A nested case-control study to evaluate the association between fetal growth restriction and vitamin B12 deficiency.

OBJECTIVES: To study the association between maternal vitamin B12 levels and fetal growth restriction. METHODS: In this nested case-control study, a cohort of low-risk women attending the antenatal clinic had their blood samples taken and stored at 28-31 weeks gestation. They were followed until delivery. Fifty-eight women delivering babies less than 2500 g were taken as cases and an equal number of controls delivering babies more than 2500 g were taken from the same cohort. Their B12 levels were assayed and studied for statistical significance. RESULTS: The baseline characteristics of both groups were similar. The number of women with serum B12 levels less than 200 pg/mL were similar in both groups: 33% versus 29% (P = 0.84). Type of kitchen fuel used was taken as a surrogate marker for socioeconomic status. More women in the cases used non-LPG (liquid petroleum gas) kitchen fuels such as kerosene and wood than in controls, 35% versus 19% (P = 0.06). CONCLUSIONS: No association between maternal vitamin B12 levels and fetal growth restriction was found in this study. Low birth weight babies were more common in women of low socioeconomic status.

Central Variant Posterior Reversible Encephalopathy Syndrome in a Pregnant Woman With Eclampsia: A Case Report.

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological diagnosis characterized by acute or subacute neurological symptoms. A 27-year-old woman at 35 weeks of pregnancy, who presented with generalized tonic-clonic seizures had persistently low Glasgow Coma Scale (GCS) score after delivery of the baby. Magnetic Resonance Imaging (MRI) of the brain showed T-2 Fluid Attenuated Inversion Recovery (FLAIR) hyperintensities in the brainstem, bilateral medial cerebellar hemispheres, bilateral medial temporal lobes, bilateral thalami, lentiform and caudate nuclei, and bilateral fronto-parieto-occipital lobes. There was diffusion restriction in bilateral caudate nuclei, left thalamus and right frontal lobe, and microhemorrhages in the left thalamus. These findings were suggestive of central variant PRES. She improved with strict blood pressure control and anti-edema measures. A repeat MRI brain on day 10 showed significant improvement, and she had no residual neurological deficits. The central variant of PRES is a rare entity that has to be considered in a patient presenting with neurological deficits in the setting of uncontrolled blood pressure, eclampsia, immunomodulatory medication use, or renal failure. While most patients with PRES fully recover with timely therapy targeted at reversing the primary cause, some may have residual neurological deficits or rarely, die.