Micronutrients and drug response: Vitamin A and vitamin E in the fetus and in the newborn

Major advances on the therapeutic use and the toxicity of two fat-soluble micronutrients, vitamin A and vitamin E, have taken place in recent years. High dosages of vitamin A and retinoids are teratogenic. The use of isotretinoid in pregnancy is associated with a high risk of congenital malformations. Retinoid metabolites (4-oxo-transretinoic acid and retinyl palmitate) have been related to teratogenicity. Studies in premature infants support the concept that supplementation of vitamin A (to achieve normal serum retinol concentrations) reduces the pulmonary damage caused by hyperoxia. Much controversy has surrounded the use of vitamin E in the low-birth-weight infant. Accumulation occurs with repeated administration and serious toxicity ensues. Thus, on the side of potential therapeutic applications, injudicious use of these vitamins is associated with previously unsuspected toxicity in the fetus and newborn.