Safe vitamin A dosage during pregnancy and lactation
Recommendations and report of a consultation
Vitamin A is essential for normal maintenance and functioning of body tissues, and for growth and development. this is also the case during pregnancy, when the fetus makes demands on the mother's vitamin A stores, and during the postpartum period when the newborn is growing rapidly and, in most cultures, depends on breast milk to obtain adequate amounts of the vitamin. Although the increased requirement during pregnancy is relatively small, in many countries where vitamin A deficiency (VAD) is endemic, women often experience deficiency symptoms such as night blindness that continue during the early period of lactation.
Beyond 4 to 6 months postpartum breast milk deficient mothers is likely to contain insufficient vitamin A to build or even maintain vitamin A stores in nursing infants. Providing a diet adequate in vitamin A neither too little nor too much is the safest solution to meeting needs during pregnancy and lactation. However, this is not easily accomplished in situations of poverty and where food with appropriate vitamin A content is in short supply and/or expensive.
In such situations the recommended approach is to provide a vitamin A supplement during pregnancy at a dosage and frequency that will safely meet the needs of growing maternal and fetal tissue and will potentially build maternal body stores in anticipation of lactation. However, using high-dose vitamin A supplements to build maternal stores during pregnancy created a dilemma because of the vitamin's potential teratogenicity during the early stages of pregnancy.
WHO has received requests for programmatic guidance on the safe use of vitamin A supplements by women of reproductive age. New data have become available concerning the return of menses relative to breastfeeding practices and country-specific contacts with the health system. To review these data and other information, WHO convened a consultation to consider both the safe dosage of vitamin A during pregnancy and the first six months postpartum, and the relevant policy and programme implications.
This document, which will be of particular interest for managers of national VAD prevention and control programmes, presents the recommendations of participating experts in nutrition, teratology, reproductive physiology and population-based surveys, who have experience in both basic research and its public health applications.