The Effects of Prenatal Carotenoid Supplementation on Infant Foveal Maturity: The Lutein and Zeaxanthin in Pregnancy (L-ZIP) Trial

Abstract

Purpose : Lutein and zeaxanthin are carotenoid pigments that accumulate in developing infants’ retinas and brains in utero and are detectable even at birth, indicating a possible transfer from the mother. Our understanding of how macular pigment affects infants’ retinal architecture and eye health is limited. Thus, for our exploratory aim in this randomized clinical trial (NCT03750968), we hypothesized that prenatal carotenoid supplementation would increase infant foveal maturity markers at birth.

Methods : In this trial, we randomly assigned 47 pregnant women to receive standard-of-care daily prenatal vitamins with added 10 mg lutein and 2 mg zeaxanthin (Carotenoid Group) or standard-of-care daily prenatal vitamins with a placebo (Control Group) for 6 to 8 months. Infant foveal morphology and maturity were evaluated via SD-OCT imaging and ImageJ. The average of foveal maturity scores assigned by two blinded graders was used for statistical analysis.

Results : Following supplementation, all participants had morphologically healthy retinas, and general foveal parameters were comparable among the Carotenoid and Control Groups (p > 0.05). The most clinically significant finding was a difference in Ellipsoid Zone (EZ) grade. EZ grading ranged from 1 (least mature) to 4 (most mature). Infants in the Carotenoid Group relative to the Control Group had more advanced EZ grades on average (2.92 ± 0.30 and 2.09 ± 0.30, respectively), but this difference was statistically insignificant (p = 0.07, Wilcoxon rank - sum (Mann Whitney test), Carotenoid Group (n=13) and Control Group (n=11)). This exploratory result should be replicated and confirmed with a larger sample size in a follow up study.

Conclusions : Lutein and zeaxanthin supplementation during pregnancy is a non-toxic intervention that may support the foveal maturation process in infants and thus could provide increased protection against damaging blue light, oxidative stresses, and foveal hypoplasia in cases of retinopathy of prematurity (ROP). The EZ, a mitochondria-rich retinal layer overlying the photoreceptor outer segments, was more morphologically mature on average in infants in the Carotenoid Group, suggesting that prenatal carotenoid supplementation may be helpful in infants’ eye maturation and health.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.