Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania
Identifieur interne : 001229 ( Main/Exploration ); précédent : 001228; suivant : 001230Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania
Auteurs : Wafaie W. Fawzi [États-Unis] ; Gernard I. Msamanga [Tanzanie] ; Donna Spiegelman [États-Unis] ; Ernest Jn Urassa [Tanzanie] ; Nuala Mcgrath [États-Unis] ; Davis Mwakagile [Tanzanie] ; Gretchen Antelman [États-Unis] ; Roger Mbise [Tanzanie] ; Saidi Kapiga [Tanzanie] ; Walter Willett [États-Unis] ; David J. Hunter [États-Unis] ; Guillermo HerreraSource :
- The Lancet [ 0140-6736 ] ; 1998.
Descripteurs français
- Wicri :
- geographic : Tanzanie.
- topic : Mortalité infantile, Santé publique, Vitamine.
English descriptors
- KwdEn :
- Additional members, Adverse birth outcomes, Adverse pregnancy outcomes, Baseline, Baseline characteristics, Beneficial effect, Beneficial effects, Birth outcomes, Birth weight, Birthweight, Carotene, Categorical variables, Cell count, Cell counts, Child health, Clinical progression, Clinical relevance, Continuous variables, Data analyses, Davis mwakagile, Donna spiegelman, Early reports, Factorial design, Fetal, Fetal death, Fetal deaths, Fetal loss, Gestation, Gestational, Gretchen antelman, Guillermo herrera, Haemoglobin concentrations, Harvard school, Head circumference, Health sciences, Heavier placentas, Higher risks, Human immunodeficiency virus infection, Human immunodeficiency virus type, Infant mortality, Intrauterine growth, Lancet, Lymphocyte subsets, Micronutrient status, Muhimbili university college, Multivitamin, Multivitamin supplementation, Multivitamin supplements, National aids control program, Nuala mcgrath, Overall effect, Placebo, Postpartum, Preformed vitamin, Pregnancy outcomes, Pregnant women, Preterm, Preterm birth, Preterm delivery, Principal investigator, Progression, Public health, Randomisation, Relative risk, Relative risk table, Roger mbise, Saidi kapiga, Serum concentrations, Severe preterm birth, Severe preterm delivery, Significant effect, Significant increase, Small size, Study design, Tanzania, Tanzania vitamin, Treatment effects, Vertical transmission, Vitamin, Vitamin deficiency, Vitamin supplements, Weeks postpartum, Weeks postpartum difference.
- Teeft :
- Additional members, Adverse birth outcomes, Adverse pregnancy outcomes, Baseline, Baseline characteristics, Beneficial effect, Beneficial effects, Birth outcomes, Birth weight, Birthweight, Carotene, Categorical variables, Cell count, Cell counts, Child health, Clinical progression, Clinical relevance, Continuous variables, Data analyses, Davis mwakagile, Donna spiegelman, Early reports, Factorial design, Fetal, Fetal death, Fetal deaths, Fetal loss, Gestation, Gestational, Gretchen antelman, Guillermo herrera, Haemoglobin concentrations, Harvard school, Head circumference, Health sciences, Heavier placentas, Higher risks, Human immunodeficiency virus infection, Human immunodeficiency virus type, Infant mortality, Intrauterine growth, Lancet, Lymphocyte subsets, Micronutrient status, Muhimbili university college, Multivitamin, Multivitamin supplementation, Multivitamin supplements, National aids control program, Nuala mcgrath, Overall effect, Placebo, Postpartum, Preformed vitamin, Pregnancy outcomes, Pregnant women, Preterm, Preterm birth, Preterm delivery, Principal investigator, Progression, Public health, Randomisation, Relative risk, Relative risk table, Roger mbise, Saidi kapiga, Serum concentrations, Severe preterm birth, Severe preterm delivery, Significant effect, Significant increase, Small size, Study design, Tanzania, Tanzania vitamin, Treatment effects, Vertical transmission, Vitamin, Vitamin deficiency, Vitamin supplements, Weeks postpartum, Weeks postpartum difference.
Abstract
Background In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.Methods In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 22 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.Results 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 061 [95 CI 039094] p=002). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44 (056 [038082] p=0003), severe preterm birth (<34 weeks of gestation) by 39 (061 [038096] p=003), and small size for gestational age at birth by 43 (057 [039082] p=0002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.Interpretation Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.
Url:
DOI: 10.1016/S0140-6736(98)04197-X
Affiliations:
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<term>Beneficial effect</term>
<term>Beneficial effects</term>
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<front><div type="abstract">Background In HIV-1-infected women, poor micronutrient status has been associated with faster progression of HIV-1 disease and adverse birth outcomes. We assessed the effects of vitamin A and multivitamins on birth outcomes in such women.Methods In Tanzania, 1075 HIV-1-infected pregnant women at between 12 and 27 weeks' gestation received placebo (n=267), vitamin A (n=269), multivitamins excluding vitamin A (n=269), or multivitamins including vitamin A (n=270) in a randomised, double-blind, placebo-controlled trial with a 22 factorial design. We measured the effects of multivitamins and vitamin A on birth outcomes and counts of T lymphocyte subsets. We did analyses by intention to treat.Results 30 fetal deaths occurred among women assigned multivitamins compared with 49 among those not on multivitamins (relative risk 061 [95 CI 039094] p=002). Multivitamin supplementation decreased the risk of low birthweight (<2500 g) by 44 (056 [038082] p=0003), severe preterm birth (<34 weeks of gestation) by 39 (061 [038096] p=003), and small size for gestational age at birth by 43 (057 [039082] p=0002). Vitamin A supplementation had no significant effect on these variables. Multivitamins, but not vitamin A, resulted in a significant increase in CD4, CD8, and CD3 counts.Interpretation Multivitamin supplementation is a low-cost way of substantially decreasing adverse pregnancy outcomes and increasing T-cell counts in HIV-1-infected women. The clinical relevance of our findings for vertical transmission and clinical progression of HIV-1 disease is yet to be ascertained.</div>
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