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American Journal of Clinical Nutrition, Vol. 73, No. 6, 1058-1065, June 2001
© 2001 American Society for Clinical Nutrition

Original Research Communication

HIV and other predictors of serum ß-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe1,2,3

Henrik Friis, Exnevia Gomo, Pernille Kæstel, Patricia Ndhlovu, Norman Nyazema, Henrik Krarup and Kim Fleischer Michaelsen

1 From the Research Department of Human Nutrition, The Royal Veterinary and Agricultural University, Frederiksberg, Denmark; the Danish Bilharziasis Laboratory, Charlottenlund, Denmark; the Blair Research Laboratory, Ministry of Health, Harare, Zimbabwe; the Department of Clinical Pharmacology, University of Zimbabwe, Harare, Zimbabwe; and the Department of Clinical Chemistry, Aalborg University Hospital, Aalborg, Denmark.

Background: Vitamin A status during pregnancy is important to maternal and infant health.

Objective: Our goal was to identify predictors of serum ß-carotene and retinol.

Design: This was a cross-sectional study of 1669 women (22–35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum {alpha}1-antichymotrypsin (ACT) on serum ß-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses.

Results: HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum ß-carotene concentrations (geometric : 0.19 µmol/L) were lower in HIV-infected women than in uninfected women (10ß = 0.78; 95% CI: 0.72, 0.84) and increased with age (10ß = 1.05; 1.02, 1.07) in gravida 1 but not in gravida >=2 (P for interaction = 0.00002). Serum retinol (xx–: 0.92 µmol/L) increased with age (ß = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-µmol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum ß-carotene. Serum retinol was lower in women carrying male (ß = –0.04; –0.08, –0.00005) and multiple (ß = –0.21; –0.35, –0.08) fetuses. Serum ACT concentrations of 0.3–0.4, 0.4–0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum ß-carotene and 0.04-, 0.15-, and 0.41-µmol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (ß = 0.10; 0.03, 0.16) and in gravida 1 than in gravida >=2 (ß = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (ß = 0.001; -0.008, 0.011).

Conclusions: HIV infection, malaria, gravidity, and gestational age were predictors of serum ß-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.

Key Words: Vitamin A • retinol • ß-carotene • reproduction • pregnancy • gestational age • gravidity • HIV • malaria • acute phase response • {alpha}1-antichymotrypsin • women • Zimbabwe




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