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ORIGINAL RESEARCH COMMUNICATION |
1 From the Departments of Nutrition (EV, ES, AB, DJH, and WWF), Biostatistics (RJB), and Epidemiology (EH, DJH, and WWF) and the Center for Biostatistics in AIDS Research (RJB), Harvard School of Public Health, Boston, MA, and the Departments of Pediatrics and Child Health (KM) and Community Health (GM), Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
Background: Linear growth retardation and wasting are common in children born to HIV-infected women. Inexpensive interventions that could improve the postnatal growth pattern of such children are needed.
Objective: The objective was to examine the effect of supplementing HIV-infected women with multivitamins or vitamin A and ß-carotene, during and after pregnancy, on the growth of their children during the first 2 y of life.
Design: We conducted a randomized placebo-controlled trial in 886 mother-infant pairs in Tanzania. At the first prenatal visit, HIV-infected women were randomly assigned to 1 of 4 daily oral regimens in a 2 x 2 factorial fashion: multivitamins (MV: thiamine, riboflavin, vitamin B-6, niacin, vitamin B-12, vitamin C, vitamin E, and folic acid), preformed vitamin A + ß-carotene (VA/BC), MV including VA/BC, or placebo. Supplementation continued during the first 2 y postpartum and thereafter. Children were weighed and measured monthly, and all received vitamin A supplements after 6 mo of age per the standard of care.
Results: Multivitamins had a significant positive effect on attained weight (459 g; 95% CI: 35, 882; P = 0.03) and on weight-for-age (0.42; 95% CI: 0.07, 0.77; P = 0.02) and weight-for-length (0.38; 95% CI: 0.07, 0.68; P = 0.01) z scores at 24 mo. VA/BC seemed to reduce the benefits of MV on these outcomes. No significant effects were observed on length, midupper arm circumference, or head circumference.
Conclusion: Supplementation of HIV-infected women with multivitamins (vitamin B complex, vitamin C, and vitamin E) during pregnancy and lactation is an effective intervention for improving ponderal growth in children.
Key Words: Children • HIV infection • multivitamins • vitamin A • growth • length • weight • wasting • underweight • Tanzania
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