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Category: Volume 07 Issue 09 September 2019
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Title: Correlation of Serum Vitamin B 12 with Red Cell Indices and Hemoglobin in Indian Women in Second and Third Trimester of Pregnancy

Authors: Shiv Pankaj Khanna, MD, Rigvardhan, MD, Anisha Aggarwal

 DOI: https://dx.doi.org/10.18535/jmscr/v7i9.124

Abstract

  

Introduction: To determine serum vitamin B 12 in pregnant women in India in second or third trimester and its correlation with red cell indices in order to determine an inexpensive screening tool to ascertain vitamin B 12 deficiency.

Material & Methods: In this prospective study, venous blood samples of consecutive 200 pregnant women in second or third trimester of pregnancy were included and their haematological and serum vitamin B 12 were determined including blood complete picture.

Results: Mean ± SD age of the subjects was 21.54 years (SD = 2.73). It was found that 72 had anemia. 25 (12.5%) women had vitamin B 12 levels below 647 pg/ml and were thus included. 37 had iron deficiency anaemia as their ferritin and iron levels were low and were thus excluded from the study. Significant correlation was seen between serum vitamin B 12 and Hb , PCV and MCHC. MCV and RDW did not show any  significant correlation with vitamin B 12 levels.

Conclusion: We could not establish a statistical correlation between the all important MCV and vitamin B12 because it may be normal in combined deficiency of iron and vitamin B12/ folate or even in sublinical vitamin B12 deficiency. There is an urgent requirement to develop a non expensive marker to screen out patients of vitamin B12 deficiency as repeated vitamin B12 level estimation is expensive and cannot be affordable to majority in developing countries. Also, there is requirement to lay down reference values for vitamin B 12 during various phases of pregnancy.

Keywords:  Vitamin B 12,  Red Cell Indices, pregnancy.

References

  1. World Health Organization. Worldwide prevalence of anemia 1993- 2005. WHO global database on anemia. Geneva, World Health Organization. 2008.
  2. Chandyo RK, Ulak M, Kvestad I, Shrestha M, Ranjitkar S, Basnet S et al. The effects of vitamin B12 supplementation in pregnancy and postpartum on growth and neurodevelopment in early childhood: Study Protocol for a Randomized Placebo Controlled Trial. BMJ Open 2017;7: e016434. doi:10.1136/bmjopen-2017-016434.
  3. CDC criteria for anemia in children and childbearing-aged women. MMWR Morb Mortal Wkly Rep. 1989;38:400- 404.
  4. Rigvardhan, Vinod Raghav, Rakhi Negi, Punyashlok Biswal, Y S Rana. Correlation of serum ferritin with red cell indices and hemoglobin in indian women in second and third trimester of pregnancy. International Journal of Contemporary Medical Research 2016;3(10):3069-3072.
  5. Cuervo LG, Mahomed K. Treatments for iron deficiency anemia in pregnancy (cochrane review). Issue 4. In: The Cochrane Library, vol. 80(1). Chichester, UK: John Wiley and Sons, Ltd (Level I); 2003:92.
  6. Bhargava M, Iyer PU, Kumar R, Ramji S. Relationship of maternal serum ferritin with foetal serum ferritin, birth weight and gestation. J Trop Pediatr 1991; 37(4): 149-52
  7. Dwarkanath P, Barzilay JR, Thomas T, et al. High folate and low vitamin B-12 intakes during pregnancy are associated with small for-gestational age infants in South Indian women: a prospective observational cohort study. Am J Clin Nutr 2013;98:1450–8.
  8. Pepper MR, Black MM. B12 in fetal development. Semin Cell Dev Biol 2011;22:619–23.
  9. Duggan C, Srinivasan K, Thomas T, et al. Vitamin B-12 supplementation during pregnancy and early lactation increases maternal, breast milk, and infant measures of vitamin B-12 status. J Nutr 2014;144:758–64.
  10. Sachdev H,Gera T, Nestel P. Effect of iron supplementation on mental and motor development in children: systematic review of randomised controlled trials. Public Health Nutr. 2005;8(2):117–32
  11. Refsum H, Yajnik CS, Gadkari M . Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr 2001; 74: 233–41.
  12. Koebnick C, Heins UA, Dagnelie PC, Wickramasinghe SN, Ratnayaka ID, Hothorn T et al.  Longitudinal Concentrations of Vitamin B12 and Vitamin B12-binding Proteins during Uncomplicated Pregnancy. Clinical Chemistry 2002; 48:928–933.
  13. Salvador Villalpando. Discussion: Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food and Nutrition Bulletin 2008; 29: S112-S115.
  14. Rumbold A, Middleton P, Crowther CA. Vitamin supplementation for preventing miscarriage. Cochrane Database Syst Rev 2005;18;(2):CD004073.
  15. Puri M, Kaur L, Walia GK, Mukhopadhhyay R, Sachdeva MP, Trivedi SS, Ghosh PK, Saraswathy KN. MTHFR C677T polymorphism, folate, vitamin B12 and homocysteine in recurrent pregnancy losses: a case control study among north Indian women. J Perinat Med. 2013; 41:549–54.
  16. Tiwari M, Kotwal J, Kotwal A, Mishra P, Dutta V, Chopra S. Correlation of hemoglobin and red cell indices with serum ferritin in Indian women in second and third trimester of pregnancy. http://dx.doi.org/10.1016/j.mjafi.2012.07.016
  17. Crichton RR. The biochemistry of ferritin. Br J Haematol. 1992;26:677-681
  18. Khanduri U and Sharma A. Megaloblastic anemia- prevalence and causative factor. Natl Med J India 2007; 20: 172–75
  19. Casterline JE, Allen LH, Ruel MT. Vitamin B-12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum. J Nutr. 1997;127:1966–72.
  20. Jathar VS, Inamdar-Deshmukh AB. Erythrocyte vitamin B12 activity in lactovegetarian pregnant Indian women. Acta Haematol. 1981;65:153–6.
  21. Garcia-Casal MN, Osorio C, Landaeta M . High prevalence of folic acid and B12 deficiency in infants, children, adolescents and pregnant women in Venezuela. Eur J Clin Nutr 2005; 59: 1064–70.
  22. Pardo J, Peled Y, Bar J, Hod M, Sela BA, Rafael ZB, et al. Evaluation of low serum vitamin B12 in the non-anaemic pregnant patient. Hum Reprod 2000;15:224–6.

Corresponding Author

Dr Rigvardhan

Professor, Dept of Pathology, Saraswati Medical College, Unnao – 209859; India