Vitamin A deficiency in Pregnancy...3

Vitamin A deficiency in Pregnancy...3

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7...  Study on Vitamin A deficiency

This cross-sectional study included 200 full term newborns and their respective mothers who were recruited from the reception room of a University Gynecology and Obstetrics Hospital, Cairo, Egypt, during the period from June 2011 to December 2011. This hospital provides antenatal and obstetric care for pregnant women at an Urban Metropolitan in Cairo of low socioeconomic standard. The study was approved by the local ethical committee of the Faculty of Medicine.

Online statistical calculator “http://www.raosoft.com/” was used for sample size calculation guided by confidence level of 95% and α error of 5%. The sample size was calculated to be 195 mother-infant pairs.

We included only apparently healthy mothers, aged 19–39 years, with singleton pregnancy and proper spacing in-between pregnancy (a gap of more than 18 months from birth to subsequent conception) who delivered through uncomplicated spontaneous vaginal delivery. All included mothers were of low income (less than 53.43 US dollars per capita per months) [10]. We excluded all women with grand multiparity (more than 5 deliveries), complicated pregnancy including multiple pregnancy, established diagnosis of maternal anemia during pregnancy, preeclampsia, renal disease, antepartum hemorrhage (placental abruption placentae, placenta previa, vasa previa), history of fever, and signs of acute infection as well as mothers who had delivered through instrumental vaginal delivery or cesarean section. We also excluded all women who had vitamin A supplementation or history of exposure to teratogens.

We excluded neonates who were delivered before 37 weeks and had birth weight below 2500 grams. Neonates with congenital anomalies, birth trauma were also excluded as well as neonates with family history of hemolytic anemia or maternofetal incompatibility (positive Coombs’ test or high reticulocyte count).

During the 6 months period, among 2058 deliveries 1554 mothers were excluded, 96 refused participation in the study, and 208 newborns were excluded. Causes of exclusion of mothers included inappropriate age for the study (87), grand multiparity (194), improper spacing in-between pregnancies (110), complicated pregnancy (204), exposure to teratogens (5), vitamin A supplementation (117), delivery by caesarean section (693), and instrumental vaginal delivery (144). Causes of exclusion of newborns included prematurity and low birth weight (70), presence of congenital anomalies and birth trauma (69), maternofetal incompatibility (22), and family history of hemolytic anemia (47).

An informed consent was taken from each mother before enrollment in the study.

8...  Clinical Evaluation

Detailed history was obtained from each woman including parity and symptoms suggestive of VAD: recurrent urinary and respiratory infections and symptoms of dry eye (eye discomfort, eye dryness, foreign body sensation, photophobia, and night blindness). Mothers were asked to recall everything consumed (including foods and fluids) a day representing their usual intake starting from first meal or beverage on awakening until midnight of the reporting day. Data were analyzed and vitamin A intake was calculated using the “Diet Analysis Program, 1995” (Lifestyles Technologies, Inc., Northbridge Point, Valencia, CA). Physical Examination was done with stress on eye examination for dry eyes using 3 simple noninvasive tests. The tests were carried out in sequence, starting with tear film break-up time (TBUT), followed by examination of the cornea by fluorescein staining and the Schirmer I test without topical anesthesia. The Schirmer strips (Tianjin Jingming New Technological Development Co., Ltd., China) were inserted into the lower conjunctival sac at the junction of the lateral and middle thirds, avoiding touching the cornea, and the length of wetting strips in millimeters was recorded after 5 minutes. The cutoff point used for diagnosis of dry eye was <10 mm per 5 minutes .

For the newborns, Apgar scores were recorded at 1 and 5 minutes to exclude the presence of perinatal asphyxia. Birth weight was measured by a digital baby scale. Length and occipitofrontal circumference (OFC) were measured by the same investigator. Gestational age was estimated using the new Ballard scoring system . Systemic examination was done to exclude hepatosplenomegaly and congenital anomalies.