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Vitamin supplementation for prevention of mother-to-child transmission of HIV and pre-term delivery: a systematic review of randomized trial including more than 2800 women.

Mills EJ, Wu P, Seely D, Guyatt GH - AIDS Res Ther (2005)

Bottom Line: BACKGROUND: Observational studies have suggested that low serum vitamin levels are associated with increased mother-to-child transmission (MTCT) of HIV and increased preterm delivery.We conducted systematic searches of 7 electronic databases.We extracted data from the RCTs independently, in duplicate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada. millsej@mcmaster.ca.

ABSTRACT
BACKGROUND: Observational studies have suggested that low serum vitamin levels are associated with increased mother-to-child transmission (MTCT) of HIV and increased preterm delivery. We aimed to determine the efficacy of vitamins on the prevention of MTCT and preterm delivery by systematically reviewing the available randomized controlled trials [RCTs]. We conducted systematic searches of 7 electronic databases. We extracted data from the RCTs independently, in duplicate. RESULTS: We included 4 trials in our review. Of the three trials on Vitamin A, two suggested no difference in MTCT, while the third and largest trial (n = 1078) suggested an increased risk of MTCT (Relative Risk 1.35, 95% Confidence Interval [CI], 1.11-1.66, P = 0.009). Two of the vitamin A trials addressed the impact of supplementation on pre-term delivery; one suggested a benefit (RR 0.65, 95% CI, 0.44-0.94) and the other no difference. All three vitamin A trials found no significant effect on infant mortality at 1 year. Of the two trials that looked at multivitamin use, only one addressed the prevention of MTCT, and found a non-significant RR of 1.04 (95% CI, 0.82-1.32). Two of the multivitamin trials found no significant effects on pre-term delivery. The single multivitamin trial examining children's mortality at 1 year yielded a non-significant RR of 0.91 (95% CI, 0.17-1.17). CONCLUSION: Randomized trials of vitamins to prevent MTCT have yielded conflicting results without strong evidence of benefit and have failed to exclude the possibility of harm.

No MeSH data available.


Related in: MedlinePlus

Meta-analysis of MTCT.
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Figure 2: Meta-analysis of MTCT.

Mentions: The combined RR of vitamin A for prevention of MTCT yielded a RR of 1.05 (95% CI, 0.78–1.41, p = 0.2, I2 = 75%, heterogeneity P = 0.01) (figure 2). The impressive variability in results is reflected in the largely non-overlapping confidence intervals between the two studies that suggested no difference between treatment and control, and the Fawzi study that suggested harm. Two trials examined the protection of vitamin A for pre-term delivery and yielded a non-significant pooled RR of 0.85 (95% CI, 0.53–1.37, P = 0.5, I2 = 77%, heterogeneity P = 0.03) (figure 3). Three trials examined the role of maternal vitamin A supplementation on children's mortality at 1 year. The pooled RR was 1.05 (95%CI, 0.88–1.27, P = 0.5, I2 = 0%, heterogeneity P = 0.8).


Vitamin supplementation for prevention of mother-to-child transmission of HIV and pre-term delivery: a systematic review of randomized trial including more than 2800 women.

Mills EJ, Wu P, Seely D, Guyatt GH - AIDS Res Ther (2005)

Meta-analysis of MTCT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1131887&req=5

Figure 2: Meta-analysis of MTCT.
Mentions: The combined RR of vitamin A for prevention of MTCT yielded a RR of 1.05 (95% CI, 0.78–1.41, p = 0.2, I2 = 75%, heterogeneity P = 0.01) (figure 2). The impressive variability in results is reflected in the largely non-overlapping confidence intervals between the two studies that suggested no difference between treatment and control, and the Fawzi study that suggested harm. Two trials examined the protection of vitamin A for pre-term delivery and yielded a non-significant pooled RR of 0.85 (95% CI, 0.53–1.37, P = 0.5, I2 = 77%, heterogeneity P = 0.03) (figure 3). Three trials examined the role of maternal vitamin A supplementation on children's mortality at 1 year. The pooled RR was 1.05 (95%CI, 0.88–1.27, P = 0.5, I2 = 0%, heterogeneity P = 0.8).

Bottom Line: BACKGROUND: Observational studies have suggested that low serum vitamin levels are associated with increased mother-to-child transmission (MTCT) of HIV and increased preterm delivery.We conducted systematic searches of 7 electronic databases.We extracted data from the RCTs independently, in duplicate.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada. millsej@mcmaster.ca.

ABSTRACT
BACKGROUND: Observational studies have suggested that low serum vitamin levels are associated with increased mother-to-child transmission (MTCT) of HIV and increased preterm delivery. We aimed to determine the efficacy of vitamins on the prevention of MTCT and preterm delivery by systematically reviewing the available randomized controlled trials [RCTs]. We conducted systematic searches of 7 electronic databases. We extracted data from the RCTs independently, in duplicate. RESULTS: We included 4 trials in our review. Of the three trials on Vitamin A, two suggested no difference in MTCT, while the third and largest trial (n = 1078) suggested an increased risk of MTCT (Relative Risk 1.35, 95% Confidence Interval [CI], 1.11-1.66, P = 0.009). Two of the vitamin A trials addressed the impact of supplementation on pre-term delivery; one suggested a benefit (RR 0.65, 95% CI, 0.44-0.94) and the other no difference. All three vitamin A trials found no significant effect on infant mortality at 1 year. Of the two trials that looked at multivitamin use, only one addressed the prevention of MTCT, and found a non-significant RR of 1.04 (95% CI, 0.82-1.32). Two of the multivitamin trials found no significant effects on pre-term delivery. The single multivitamin trial examining children's mortality at 1 year yielded a non-significant RR of 0.91 (95% CI, 0.17-1.17). CONCLUSION: Randomized trials of vitamins to prevent MTCT have yielded conflicting results without strong evidence of benefit and have failed to exclude the possibility of harm.

No MeSH data available.


Related in: MedlinePlus