BMJ 1999;319:1201 ( 30 October )

Letters

Effect of supplementation with vitamin A or beta  carotene on mortality related to pregnancy

    Pooling of groups may not be appropriate
    No magic pills exist for reducing mortality related to pregnancy
    Slight modifications in definitions could alter interpretation of results
    Authors' reply

Pooling of groups may not be appropriate

The first 150 words of the full text of this article appear below.

EDITOR---West et al reported that vitamin A and beta  carotene reduced mortality related to pregnancy up to 12 weeks post partum,1 but the conclusions cannot be considered to be unequivocal. Any differentials in ascertainment of pregnancies in the different groups could vitiate the results. About 6-7% of the pregnancies ended as miscarriages and stillbirths, and 2% had no reported outcome. Were there any differences between the groups in this outcome? If the 157 women were lost to follow up because they had died it would spuriously decrease mortality in the vitamin A group compared with the placebo group.

Although only half the women received >= 80% of the intended quantity of vitamin A or beta  carotene supplements, mortality was reduced substantially (40-50%). The authors report that the evidence of survival was noticed after 1.5 years of the trial, indicating a cumulative effect of supplementation, which depends on duration of feeding. Thus the women participating . . . [Full text of this article]
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Relevant Article

Double blind, cluster randomised trial of low dose supplementation with vitamin A or beta  carotene on mortality related to pregnancy in Nepal
Keith P West, Jr, Joanne Katz, Subarna K Khatry, Steven C LeClerq, Elizabeth K Pradhan, Sharada R Shrestha, Paul B Connor, Sanu M Dali, Parul Christian, Ram P Pokhrel, and Alfred Sommer
BMJ 1999 318: 570-575. [Abstract] [Full Text] [PDF]

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