Vitamin A supplementation: who, when and how

The majority of countries where vitamin A important to note that far lower doses are

HKI
deficiency (VAD) is known to be a severe needed for pregnant women than for
public health problem have policies children, and doses need to be given on a
supporting the distribution of vitamin A. more frequent basis (see Table 2).
This article provides guidelines for
vitamin A supplementation in children Vitamin A supplements for women
and women and discusses when it is safe who have recently given birth are
to phase out supplementation. not routinely recommended
Giving high-dose vitamin A to women
Vitamin A supplements for young immediately after delivery is also not
children aged 6–59 months recommended by the WHO (2011
The World Health Organization (WHO) Guidelines).
recommends that all children aged 6–59
months should receive supplements if When to phase out
they live in a community where VAD is a vitamin A supplements
public health problem. These are WHO and the United Nations Children’s
communities where the prevalence of Fund (UNICEF) recommend phasing out
night blindness is ≥ 1% in children aged vitamin A supplementation when VAD is
24–59 months, or where the prevalence no longer a public health problem. This
of VAD is ≥ 20% in infants and children means there must be clear evidence that
aged 6–59 months. High-dose vitamin A in oral liquid form is the prevalence of night blindness or
The suggested vitamin A supplemen- given to a child reduced serum retinol levels are well below
tation scheme for prevention of deficiency the minimum public health thresholds for
in children aged 6–59 months in areas VAD during pregnancy, vitamin A
an extended period of time and, at the
where VAD is a severe public health supplementation during pregnancy is
same time, that mortality rates in under-5s
problem is shown in Table 1. not recommended, as high-dose vitamin
are in long-term decline.
A from supplements may cause harm to
Vitamin A supplements for newborns the developing baby. Instead, pregnant Further reading
World Health Organization guidelines on vitamin A supple-
and children aged 1–5 months women are encouraged to meet their mementation (2011). Visit www.who.int/nutrition/
Vitamin A supplementation of newborns increased requirements by eating enough publications/vitamins_minerals/en/index.html
and children aged 1–5 months is not yet vitamin A-rich foods (see pages 65
recommended by WHO. Exclusive breast- and 72); this is unlikely to harm the Safety
feeding of infants is encouraged for the developing foetus.
first six months of life, to help achieve The only circumstance in which vitamin A Pregnant women
optimal growth, development and health. supplementation during pregnancy may Vitamin A supplements are not routinely
be considered is when women live in an recommended for pregnant women
Vitamin A supplements for pregnant area where VAD is a severe public health unless there is a severe public health
women are not routinely recommended problem (i.e. ≥5% of pregnant women in problem. The far lower doses recom-
Although women are highly susceptible to that area have night blindness). It is very mended in Table 2 are safe. Higher
doses are contra-indicated because of
Table 1. High-dose vitamin A supplementation to prevent deficiency in children aged uncertain effects on the unborn child.
6–59 months
Children
Target Oral dose Frequency Route of administration Vitamin A supplementation reduces
age group child morbidity and mortality and is
recommended for infants and
6­–11 100,000 IU Once Oral liquid, oil-based preparation of children 6–59 months when VAD is a
months retinyl palmitate or retinyl acetate public health problem. Vitamin A
supplements given to children will not
12–59 200,000 IU Every 4–6 Oral liquid, oil-based preparation of cause any significant side effects
months months retinyl palmitate or retinyl acetate when the recommended age-specific
vitamin A dose is administered. Trials
Table 2. Low-dose vitamin A supplementation to prevent deficiency in pregnant women of vitamin A supplementation of
(Note: ONLY in areas where vitamin A deficiency is a severe public health problem) infants and children aged 6–59
months have found uncommon,
Target Route of transient, and mild adverse symptoms
Oral dose Frequency Duration
group administration (irritability, headache, fever, diarrhoea,
Pregnant Up to 10,000 Daily dose Oral liquid, A minimum of nausea and vomiting). The impact of
women IU vitamin A oil-based 12 weeks high-dose vitamin A supplements on
OR preparation of during preventing blindness and mortality,
Up to 25,000 Weekly dose retinyl palmitate pregnancy, however, far outweigh these rare and
IU vitamin A or retinyl acetate until delivery transient side effects.

© The author/s and Community Eye Health Journal 2013. This is an Open Access article distributed under the Creative Commons Attribution Non-Commercial License.

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