B12 Deficiency is the Commonest Cause of Anaemia During Pregnancy in Northern India: Study from a Tertiary Care Institute.

Iron deficiency anemia is considered the leading cause of anemia during pregnancy; however, there is a lack of comprehensive studies on the etiological factors of anemia in pregnant women. The objective of this study was to systematically investigate the causes of anemia in pregnancy. Five hundred women with hemoglobin levels < 11 g/dl between 6 and 40 weeks of pregnancy underwent a complete hemogram, iron studies, serum folate, serum B12, serum copper, and serum zinc level assessments using standard methods. The median age of the patients was 26 years (range 24-29 years). The majority of patients were in the third trimester (449/500, 89.8%). Among the patients, 325 (65%) had vitamin B12 deficiency, with 159 (31.8%) having isolated B12 deficiency and 142 (28.4%) having combined B12 and iron deficiency. Isolated iron deficiency anemia was present in 74 patients (14.8%). Additionally, 28 patients (5.6%) had beta-thalassemia minor, and anemia of chronic disease was found in 17.2% (86) of the patients. Vitamin B12 deficiency was the most common cause of anemia, followed by combined B12 and iron deficiency. Further studies in diverse populations are warranted as they have broader implications for nutrient supplementation during pregnancy. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01682-x.

Isotonic versus hypotonic fluid supplementation in term neonates with severe hyperbilirubinemia - a double-blind, randomized, controlled trial.

AIM: To compare the incidence of hyponatremia in full-term neonates with severe hyperbilirubinemia, receiving intravenous fluid supplementation with 0.2% saline in 5% dextrose versus 0.9% saline in 5% dextrose, to prevent blood exchange transfusion (BET). METHODS: In this double-blind, randomized, controlled trial, full-term newborns (≥37 weeks), appropriate for gestational age, with severe non-haemolytic hyperbilirubinemia (serum bilirubin ≥ 20 mg/dL) were enrolled. Eligible neonates were randomized to receive either 0.2% saline in 5% dextrose (hypotonic fluid group) or 0.9% saline in 5% dextrose (isotonic fluid group) over 8 hrs, in addition to phototherapy. The primary outcome was proportion of neonates developing hyponatremia (serum Na < 135 mmol/L) after 8 h. RESULTS: Forty-two neonates were analysed in each group. Proportion of neonates developing hyponatremia after 8 h was higher in hypotonic fluid group as compared to isotonic fluid group (48.8% vs. 10.5%, p < 0.001). However, a larger proportion in isotonic fluid group developed hypernatremia (39.5% vs. 12.2%, p < 0.001). The rate of BET was similar in both groups. CONCLUSION: In full-term neonates with severe hyperbilirubinemia, administration of hypotonic fluid to prevent BET was associated with a higher incidence of hyponatremia while isotonic fluid was associated with an increased incidence of hypernatremia.

Fluid supplementation in hyperbilirubinemia.

OBJECTIVE: To analyze the factors responsible for failure of fluid supplementation in full-term neonates with severe non-hemolytic hyperbilirubinemia. METHODS: The data from two previous randomized controlled trials was used in this study. Full-term (≥37 wks) neonates with severe hyperbilirubinemia (serum total bilirubin 18-25 mg/dL), who received intravenous fluid supplementation in addition to phototherapy were included. Intravenous fluid supplementation was given for 8 h. Those neonates, whose serum bilirubin levels increased by 2 mg/dL or crossed 22 mg/dL, underwent exchange transfusion. The authors compared baseline serum bilirubin, sodium, and osmolality and their changes during study period in neonates who required exchange transfusion (Non-responders) with those who didn't (Responders). RESULTS: The data of 121 neonates was analyzed (non-responders = 17, responders = 104). Both the groups had similar weight loss since birth, baseline serum sodium and osmolality. Mean baseline serum bilirubin [22.5 (1.7) vs 21.6 (1.6) mg/dL, p = 0.04] and cesarean/ instrumental delivery (27.6% vs 20.2%, p = 0.02) were significantly higher in non-responders. With fluid supplementation, serum sodium and osmolality changed similarly in both the groups over 8 h. On multiple regression analysis, only cesarean/instrumental delivery [OR 3.9 (95% CI-1.2, 13.4)] retained independent significance. CONCLUSIONS: Fluid supplementation for severe non-hemolytic hyperbilirubinemia is less likely to be successful in neonates born by cesarean/instrumental delivery as compared to normal vaginal delivery.