Gannon, B. M., Jones, C., & Mehta, S. (2020). Vitamin A Requirements in Pregnancy and Lactation. Current developments in nutrition, 4(10), nzaa142. https://doi.org/10.1093/cdn/nzaa142
Gannon BM, Jones C, Mehta S. Vitamin A Requirements in Pregnancy and Lactation. Current developments in nutrition. 2020;4(10):nzaa142. doi:10.1093/cdn/nzaa142
Gannon, B. M., et al. "Vitamin A Requirements in Pregnancy and Lactation." Current developments in nutrition, vol. 4, no. 10, 2020, pp. nzaa142.
A mother's vitamin A intake can affect her status, milk and child
A narrative review of MEDLINE research from 2000 to 2019 concludes that a mother's vitamin A intake can affect her own vitamin A status, her breastmilk, and some child health outcomes. The evidence is intermediate and indirect. Steady dietary sources of vitamin A can lead to more sustained status in mothers and children.
Key Findings
The authors searched MEDLINE for studies published between January 1, 2000, and December 28, 2019, and grouped them by how maternal intake links to mother and child outcomes.
In NHANES data from 2001–2014, 15% of 1003 pregnant women in the US, ages 20 to 40, fell short of the Estimated Average Requirement for vitamin A, even with supplements.
In a 2015 Cochrane review with meta-analysis, vitamin A supplementation showed no association with maternal mortality (RR: 0.88; 95% CI: 0.65, 1.20).
In a Norwegian case-control study, the highest quarter of maternal vitamin A intake had lower odds of cleft palate than the lowest quarter (OR: 0.47; 95% CI: 0.24, 0.94).
Teratogenic effects of excess vitamin A are rare. An earlier review by Azaïs-Braesco and Pascal counted fewer than 20 reports over the preceding 30 years.
Interpretation
The review is a narrative synthesis. It draws on earlier reviews, meta-analyses, and human and animal studies. Results come from observational work, supplementation trials with mixed findings, and animal models. The authors report no direct evidence that links a mother's vitamin A intake to her own or her child's outcomes, so the 2001 reference intakes are estimates. They call for studies that measure intake, better markers of body stores, and work on how retinol crosses the placenta.
RRM Context
Restorative reproductive medicine looks for root causes, and nutrient status belongs in that search. The review reports that continuous food-based vitamin A sources can lead to more sustained status than high-dose supplements. That fits the restorative aim of working with the body. Deficiency and excess both carry risks in pregnancy, so each woman's status is a clinical question.
Our editorial summary of this paper, not the article's abstract.
Abstract
Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.
Clinical Guidelines and Standards › Guideline Appraisal › Evidence Base and Strength of Recommendation · Lifestyle and Environment › Nutrition and Metabolic Health › Micronutrients and Supplements · Postpartum › Infant Feeding › Breastfeeding Support
Bryan M Gannon, Camille Jones, Saurabh Mehta
B Gannon, C Jones, S Mehta
PMID 32999954 32999954 DOI 10.1093/cdn/nzaa142 10.1093/cdn/nzaa142 Gannon et al. 2020, Gannon 2020
