{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:23:42Z","timestamp":1785425022816,"version":"3.56.0"},"reference-count":63,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Nutr"],"published-print":{"date-parts":[[2026,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Vitamin A deficiency (VAD) is common among pregnant women (PW) and has been associated with anaemia and adverse birth outcomes. However, in the Free State Province of South Africa, evidence regarding this is limited. Hence, this cross-sectional study investigated the vitamin A (vitA) intake and status of PW in Bloemfontein and its association with anaemia, iron status and birth outcomes. Blood was taken from 427 PW to assess the status of vitA (retinol-binding protein 4 (RBP4)), iron (ferritin, soluble transferrin receptor (sTfR)) and anaemia (Hb). Sociodemographic, HIV, birth outcomes (birthweight and gestational age) and dietary vitA intake data were obtained using a questionnaire in an interview and medical records. Descriptive statistics and linear regression were used to describe variables and the association between vitA and iron status and birth outcomes. Median vitA intake was 1007\u00a0\u00b5gRAE\/d with 19 % of participants\u2019 intake below the estimated average requirement of 550\u00a0\u00b5gRAE\/d. Median (IQR) RBP4 was 1\u00b751 (0\u00b778) \u00b5mol\/l. Insufficient vitA status and VAD prevalence were 12\u00b72 % and 1\u00b72 %, respectively. VitA intake was positively associated with RBP4 (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    = 0\u00b7068; 95 % CI 0\u00b7020, 0\u00b7116; P = 0\u00b7006). RBP4 was positively associated with Hb (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    = 0\u00b7363; 95 % CI 0\u00b7186, 0\u00b7539; P &lt; 0\u00b7001) and ferritin (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    = 0\u00b7359; 95 % CI 0\u00b7139, 0\u00b7579; P = 0\u00b7001) but negatively with sTfR (\n                    <jats:italic>\u03b2<\/jats:italic>\n                    = \u22120\u00b7125; 95 % CI \u22120\u00b7246, \u22120\u00b7005; P = 0\u00b7041). No significant association between plasma RBP4 and birth weight, as well as preterm birth, was observed. There was a low prevalence of VAD in the study population. Nonetheless, the positive association between RBP4 and Hb and ferritin highlights the importance of optimal vitA status in preventing anaemia in pregnancy.\n                  <\/jats:p>","DOI":"10.1017\/s0007114526106473","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:25:59Z","timestamp":1770960359000},"page":"1164-1174","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Vitamin A intake and status and associations with iron status, anaemia and birth outcomes of pregnant women in the Free State Province, South Africa: the Nutritional Status of Expectant Mothers and their newborn Infants (NuEMI) study"],"prefix":"10.1017","volume":"135","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7435-4520","authenticated-orcid":false,"given":"Janet Adede","family":"Carboo","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009xwd568","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Free State"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Ngounda","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009xwd568","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Free State"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannine","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liska","family":"Robb","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009xwd568","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Free State"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth Margaretha","family":"Jordaan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009xwd568","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Free State"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5578-9246","authenticated-orcid":false,"given":"Corinna M.","family":"Walsh","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/009xwd568","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Free State"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"S0007114526106473_ref7","unstructured":"7. World Health Organization (2009) Global prevalence of vitamin A deficiency in populations at risk 1995\u20132005: WHO Global Database on Vitamin A Deficiency Geneva: WHO. https:\/\/iris.who.int\/bitstream\/handle\/10665\/44110\/9789241598019_eng.pdf?sequence=1."},{"key":"S0007114526106473_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.nutres.2021.12.002"},{"key":"S0007114526106473_ref5","doi-asserted-by":"publisher","DOI":"10.1002\/ncp.11096"},{"key":"S0007114526106473_ref1","article-title":"Status of retinoids and carotenoids and associations with clinical outcomes in maternal-infant pairs in Nigeria","volume":"10","author":"Hanson","year":"2018","journal-title":"Nutrients"},{"key":"S0007114526106473_ref39","volume-title":"Born Too Soon: The Global Action Report on Preterm Birth","year":"2012"},{"key":"S0007114526106473_ref31","doi-asserted-by":"publisher","DOI":"10.1017\/S0007114523001782"},{"key":"S0007114526106473_ref62","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200110190-00010"},{"key":"S0007114526106473_ref49","first-page":"Cd008666","article-title":"Vitamin A supplementation during pregnancy for maternal and newborn outcomes","volume":"2015","author":"McCauley","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"S0007114526106473_ref50","doi-asserted-by":"publisher","DOI":"10.1159\/000315528"},{"key":"S0007114526106473_ref25","year":"2017"},{"key":"S0007114526106473_ref26","unstructured":"26. National Department of Health (2015) Guidelines for maternity care in South Africa. https:\/\/health-e.org.za\/wp-content\/uploads\/2015\/11\/Maternal-Care-Guidelines-2015_FINAL-21.7.15.pdf."},{"key":"S0007114526106473_ref42","volume-title":"Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc","year":"2001"},{"key":"S0007114526106473_ref47","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2011.08.015"},{"key":"S0007114526106473_ref56","doi-asserted-by":"publisher","DOI":"10.1159\/000072400"},{"key":"S0007114526106473_ref4","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2012-0026"},{"key":"S0007114526106473_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.hnm.2023.200224"},{"key":"S0007114526106473_ref34","doi-asserted-by":"publisher","DOI":"10.3945\/jn.114.194712"},{"key":"S0007114526106473_ref30","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/79.2.218"},{"key":"S0007114526106473_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-805378-2.00016-4"},{"key":"S0007114526106473_ref44","unstructured":"44. WHO (1998) Safe vitamin A dosage during pregnancy and lactation: recommendations and report of a consultation: World Health Organization. https:\/\/iris.who.int\/bitstream\/handle\/10665\/63838\/WHO_NUT_98.4_eng.pdf."},{"key":"S0007114526106473_ref40","volume-title":"Low Birthweight: Country, Regional and Global Estimates","year":"2004"},{"key":"S0007114526106473_ref16","doi-asserted-by":"publisher","DOI":"10.3390\/nu9101096"},{"key":"S0007114526106473_ref48","doi-asserted-by":"publisher","DOI":"10.1007\/s12291-024-01228-6"},{"key":"S0007114526106473_ref29","doi-asserted-by":"publisher","DOI":"10.1186\/s12986-023-00768-7"},{"key":"S0007114526106473_ref2","doi-asserted-by":"publisher","DOI":"10.3390\/nu11030681"},{"key":"S0007114526106473_ref6","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-14521-6_12"},{"key":"S0007114526106473_ref10","doi-asserted-by":"publisher","DOI":"10.1086\/342297"},{"key":"S0007114526106473_ref27","volume-title":"Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide","author":"Coates","year":"2007"},{"key":"S0007114526106473_ref19","doi-asserted-by":"publisher","DOI":"10.4102\/hsag.v24i0.1114"},{"key":"S0007114526106473_ref18","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980011002126"},{"key":"S0007114526106473_ref20","doi-asserted-by":"publisher","DOI":"10.1080\/03670244.2014.964230"},{"key":"S0007114526106473_ref54","doi-asserted-by":"publisher","DOI":"10.1079\/BJN19930173"},{"key":"S0007114526106473_ref61","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0050213"},{"key":"S0007114526106473_ref3","doi-asserted-by":"publisher","DOI":"10.1080\/10408398.2022.2099810"},{"key":"S0007114526106473_ref63","doi-asserted-by":"publisher","DOI":"10.1016\/S0079-6603(08)60722-9"},{"key":"S0007114526106473_ref13","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ejcn.1601320"},{"key":"S0007114526106473_ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2008.11.030"},{"key":"S0007114526106473_ref35","doi-asserted-by":"publisher","DOI":"10.3390\/nu12030633"},{"key":"S0007114526106473_ref51","doi-asserted-by":"publisher","DOI":"10.1007\/BF02786241"},{"key":"S0007114526106473_ref12","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-018-1880-1"},{"key":"S0007114526106473_ref57","doi-asserted-by":"publisher","DOI":"10.1080\/10408398.2018.1427552"},{"key":"S0007114526106473_ref17","volume-title":"Guidelines for the Implementation of Vitamin A Supplementation","year":"2004"},{"key":"S0007114526106473_ref37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221299"},{"key":"S0007114526106473_ref11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2002.01010.x"},{"key":"S0007114526106473_ref36","unstructured":"36. WHO (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity: Vitamin and mineral nutrition information system. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/85839\/WHO_NMH_NHD_MNM_11.1_eng.pdf."},{"key":"S0007114526106473_ref53","doi-asserted-by":"publisher","DOI":"10.1079\/BJN19940176"},{"key":"S0007114526106473_ref22","doi-asserted-by":"publisher","DOI":"10.1080\/16070658.2013.11734455"},{"key":"S0007114526106473_ref15","doi-asserted-by":"publisher","DOI":"10.3390\/nu3040429"},{"key":"S0007114526106473_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-1943-6"},{"key":"S0007114526106473_ref59","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-024-06845-w"},{"key":"S0007114526106473_ref14","unstructured":"14. Steyn, N , Bradshaw, D , Norman, R , et al. (2006) Dietary changes and the health transition in South Africa: implications for health policy The double burden of malnutrition: case Studies from six developing countries. 84, 259. https:\/\/www.fao.org\/4\/a0442e\/a0442e0v.htm"},{"key":"S0007114526106473_ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjnut.2023.02.016"},{"key":"S0007114526106473_ref41","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqab033"},{"key":"S0007114526106473_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.cdnut.2024.103045"},{"key":"S0007114526106473_ref46","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/84.3.580"},{"key":"S0007114526106473_ref60","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2012.01284.x"},{"key":"S0007114526106473_ref45","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/652148"},{"key":"S0007114526106473_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.nutres.2007.09.005"},{"key":"S0007114526106473_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/152.6.542"},{"key":"S0007114526106473_ref58","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-8981(03)00005-6"},{"key":"S0007114526106473_ref55","first-page":"460","article-title":"Anaemia and vitamin A deficiency in poor urban pregnant women of Bangladesh","volume":"12","author":"Ahmed","year":"2003","journal-title":"Asia Pac J Clin Nutr"},{"key":"S0007114526106473_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2011.02.042"},{"key":"S0007114526106473_ref38","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/134.11.3127"}],"container-title":["British Journal of Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007114526106473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T12:16:47Z","timestamp":1784809007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007114526106473\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":63,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,6,14]]}},"alternative-id":["S0007114526106473"],"URL":"https:\/\/doi.org\/10.1017\/s0007114526106473","relation":{},"ISSN":["0007-1145","1475-2662"],"issn-type":[{"value":"0007-1145","type":"print"},{"value":"1475-2662","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press on behalf of The Nutrition Society","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided that no alterations are made and the original article is properly cited. The written permission of Cambridge University Press or the rights holder(s) must be obtained prior to any commercial use and\/or adaptation of the article.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}