Vitamin A or -Carotene Supplementation Reduces but Does Not Eliminate Maternal Night Blindness in Nepal

Manuscript received 18 February 1998. Initial reviews completed 22 March 1998. Revision accepted 26 May 1998.

Center for Human Nutrition, Department of International Health, School of Hygiene & Public Health, Johns Hopkins University, Baltimore, MD 21205 and ^* Nepal Intervention Project Sarlahi-NNIPS, The National Society for Eye Health and Blindness Prevention, Nepal Eye Hospital Complex, Tripureswor, Kathmandu, Nepal

We investigated the effect of supplementing women weekly with 7000 µg retinol equivalents as preformed vitamin A or -carotene vs. a placebo, on the incidence of night blindness during pregnancy and the postpartum period in the rural plains of Nepal. Over a period of ~3 y, ~29,000 women of child-bearing age, living in 171 wards that were randomized to one of the three supplements, contributed 9932 first pregnancies. A prospective, weekly surveillance identified night blindness in pregnant women, verified further by detailed questioning about nighttime vision. After delivery, women were also interviewed at ~3 and ~6 mo postpartum to elicit a night blindness history over the preceding 3 mo. Vitamin A supplementation reduced the incidence of night blindness during pregnancy from 10.7% among controls to 6.7% (relative risk 0.62, 95% confidence interval: 0.45-0.85). -Carotene supplementation had less of an effect (0.83, 0.63-1.11). Among women who took >95% of their vitamin A supplements during pregnancy, incidence of verified night blindness was reduced by 67%. Incidence (per 100 person-years) of night blindness during the first 3 mo postpartum was 11.3 in the control, 4.3 in the vitamin A and 8.7 in the -carotene groups, yielding corresponding relative risks of 0.38 (0.26-0.55) and 0.77 (0.57-1.04). In the second 3 mo postpartum, both vitamin A and -carotene reduced night blindness by ~50%. Vitamin A intakes approaching a recommended amount for pregnancy markedly reduced but did not eliminate night blindness in Nepali women. Greater intakes of vitamin A than provided and/or other nutrients may be needed to prevent maternal night blindness in rural South Asia.

The Journal of Nutrition Vol. 128 No. 9 September 1998, pp. 1458-1463
Copyright ©1998 by the American Society for Nutritional Sciences

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