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

Edward J Mills¹ , Ping Wu²^,3 , Dugald Seely³^,4 and Gordon H Guyatt¹

¹Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada

²London School of Hygiene & Tropical Medicine, London, UK

³Division of Clinical Epidemiology, Canadian College Of Naturopathic Medicine, Toronto, Canada

⁴Hospital for Sick Children, University of Toronto, Toronto, Canada

author email corresponding author email

AIDS Research and Therapy 2005, 2:4doi:10.1186/1742-6405-2-4


Published:	6 May 2005

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.