Association of Maternal Serum Vitamin A Levels and Dietary Intake with the Risk of Anorectal Malformations in Neonates: A Case–Control Study

Abstract Background: Anorectal malformations (ARMs) are major congenital anomalies occurring in approximately 1 in 5000 live births, often causing lifelong morbidity. Although disruptions in hindgut development are recognized as the embryological basis, the effect of specific maternal nutritional deficiencies – especially Vitamin A – remains insufficiently explored in humans. Objectives: The objective of this study was to assess the correlation between maternal serum Vitamin A levels, dietary intake during pregnancy, and the incidence of ARM in neonates. Materials and Methods: A retrospective case–control study was conducted at a tertiary care hospital, including 30 mothers – 15 of neonates with ARM (cases) and 15 of healthy neonates (controls). Data on sociodemographic factors, antenatal history, and dietary habits were collected using a structured questionnaire. Maternal serum Vitamin A (retinol) was estimated by high-performance liquid chromatography. Statistical analyses used independent t -tests, Chi-square tests, and binary logistic regression to identify predictors of ARM. Results: Mean maternal serum Vitamin A levels were significantly lower among mothers of neonates with ARM compared to controls (18.6 ± 3.5 μg/dL vs. 26.8 ± 4.2 μg/dL; P < 0.001). Mothers in the case group also reported lower weekly intake of Vitamin A-rich foods, including green leafy vegetables ( P = 0.01) and milk products ( P = 0.03). On multivariable logistic regression, low serum Vitamin A (<20 μg/dL) (adjusted odds ratio aOR =3.9; 95% confidence interval CI: 1.2–8.6; P = 0.01) and inadequate antenatal care (<4 visits) (aOR = 2.7; 95% CI: 1.1–6.3; P = 0.04) were independent predictors of ARM. Conclusion: Maternal Vitamin A deficiency is strongly associated with a higher risk of ARMs in neonates. Strengthening antenatal nutritional counseling, ensuring adequate Vitamin A intake, and promoting regular antenatal visits may help prevent these anomalies.