HIV and other predictors of serum β-carotene and retinol in pregnancy: a cross-sectional study in Zimbabwe

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Abstract
Background: Vitamin A status during pregnancy is important to maternal and infant health. Objective: Our goal was to identify predictors of serum β-carotene and retinol. Design: This was a cross-sectional study of 1669 women (22–35 wk of gestation) in Harare, Zimbabwe, who were receiving prenatal care. The statistical effects of age, season, gestational age, gravidity, HIV-1 infection, malaria parasitemia, and serum α1-antichymotrypsin (ACT) on serum β-carotene (log10 transformed) and retinol were estimated by using multiple linear regression analyses. Results: HIV infection was found in 31.5% of the women; 0.4% had malaria. Serum β-carotene concentrations (geometric x̄: 0.19 μmol/L) were lower in HIV-infected women than in uninfected women (10β = 0.78; 95% CI: 0.72, 0.84) and increased with age (10β = 1.05; 1.02, 1.07) in gravida 1 but not in gravida ≥2 (P for interaction = 0.00002). Serum retinol (xx–: 0.92 μmol/L) increased with age (β = 0.004; 0.0001, 0.008) in uninfected women but not in HIV-infected women (P for interaction = 0.02) and was 0.05-μmol/L (0.02, 0.09) lower in HIV-infected women than in uninfected women at 24 y of age. Furthermore, gestational age, season, use of prenatal supplements, and malaria were predictors of serum β-carotene. Serum retinol was lower in women carrying male (β = –0.04; –0.08, –0.00005) and multiple (β = –0.21; –0.35, –0.08) fetuses. Serum ACT concentrations of 0.3–0.4, 0.4–0.5, and >0.5 g/L were associated with 3%, 11%, and 44% lower serum β-carotene and 0.04-, 0.15-, and 0.41-μmol/L lower serum retinol. Serum ACT (g/L) was higher in women with malaria than in those without (β = 0.10; 0.03, 0.16) and in gravida 1 than in gravida ≥2 (β = 0.012; 0.003, 0.021), but was not higher in HIV-infected women than in uninfected women (β = 0.001; −0.008, 0.011). Conclusions: HIV infection, malaria, gravidity, and gestational age were predictors of serum β-carotene and retinol. Serum ACT was an important predictor of both and was associated with gravidity and gestational age.