Efect of vitamin A suplementation: a systematic review

Soares, Marcela Martins; Silva, Mariane Alves; Garcia, Pauliana Pimentel Coelho; Silva, Luciana Saraiva da; Costa, Glauce Dias da; Araújo, Raquel Maria Amaral; Cotta, Rosângela Minardi Mitre

doi:10.1590/1413-81232018243.07112017

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REVIEW • Ciênc. saúde colet. 24 (3) • Mar 2019 • https://doi.org/10.1590/1413-81232018243.07112017 copy

Efect of vitamin A suplementation: a systematic review

Efeito da suplementação de vitamina A: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

To evaluate the effect of vitamin A supplementation in postpartum infants and women on serum retinol levels and breast milk. The databases Medline, PubMed, Lilacs and SciELO were consulted. The descriptors used were vitamin A, dietary supplement, child, postpartum period, infant and nutrition programs policies. Search found 7432 articles. After elimination of duplicity and application of eligibility criteria, 8 studies remained. All evaluated the effect of vitamin A supplementation on immediate postpartum, five studies used retinyl palmitate supplementation, one with retinyl palmitate and two did not specify the form of supplementation. Six studies evaluated colostrum and two included supplementation of children. It was found that supplementation in the puerperium increases the concentrations of serum retinol and breast milk, however, this result was in the short term and was relevant when the previous concentrations of the mother were low. When maternal serum concentrations are adequate, the retinol content in milk does not change, with little relevance for children. Further studies should be performed to evaluate the effect of megadoses supplementation on serum concentrations of children.

Vitamin A; Nutritional supplements; Postpartum period; Infant

Author/ year	Local/ Design	Sample group	Purpose	Method	Used dosage	Results
Bezerra et al. (2009)	Brazil (RN) Clinical Trial	85 women after delivery	To evaluate the effect of maternal supplementation with a single dose of retinyl palmitate during the postpartum for the supply of vitamin A in the infant.	The sample was divided into 2 groups, one received supplementation postpartum, and measured the concentration of retinol in in the colostrum 24 hours and 30 days after supplementation. The second group was the control group, it was assesses retinol dosage in the colostrum at the same times as the group 1, and was provided supplementation after 30 days of delivery.	200.000 UI	There was an increase of 39% of retinol in the colostrum after supplementation, showing that its effective both in the immediate postpartum period as 30 days later.
Dimenstein et al. (2007)	Brazil (RN) Clinical Trial	33 mothers	To evaluate the effect of supplementation with retinyl palmitate of retinol levels in the colostrum, investigating the influence of maternal variables on those levels.	The sample was collected from blood and the colostrum in the first 24 hours postpartum. It was then administered megadose of retinyl palmitate, and after 6 hours held new collection of colostrum.	200.000 UI	There was an increase of concentration in the colostrum, however, some mothers did not respond to supplementation or had increase lower to 10%. Cesarean section decreased retinol concentration in the serum.
Ayah et al. (2007)	Kenya Random study	564 women after delivery	Evaluate the effectiveness of vitamin A supplementation on postpartum mothers and newborns	The sample was divided in two groups, one received vitamin A supplementation and the other placebo. The groups were monitored and retinol levels were measured in the milk in the 4th, 14th and 26th week and dosed the maternal and infant serum retinol in the 14th and 26th week.	400.000 UI	The retinol concentration was higher in the group that received supplementation. The infant serum retinol did not differ between groups.
Grilo et al. (2015)	Brazil (RN) Intervention study	33 parturients	To investigate the effect of vitamin A supplementation on the retinol concentration in colostrum and in the milk in fasting and postprandial conditions.	The collection of blood and colostrum to retinol dosage was performed. Then administered supplementation with retinyl palmitate. New samples were taken 2 hours after supplementation and the next day.	200.000 UI	Supplementation with retinyl palmitate increased the retinol concentration in the colostrum.
Tchum et al. (2006)	Gana Random study	168 women after delivery	Stablish the duration of vitamin A supplementation in women after receiving doses of vitamin A postpartum.	The samples were divided into two groups, both supplemented postpartum. After 2 weeks a group received supplementation again and the other received placebo, being held dosage retinol serum	200.000 e 400.000 UI	There was no difference of retinol concentrations in the serum between the 2 study groups.
Ribeiro, Araújo e Dimenstein (2009)	Brazil (RN) Transversal study	91 purples	To evaluate the effect of vitamin A supplementation on the retinol levels in the colostrum of mothers attended at a public hospital, analyzing the influence of maternal nutritional status and retinol in the colostrum in response to this supplementation.	The sample was divided into two comparable groups, one without supplements and the other supplemented with 200,000 IU of vitamin A. It has been collected blood and breast milk (milk 0 hour), later was provided a retinol capsule (200,000 IU) for the supplemented group. After 24hr of supplementation, a new collection of colostrum was obtained in both groups (24 hr milk).	200.000 UI	The megadose was effective within the first 24 hr after supplementation. The basal levels of retinol in the colostrum influenced the response to supplementation. The mothers who had low levels of retinol transferred more retinol derived from megadose milk compared to infants with sufficient levels
Martins et al (2010)	Brazil (SP) Clinical Trial	66 pregnant	Assess the impact of vitamin A supplementation on mother and neonate	The sample was divided into 2 groups, in which one of them pregnant women received 200,000 IU of vitamin A and other soybean oil. This supplementation occurred between 20 and 30 days postpartum. Blood and breast milk were collected immediately before supplementation and 3 months after delivery. It collected baby’s blood.	200.000 UI	The increase of retinol level in the serum was observed in the supplemented group compared to pre-supplemented levels. Supplementation had a positive impact on the mother status of vitamin A, but had no effect on the infants status 2 months after a single dose supplementation.
Bezerra et al. (2010)	Brazil (RN) Clinical trial	199 women after immediate delivery	Comparing the effects of postnatal maternal supplementation with 200,000 IU or 400,000 IU of retinol palmitate (2 doses: 200,000 IU + 200,000 IU 24 hours apart) on the retinol concentration in the milk from healthy women.	The sample was randomly divided into 3 groups. Group 1 received a single dose of 200,000 IU of retinol palmitate, group 2 received a double dose of 200,000 with a 24 hr interval between them and group 3 received no supplementation. Retinol content in the colostrum and in he mature milk was measured after 4 weeks.	200.000 UI	The double dose of vitamin A did not significantly increased the concentration of retinol in the milk, after 4 weeks postpartum as compared to single dose

	Bezerra et al., (2009)	Dimenstein et al., (2007)	Ayah et al., (2007)	Grilo et al., (2015)	Tchum et al., (2006)	Ribeiro et al., (2009)	Martins et al., (2010)	Bezerra et al., (2010)
Limitação do estudo (presença de viés)	-1	0	0	-1	0	-1	0	-1
Inconsistência dos resultados	0	0	0	0	0	0	0	0
Evidência indireta	0	-1	0	0	0	0	0	0
Imprecisão	0	-1	0	0	-2	-1	-2	-1
Viés de publicação	0	0	0	0	0	0	0	0
Grande Magnitude de efeito	NA	NA	0	NA	0	0	NA	NA
Gradiente dose – resposta	NA	NA	+2	NA	+2	0	NA	NA
A presença de confundidores ou vieses reduziram o efeito encontrado	NA	NA	+1	NA	+1	+1	NA	NA
Total	3 pontos	2 pontos	5 pontos	3 pontos	3 pontos	3 pontos	2 pontos	2 pontos

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[1] Collaborations

MM Soares, MA Silva and PPC Garcia participated in the article design, information gathering, analysis and writing. LS Silva, GD Costa, RMA Araújo and RMM Cotta contributed to the revision and adequacy of the text.