Vitamin A supplementation of women postpartum and of their infants at immunization alters breast milk retinol and infant vitamin A status

Rajiv Bahl, Nita Bhandari, Mohammed A. Wahed, Geeta T. Kumar, Maharaj K. Bhan, P. Arthur, B. R. Kirkwood, S. Morris, S. A. Etego, C. Zandoh, O. Boahen, M. E. Penny, C. F. Lanata, B. Butron, A. R. Huapaya, K. B. Rivera, M. A. Wahed, L. H. Moulton, M. Ram, C. L. KjolhedeL. Propper, J. Martines, B. Underwood

Research output: Contribution to journalArticlepeer-review

49 Scopus citations


Vitamin A supplementation of lactating mothers and of infants at the time of diphtheria-pertussis-tetanus (DPT) and oral polio vaccine (OPV) immunizations have both been suggested as measures to prevent deficiency among infants. This multicenter randomized, double-blind, placebo-controlled trial was conducted in Ghana, India and Peru to determine the effect of maternal vitamin A supplementation on breast milk retinol and of maternal and infant supplementation on infant vitamin A status. Mothers in the intervention group received 60 mg vitamin A (as retinol palmitate) at 18-42 d postpartum; their infants were given 7.5 mg three times, i.e., at 6, 10 and 14 wk of age with DPT and OPV immunizations. Mothers and infants in the comparison group received a placebo. Maternal supplementation resulted in higher breast milk retinol at 2 mo postpartum [difference in means 7.1, 95% confidence interval (CI), 3.4, 10.8 nmol/g fat] and lower proportion of mothers with breast milk retinol ≤ 28 nmol/g fat (15.2 vs. 26.6%, 95% Cl of difference -16.6, -4.1%). At 6 and 9 mo, maternal supplementation did not affect breast milk retinol or the proportion of mothers with low breast milk retinol. Vitamin A supplementation of the mothers and their infants reduced the proportion of infants with serum retinol ≤ 0.7 μmol/L (30.4 vs. 37%, 95% Cl of difference - 13.7, 0.6%) and that with low vitamin A stores as indicated by the modified relative dose response (MRDR) > 0.06 (44.2 vs. 52.9%, 95% Cl of difference -16.6, -0.9%) at 6 mo. Supplementation had no effect at 9 mo. The beneficial effect of supplementation on breast milk retinol and infants' vitamin A status varied by site. It was greatest in India followed by Ghana and Peru. At the doses used, maternal supplementation improved breast milk retinol status at 2 mo (P < 0.001) and maternal and infant supplementation modestly increased (P = 0.03) infant vitamin A status at 6 mo of age.

Original languageEnglish (US)
Pages (from-to)3243-3248
Number of pages6
JournalJournal of Nutrition
Issue number11
StatePublished - Nov 1 2002
Externally publishedYes


  • Breast milk retinol
  • Human infants
  • Serum retinol
  • Vitamin A supplementation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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