Abstract
Background/Objective:
The effect of daily prenatal and postnatal vitamin supplementation on concentrations of breast milk nutrients is not well characterized in HIV-infected women. We examined the impact of vitamin supplementation during pregnancy and lactation on breast milk concentrations of retinol, carotenoids and tocopherols during the first year postpartum among 626 HIV-infected Tanzanian women.
Subjects/Methods:
We conducted a randomized, double-blind, placebo-controlled trial. Women were assigned to one of four daily oral supplements: vitamin A+β-carotene (VA+BC); multivitamins (MV; B, C and E); MV+VA+BC or placebo. Concentrations of breast milk nutrients were determined by high-performance liquid chromatography at birth and every 3 months thereafter.
Results:
Supplementation with VA+BC increased concentrations of retinol, β-carotene and α-carotene at delivery by 4799, 1791 and 84 nmol l−1, respectively, compared to no VA+BC (all P<0.0001). MV supplementation did not increase concentrations of α-tocopherol or δ-tocopherol at delivery but significantly decreased concentrations of breast milk γ-tocopherol and retinol. Although concentrations of all nutrients decreased significantly by 3 months postpartum, retinol, α-carotene and β-carotene concentrations were significantly higher among those receiving VA+BC at 3, 6 and 12 months compared to no VA+BC. α-Tocopherol was significantly higher, while γ-tocopherol concentrations were significantly lower, among women receiving MV compared to no MV at 3, 6 and 12 months postpartum.
Conclusions:
Sustained supplementation of HIV-infected breastfeeding mothers with MV could be a safe and effective intervention to improve vitamin E concentrations in breast milk. VA+BC supplementation increases concentrations of breast milk retinol but it is not recommended in HIV-infected mothers due to the elevated risk of vertical transmission.
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Acknowledgements
We thank the mothers and children, field teams including nurses, midwives, supervisors, laboratory staff and the administrative staff who made the study possible. We also thank Muhimbili Medical Centre, Muhimbili University College of Health Sciences and the National AIDS Control Program in Dar es Salaam for their institutional support. This work was supported by grants R01HD045134 and T32DK07703 from the National Institutes of Health. Clinical trials identifier: NCT00197756
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Contributors: AW carried out the data analyses and wrote the initial draft of the manuscript. SA, WWF (principal investigator of the ‘Tanzania Trial of Vitamins’ study) and EV (principal investigator of the ‘Vitamins, Breast Milk HIV Shedding, and Child Health’ study) participated in the study design and implementation in the field. JF, CM and HC carried out the analyses of breast milk samples and contributed to the study implementation. All authors participated in the interpretation of the data and in writing the final draft of the manuscript.
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Webb, A., Aboud, S., Furtado, J. et al. Effect of vitamin supplementation on breast milk concentrations of retinol, carotenoids and tocopherols in HIV-infected Tanzanian women. Eur J Clin Nutr 63, 332–339 (2009). https://doi.org/10.1038/sj.ejcn.1602929
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DOI: https://doi.org/10.1038/sj.ejcn.1602929
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