Study Shows Multivitamins Offer Low-Cost Way to Reduce Fetal Deaths, Raise Immune Status of HIV-Positive Mothers
For immediate release: May 14, 1998
Boston, MA--A team of researchers based at the Harvard School of Public Health has found that daily doses of multi-vitamin 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 human immunodeficiency virus (HIV).
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 1075 women in Tanzania.
The doses of multivitamins resulted in approximately 40 per cent 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 the HIV from the mothers to their offspring but follow-up results are expected within the year. The study did not examine whether the multivitamin doses slowed the clinical progression of HIV disease.
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, to be published in the May 16, 1998 edition 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 risks of fetal and postpartum acquisition of the AIDS virus.
"While there has been much excitement in the US 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," Fawzi said. "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 pre-term birth among the offspring of HIV positive mothers." Vitamin supplements cost pennies a day per patient, compared with some protease inhibitors, which may cost many thousands of dollars per year.
The beneficial effect of the vitamin supplements is probably mediated through the 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.
Since 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 randomized, double blind study, 1075 HIV-positive pregnant women, who were between 12 and 27-weeks 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 of the groups received daily doses of iron and folate supplements and weekly doses of prophylactic antimalarial medication--standard prenatal care in Tanzania.
Women assigned multivitamins experienced 30 fetal deaths compared with 49 among those not on multivitamins--a 39 percent reduction. Multivitamin supplementation decreased the risk of low birthweight [less than 2500 grams] by 44 percent and severe preterm birth [gestation of less than 34 weeks] by 43 percent. Women given multivitamins exhibited significant increases in CD4+ and CD8+ cells--blood cells known as lymphocytes which increase immunity to infection. Vitamin A supplementation had no significant effect on these outcomes.
The $2.6M study was conducted in Dar es Salaam beginning in 1994 by research teams from the Harvard School of Public Health (HSPH) in Boston and the Muhimbili University College of Health Sciences in Dar es Salaam, Tanzania. In addition to Fawzi, team members include: Gretchen Antelman, Guillermo Herrera, David Hunter, Nuala McGrath, Donna Spiegelman, and Walter Willett of HSPH; and Saidi Kapiga, Roger Mbise, Gernard Msamanga, Davis Mwakaglie, and Ernest Urassa, of Muhimbili University. The study was funded by the National Institute of Child Health and Human Development and the Fogarty International Center, both part of the National Institutes of Health.
For further information, please contact:
Office of Communications
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115