Maternal medicine: Randomised trial of vitamin A supplementation in pregnant women in rural Malawi found to be anaemic on screening by HemoCue


Prof. JP Neilson, School of Reproductive & Developmental Medicine, University of Liverpool, 1st floor, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK. Email


Objective  To assess the effects of vitamin A supplementation in women with anaemia during pregnancy.

Design  Single-centre randomised controlled trial.

Setting  Rural community in southern Malawi, central Africa.

Population  Seven hundred women with singleton pregnancies at 12–24 weeks measured by ultrasound scan and with haemoglobin <11.0 g/dl by HemoCue screening method. Analysis was by intention to treat. All received iron and folate, and sulphadoxine/pyrimethamine for antimalarial prophylaxis.

Methods  Women were randomised to receive oral supplementation with daily 5000 or 10 000 iu vitamin A, or placebo.

Main outcome measures  Anaemia, as assessed by Coulter counter, severe anaemia, iron status and indices of infection.

Results  Vitamin A deficiency was, in this rural population, less common than predicted. Vitamin A supplementation had no significant impact on anaemia, severe anaemia, iron status and indices of infection. Vitamin A stores were less likely to be depleted at the end of pregnancy in supplemented groups.

Conclusions  Vitamin A supplementation programmes to reduce anaemia should not be implemented in similar antenatal populations in rural sub-Saharan Africa unless evidence emerges of positive benefit on substantive clinical outcomes. Introducing public health interventions of unknown benefit and with unclear biological mechanisms can divert scarce resources from clinical and social interventions more likely to impact maternal mortality.