest
The authors declare that they have no conflict of interest.
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.
A full list of the MINA-Brazil Study Group members can be found in the Acknowledgements.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
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
- Vitamin A
- Birth weight