Vitamins Reduce Fetal Deaths, Improve Immune Status of Pregnant Women with HIV

A team of researchers based at the Harvard School of Public Health (SPH) has found that daily doses of multivitamin supplements offer a low-cost way to lower the risk of adverse pregnancy outcomes and to raise the immune status of pregnant women infected with HIV, the virus that causes AIDS.

The study, believed to be the first-ever randomized trial to measure the effects of vitamin supplements on the health of HIV-positive pregnant women, was conducted over a four-year period among a group of 1,075 women in Tanzania.

The doses of multivitamins resulted in approximately 40 percent reductions in fetal deaths, low birth weight, and severe preterm births. The doses also significantly improved the immune status of the mothers.

It is not yet clear whether the vitamin supplements also reduced the transmission of HIV from the mothers to their offspring, but follow-up results are expected within the year.

With some 13 percent of mothers in Tanzania and up to 30 percent of those in neighboring countries such as Malawi, Rwanda, and Zimbabwe infected, HIV is a major public health problem, said Wafaie W. Fawzi, who led the study, which is published in the current issue of The Lancet. Worldwide, some 30 million people are infected with HIV, of whom 90 percent are in the developing world. Sixty-five percent of HIV-infected people live in Sub-Saharan Africa. HIV-infected women are at a significantly higher risk than uninfected women for fetal loss, preterm birth, and intrauterine growth retardation, all of which are associated with higher risk of AIDS.

"While there has been much excitement in the U.S. and elsewhere concerning access to newly developed combination antiviral therapies, which include protease inhibitors, these are so expensive that the great majority of those infected with the AIDS virus have no access to them," said Fawzi, an assistant professor in the Department of Nutrition at SPH, "The idea of this study was to determine whether an inexpensive intervention would have at least some protective effect. Clearly, the vitamin supplements have had an effect on lowering rates of fetal death, low birth weight, and preterm birth among the offspring of HIV positive mothers." Vitamin supplements cost pennies a day per patient, compared with protease inhibitors, which may cost many thousands of dollars per year.

The beneficial effect of the vitamin supplements is probably due to improvement of the mothers' immune status and hemoglobin levels, Fawzi said. In turn, Fawzi hypothesized, this may lead to greater fetal immunity and to lower risks of fetal malnutrition and death.

Because the study included only HIV-positive mothers, further research is required to determine whether multivitamins taken by HIV-negative mothers might have similar beneficial effects on offspring, Fawzi said.

In the study, 1,075 HIV-positive pregnant women, who were between 12- and 27-weeksÕ gestation, were divided into four groups. One group received only vitamin A, on which numerous previous studies concerning HIV and vitamins have focused. A second group received multivitamins and no vitamin A. A third group received multivitamins and vitamin A. A fourth group received a placebo. (The multivitamins, given daily included: 20 mg B1; 20 mg B2; 25 mg B6; 100 mg niacin; 50 mcg B12; 500 mg C; 30 mg E; and 0.8 mg folic acid). All groups received daily doses of iron and folate supplements and weekly doses of prophylactic antimalarial medication Ñ standard prenatal care in Tanzania.

Women assigned multivitamins experienced 30 fetal deaths compared with 49 among those not on multivitamins Ñ a 39 percent reduction. Multivitamin supplementation decreased the risk of low birth weight (less than 2,500 grams) by 44 percent and severe preterm birth (gestation of less than 34 weeks) by 43 percent. Women given multivitamins exhibited significant increases in

blood cells, known as lymphocytes, which increase immunity to infection. Vitamin A supplementation had no significant effect on these outcomes.

The $2.6 million study was conducted in Dar es Salaam, beginning in 1994 by research teams from the School of Public Health and the Muhimbili University College of Health Sciences in Dar es Salaam, Tanzania.