Iron-folic Acid Research Articles

Effect of iron folic acid with tablet vitamin C compared to iron folic acid with routine verbal advice of vitamin C rich foods on the hemoglobin levels of anemic pregnant women attending a tertiary care hospital in Puducherry: protocol for a pragmatic trial

Background: In routine practice, pregnant women are advised to take iron folic acid (IFA) tablets with vitamin C-rich foods. If vitamin C tablets are given instead, there may be an improvement in the hemoglobin levels of pregnant women. The study aims to find the effectiveness of IFA tablet with vitamin C tablet compared to IFA tablet with verbal advice of vitamin C rich foods, over 6 weeks, on the hemoglobin levels of anemic pregnant women (13-33 weeks) attending a tertiary care hospital in Puducherry. Methods: A pragmatic trial will be conducted in the antenatal OPD of a hospital in Puducherry. Anemic pregnant women will be consecutively recruited until a sample size of 86 is attained. Permuted block randomization and allocation concealment will be used. After eligibility assessment, participants will be randomly assigned two arms. The intervention arm will receive IFA tablets with vitamin C tablets, while the control arm will be advised to take IFA tablets with vitamin C-rich food. Participants will be followed up at 6 weeks. The intention-to-treat approach will be used. Linear regression will be performed followed by multivariable linear regression to adjust for confounding variables. Conclusions: This study protocol is designed to investigate whether the hemoglobin status and control of anemia in anemic mothers can be improved by giving IFA tablets with vitamin C tablets in routine practice, rather than verbal advice to take IFA tablets with vitamin C-rich foods.

Effect of prenatal micronutrient-fortified balanced energy-protein supplementation on maternal and newborn body composition: A sub-study from the MISAME-III randomized controlled efficacy trial in rural Burkina Faso.

Micronutrient-fortified balanced energy-protein (BEP) supplements are promising interventions to prevent intrauterine growth retardation in low- and middle-income countries. On the other hand, one concern with blanket prenatal supplementation programs using energy-dense supplements is that they could lead to more maternal and/or infant overweight. However, evidence is lacking on the potential effect of BEP on maternal and offspring body composition. This study evaluates the effects of micronutrient-fortified BEP supplementation during pregnancy on body composition of mothers and their newborns in rural Burkina Faso. The MISAME-III study is an open label individually randomized controlled trial where pregnant women (n = 1,897) of gestational age <21 weeks received either a combination of micronutrient-fortified BEP and iron-folic acid (IFA) tablets (i.e., intervention) or IFA alone (i.e., control). The prenatal phase of the MISAME-III study was conducted between the first enrollment in October 2019 and the last delivery in August 2021. In a sub-study nested under the MISAME-III trial, we evaluated anthropometry and body composition in newborns who were born starting from 17 November 2020 (n: control = 368 and intervention = 352) and their mothers (n: control = 185 and intervention = 186). Primary study outcomes were newborn and maternal fat-free mass (FFMI) and fat-mass (FMI) indices. We used the deuterium dilution method to determine FFMI and FMI and %FFM and %FM of total body weight within 1 month postpartum. Our main analysis followed a modified intention-to-treat approach by analyzing all subjects with body composition data available. Univariable and multivariable linear regression models were fitted to compare the intervention and control arms, with adjusted models included baseline maternal age, height, arm fat index, hemoglobin concentration and primiparity, household size, wealth and food security indices, and newborn age (days). At study enrollment, the mean ± SD maternal age was 24.8 ± 6.13 years and body mass index (BMI) was 22.1 ± 3.02 kg/m2 with 7.05% of the mothers were underweight and 11.5% were overweight. Prenatal micronutrient-fortified BEP supplementation resulted in a significantly higher FFMI in mothers (MD (mean difference): 0.45; 95% CI (confidence interval): 0.05, 0.84; P = 0.026) and newborns (MD: 0.28; 95% CI: 0.06, 0.50; P = 0.012), whereas no statistically significant effects were found on FMI. The effect of micronutrient-fortified BEP on maternal FFMI was greater among mothers from food secure households and among those with a better nutritional status (BMI ≥21.0 kg/m2 or mid-upper arm circumference (MUAC) ≥23 cm). Key limitations of the study are the relatively high degree of missing data (approximately 18%), the lack of baseline maternal body composition values, and the lack of follow-up body composition measurements to evaluate any long-term effects. Micronutrient-fortified BEP supplementation during pregnancy can increase maternal and newborn FFMI, without significant effects on FMI. ClinicalTrials.gov with identifier NCT03533712.

Maternal Pregnancy Intention and Antenatal Care Seeking Behaviors in Bangladesh: Evidence From Bangladesh Demographic and Health Survey, 2018.

Objective: This study aimed to examine the association between pregnancy intention and antenatal care (ANC)-seeking behaviors among women in Bangladesh. Methods: ANC-related data of 5,012 women, from the 2018 Bangladesh Demographic and Health Survey (BDHS), who had a live birth within 3years preceding the survey were analyzed in the study. Multivariate logistic regression models were used to assess the association of pregnancy intention with ANC utilization. Results: Approximately one-fifth (20.9%) of the women had unintended pregnancy. Among all the women, 40.4% received their first ANC visit within the first three months of pregnancies, 47% had at least four ANC visits, 26.1% received all the components of ANC services, and 22.2% received an adequate dosage of supplementary iron-folic acid tablets/syrup. Women with unintended pregnancy were less likely to receive their first ANC visit within the first 3months, four or more ANC visits, and all ANC services than those with intended pregnancy. Conclusion: Unintended pregnancy was inversely associated with the proper utilization of ANC among women in Bangladesh. Appropriate measures to reduce unintended pregnancy might foster the utilization of optimum antenatal care.

Contextual factors affecting the implementation of an anemia focused virtual counseling intervention for pregnant women in plains Nepal: a mixed methods process evaluation

BackgroundAnemia is estimated to cause 115,000 maternal deaths each year. In Nepal, 46% of pregnant women have anemia. As part of an integrated anemia-prevention strategy, family engagement and counseling of pregnant women can increase compliance to iron folic acid tablets, but marginalized women often have lower access to these interventions. We implemented the VALID (Virtual antenatal intervention for improved diet and iron intake) randomized controlled trial to test a family-focused virtual counseling mHealth intervention designed to inclusively increase iron folic acid compliance in rural Nepal; here we report findings from our process evaluation research.MethodsWe conducted semi structured interviews with 20 pregnant women who had received the intervention, eight husbands, seven mothers-in-laws and four health workers. We did four focus groups discussions with intervention implementers, 39 observations of counseling, and used routine monitoring data in our evaluation. We used inductive and deductive analysis of qualitative data, and descriptive statistics of monitoring data.ResultsWe were able to implement the intervention largely as planned and all participants liked the dialogical counseling approach and use of story-telling to trigger conversation. However, an unreliable and inaccessible mobile network impeded training families about how to use the mobile device, arrange the counseling time, and conduct the counseling. Women were not equally confident using mobile devices, and the need to frequently visit households to troubleshoot negated the virtual nature of the intervention for some. Women’s lack of agency restricted both their ability to speak freely and their mobility, which meant that some women were unable to move to areas with better mobile reception. It was difficult for some women to schedule the counseling, as there were competing demands on their time. Family members were difficult to engage because they were often working outside the home; the small screen made it difficult to interact, and some women were uncomfortable speaking in front of family members.ConclusionsIt is important to understand gender norms, mobile access, and mobile literacy before implementing an mHealth intervention. The contextual barriers to implementation meant that we were not able to engage family members as much as we had hoped, and we were not able to minimize in-person contact with families. We recommend a flexible approach to mHealth interventions which can be responsive to local context and the situation of participants. Home visits may be more effective for those women who are most marginalized, lack confidence in using a mobile device, and where internet access is poor.

KAJIAN PERBANDINGAN TABLET TAMBAH DARAH HARIAN DAN MINGGUAN PADA IBU HAMIL TERHADAP KADAR HEMOGLOBIN

The prevalence of anemia in pregnant women is still high. According to the RISKESDAS 2018, the prevalence of anemia in pregnant women is 48.9%. The impact caused by anemia is low birth weight and bleeding in pregnant women and premature babies. Compliance in consuming daily Iron Folic Acid (IFA) is still a significant obstacle to date, so it is hoped that weekly IFA supplementation can improve compliance in pregnant women. This study aimed to determine the effect of daily versus weekly use of IFA in pregnant women on hemoglobin levels. The method used is a literature review. The search strategy used uses a database (Pubmed, Google Scholar, and Science Direct) with the keywords Pregnancy (Population), Iron supplementation (Intervention), Daily and Weekly (Comparison), and Hemoglobin (Outcome). The study obtained nine journals as study material. The nine journals showed that daily iron supplementation in non-anemic pregnant women gave better results in terms of adherence, and hemoglobin levels showed an increase that was not significantly different from daily. Weekly iron supplementation can be ensured in non-anemic pregnant women because it can increase hemoglobin levels to prevent anemia in pregnant women.

OR01-07-23 Validation of Pregnant Women's Recall of Iron-Folic Acid Supplements Consumed and Nutrition Counseling Received During Antenatal Care in Burkina Faso

OR01-07-23 Validation of Pregnant Women's Recall of Iron-Folic Acid Supplements Consumed and Nutrition Counseling Received During Antenatal Care in Burkina Faso

P18-041-23 Prevalence of Oral Iron-Folic Acid Supplementation and Dietary Intakes Among Pregnant Women at Peri-Urban Areas of Dodoma City, Tanzania

P18-041-23 Prevalence of Oral Iron-Folic Acid Supplementation and Dietary Intakes Among Pregnant Women at Peri-Urban Areas of Dodoma City, Tanzania

P18-050-23 Milk B Vitamin Response to Supplementation With Multiple Micronutrients Versus Iron-Folic Acid During Pregnancy Through 3 Months Postpartum in Rural Bangladesh

P18-050-23 Milk B Vitamin Response to Supplementation With Multiple Micronutrients Versus Iron-Folic Acid During Pregnancy Through 3 Months Postpartum in Rural Bangladesh

Self-reported adherence to iron-folic acid supplementation and its associated factors among pregnant women attending antenatal care in Tamale Metropolis, Ghana

BackgroundThis study assessed self-reported adherence to iron-folic acid supplementation and its associated factors among pregnant women attending antenatal care in Tamale Metropolis, Northern Ghana.MethodsThis was a health facility-based cross-sectional design. A total of 389 pregnant women attending antenatal care (ANC) were consented and recruited to participate in the study, using systematic sampling. Data were collected using a questionnaire on socio-demographic characteristics, obstetric factors, iron-folic acid (IFA) supplements, and adherence (self-reported). Respondents who consumed ≥70% (5/7 per week) of IFA tablets were considered to be adherent and vice-versa. Logistic regression models were used to determine factors associated with IFA adherence.ResultsIFA adherence was 41% among the respondents. Using multivariate logistic regression, secondary education [AOR=1.37, (95% CI= 1.18-1.82)], having ≥4 ANC visits [AOR=1.44, (95% CI= 1.28-1.67)], urban residence [AOR=1.59, (95% CI= 1.36-1.97)] and receiving IFA supplements at a health facility [AOR=1.98, (95% CI=1.02-3.83)] were associated with higher IFA adherence.ConclusionIron-folic acid adherence was low (41%). Education, residence, ANC visits and supply of IFA supplements at the health facility attended were associated with IFA adherence. Barriers to IFA adherence were mainly forgetfulness, unavailability of IFA, and perceived side effects.

The effects of adherence to recommended antenatal services on adverse pregnancy outcomes in Northwest Ethiopia: multilevel and propensity score matching (PSM) modeling.

Adverse pregnancy outcomes are a personal and social crisis caused by easily preventable pregnancy-related problems. Despite that, studies on the effectiveness of adherence to the continuity of antenatal care (ANC) services are scarce. Therefore, this study aims to determine the effectiveness of the continuity of ANC services and the determinants of adverse pregnancy outcomes. A prospective follow-up study design was conducted from March 2020 to January 2021 in Northwest Ethiopia among randomly selected study subjects. Data were collected by trained data collectors using pre-tested structured questionnaires and analyzed using STATA Software version 14. A multilevel regression model was used to identify determinant factors, whereas the propensity score matching (PSM) model was used to look at the effectiveness of adherence to ANC services on adverse pregnancy outcomes. Among 2,198 study participants, 26.8% had adverse pregnancy outcomes, with 95% CI: 24.9-28.7 [abortion (6.1%; 95% CI: 5.1-7.1), low birth weight (11.5%; 95% CI: 10.2-12.9), and preterm birth (10.9; 95% CI: 9.6-12.3)]. Determinant factors were iron-folic acid supplementation (AOR = 0.52; 95% CI: 0.41, 0.68), delayed initiation of ANC visits at 4-6 months (AOR = 0.5; 95% CI: 0.32, 0.8), initiation of ANC visits after 6 months (AOR = 0.2; 95% CI: 0.06, 0.66), received four ANC visits (AOR = 0.36; 95% CI: 0.24, 0.49), an average time of rupture of the amniotic membrane of between 1 and 12 h (AOR = 0.66; 95% CI: 0.45, 0.97), and pregnancy-related problems (AOR = 1.89; 95% CI: 1.24, 2.9). As a treatment effect, completion of a continuum of visit-based ANC (ATET; β = -0.1, 95% CI: -0.15, -0.05), and continuum of care via space dimension (ATET; β = -0.11, 95% CI: -0.15, -0.07) were statistically significant on the reduction of adverse pregnancy outcomes. In the study area, the rate of adverse pregnancy outcomes was high. Even though adherence to the continuity of ANC services via time and space dimensions is effective in the prevention of adverse pregnancy outcomes, programmatically important factors were also detected. Therefore, key strategies for promoting the uptake of antenatal services and strengthening iron-folic acid supplementation are strongly recommended.

Risk Factors for Anaemia in Pregnant Women who Take Iron Folic Acid Tablets in Locus Stunting Districts in Indonesia

Controlling anaemia in pregnant women is carried out through iron folic acid tablets (IFA) supplementation. The IFA supplementation for pregnant women in Indonesia has been carried out for a long time, but the prevalence of anaemia among pregnant women is still high. The results from the evaluation of anaemia management of pregnant women in Locus Stunting in 2021, showed that the proportion of anaemic pregnant women is higher in pregnant women who have taken IFA. Therefore, analysis was carried out to identify risk factors for anaemia in pregnant women who had taken IFA. Data analysis was carried out descriptively, along χ2 tests and logistic regression. The proportion of anaemic pregnant women who have taken IFA was 39.8% while the proportion of pregnant women who have never consumed IFA was 33.7% (p&lt;0.05). The results of the bi-variate analysis of risk factors for anaemia in pregnant women who consume IFA were poor families, chronic energy malnutrition, and low consumption of meat, poultry, or fish. The results of the multivariate analysis showed that the risk factors for anaemia in pregnant women were those who have low family well-being, chronic energy malnutrition, second and third trimesters gestational age and low consumption of meat, poultry and fish.&#x0D; Keywords: anemia, pregnant women, iron folic acid

Co-occurrence of iron, folate, and vitamin A deficiency among pregnant women in eastern Ethiopia: a community-based study

BackgroundIt is well known that the magnitude of undernutrition in Ethiopia is unacceptably high. The burden of co-occurrence of iron, folate, and vitamin A deficiency, on the other hand, has received less attention. Thus, in this study, we looked at the prevalence of iron, folate, and vitamin A deficiency in pregnant women in eastern Ethiopia.MethodsA community-based cross-sectional study was conducted among 397 pregnant women in Haramaya district, eastern Ethiopia. An interview-assisted questionnaire and blood serum were collected from pregnant women using standard techniques and shipped to an EPHI for micronutrient analysis. Factors associated with the co-occurrence of iron, folate, and vitamin A deficiency were identified using binary and multiple logistic regressions.ResultsAccording to this study, 81.6% of the participants were deficient in at least one micronutrient, and 53.53.2% were deficient in two or more. Women who did not receive iron-folic acid supplementation (AOR = 2.44; 95% CI = 1.52–3.92), did not attend Antenatal care (ANC) follow up (AOR = 2.88; 95% CI = 1.81–4.61), and reported low consumption of diversified diet (AOR = 2.18 (95% CI = 1.35–3.51) had a higher risk of co-occurrence of iron, folate, and vitamin A deficiency.ConclusionThis study found that more than half of pregnant women were in multiple micronutrients, indicating a major public health issue. In addition to the IFA supplementation programs that are already in place, there is a need for multiple micronutrient supplementation.

Compliance with Iron-Folic Acid Supplementation Among Pregnant Women in the Bekwai Municipality, Ghana

Compliance with Iron-Folic Acid Supplementation Among Pregnant Women in the Bekwai Municipality, Ghana

Prevalence of anemia and its associated factors among pregnant women in Ilala Municipality - Tanzania: Analytical cross-sectional study.

Anaemia during pregnancy is still 1 of the leading causes of maternal and neonatal mortality in low and middle-income countries. Initiatives to address this need evidence on trends and their relevant factors, as they vary from 1 area to another. This study determined the prevalence of anemia and its associated factors among pregnant women in Ilala, Tanzania. This community-based, analytical cross-sectional study was conducted in April 2022 involving 367 randomly selected pregnant women. An interviewer-administered questionnaire and a HemoCue analyzer were used for data collection The data was described using descriptive statistics (frequency distributions, percentages, etc) and inferential statistics (Chi-square tests and logistic regression) were used to explore the associations between the study's outcome and its explanatory variables, with a significance level of P < .05. The mean age of participants was 26.2 (standard deviation = 5.2) years, 58.0% had a secondary education level, and 45.2 were prime-para. About half (57.2%) of all participants had low hemoglobin level, among which, 36.2% had moderate anemia. Having a primary education level (adjusted odds ratio [AOR] = 2.3, confidence interval [CI] = 1.1-4.7), having an inter-pregnancy interval of <18 months (AOR = 2.6, CI = 1.2-5.5), being in the third trimester (AOR = 2.4, CI = 1.2-4.7), not taking Intermittent Prophylaxis Treatment (AOR = 3.7, CI = 1.3-10), not taking iron supplement and folic acid (AOR = 3.7, CI = 1.3-10), and having a moderate appetite(AOR = 1.6, CI = 1.0-2.6) were predictors of anemia. Nutritionally related factors were not consuming on a daily basis dairy food (AOR = 3.7, CI = 1.4-9.3), meat/fish (AOR = 6.6, CI = 3-14), dark green and other vegetables (AOR = 6.6, CI = 3.1-14), fruits (AOR = 4.2, CI = 1.4-12) and having a lower dietary diversity score (AOR = 84, CI = 37-188). Approximately half of pregnant women in Ilala municipality were anemic with 1 third of them having moderate anemia. The associated factors varied from nutritional, obstetric, and socio-demographic factors. The targeted interventions should focus on health promotion campaign to sensitize the population on the dangers of anemia in pregnancy and preventive measures that must be adhered to.

Factors related to the compliance to consuming iron-folic acid in young women in East Kalimantan, Indonesia

Weekly Iron Folic Acid supplementation/WIFAS program for adolescent girls is an effective strategy for preventing anemia. However, in Indonesia, only 1,4% adhere to taking WIFAS. This study aimed to discover the factors related to adolescent girls’ adherence to consuming WIFAS in East Kalimantan. The design of this study was cross-sectional, using a purposive sampling technique to find a sample of 825 adolescent girls. The research location was the East Kalimantan Provincial Health Office from November 15 to December 15, 2021. The analytical method uses the Chi-Square test and binary logistic regression test. The results showed that the level of adherence to the consumption of iron folic acid for adolescents girl was 17,6%. The factors related to the adherence of adolescent girls in consuming WIFAS in East Kalimantan were the area of residence (p=0,023), hemoglobin check (р=0,0001), access to information on iron-folic acid (p=0,014), received/purchased iron-folic acid (p=0,000), knowledge (p=0,010) and the use of the Cegah Anemia Remaja Indonesia (CERIA) application (р=0,0001). Based on reg log analysis, factors such as having received/purchased iron WIFAS, Hb checks, knowledge, and use of the CERIA application were associated with adolescent girls’ adherence to WIFAS. In conclusion, adolescent girls with regular WIFAS consumption were easier to get WIFA, check Hb, have good knowledge and use the CERIA application. These findings suggest the need to carry out hemoglobin checks on adolescent girls, increase the availability of WIFAS and socialize the use of the CERIA app.

Magnitude and predictors of anemia among preschool children (36-59 months) in Atingo town, Jimma, Ethiopia.

Anemia is a serious public health concern that affects more than 25% of the world's population. It is still widespread and at its most severe in Ethiopia. This study pointed to identify the magnitude and predictors of anemia in preschool children in Atinago. A structured interview and anthropometric metrics had been used in a cross-sectional study to collect data from 309 preschool children using a systematic sampling strategy from May 10 to June 25, 2022. Frequencies, percentages, means, and a bar chart were created as descriptive statistics. Factors that were significant at the 25% level in univariate analysis were run through multiple logistic models. Odds ratios with respective 95% confidence intervals were developed to determine the relevant predictors. The majority (51.7%) of preschool children in Atinago town had anemia. The finding reveals that poor dietary diversity (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.02-3.07), children from families with food insecurity (AOR = 2.28, 95% CI = 1.31-3.9), child-mothers used iron folate for less than 3 months during pregnancy (AOR = 1.93, 95% CI = 1.07-3.48), households with more than five children (AOR = 1.880, 95% CI = 1.12-3.18), and stunted children (AOR = 1.78, 95% CI = 1.05-3.01) were highly susceptible to anemia. The findings indicate that anemia was a serious issue among preschool children in Atinago. Therefore, stakeholders should provide community-based nutrition training on consuming diverse diets, dietary improvements in the home, consuming iron-rich meals, and the like; encourage mothers to participate in early ANC follow-up; and strengthen activities aimed at identifying households with food insecurity status.

There Is No Relationship Between The Level Of Zinc Consumption And The Incidence Of Anemia In Female Workers At The Badung Mall, Bali

Women workers are included in the group of women of childbearing age who are prone to health problems due to the low intake of nutrients consumed. The low intake of nutrients consumed and the bleeding experienced during menstruation can affect hemoglobin levels and productivity in workers. The health problem that is often experienced by female workers is anemia. Anemia is a condition where the level of hemoglobin in the blood is below the normal value. This study aims to determine the relationship between the level of consumption of micronutrients (iron, zinc, folic acid, and vitamin C) with the incidence of anemia in female workers at Mall Badung. The research design used was cross-sectional with a sample of 35 female workers at Mall. The data taken were Hb levels using the easy touch tool, and food intake data obtained using a 24-hour recall form. Data analysis used the Pearson Product Moment Correlation and Spearman Rank Correlation tests. The results showed that the proportion of anemia was 22,9%. The average Hb level obtained was 13,8 g/dL. The average level of consumption of iron (86,2%), zinc (80,6%), folic acid (84,9%), and vitamin C (93,7%). Based on the results of the correlation test showed that there was a significant relationship between the level of iron consumption (p-value = 0,000), folic acid (p-value = 0,009), and vitamin C (p-value = 0,026) with the incidence of anemia in female workers and there was no relationship between levels of consumption of zinc (p-value = 0,601) with the incidence of anemia in female workers..

Association between iron-folic acid supplementation and pregnancy-induced hypertension among pregnant women in public hospitals, Wolaita Sodo, Ethiopia 2021: a case- control study

BackgroundPregnancy-induced hypertension is the new onset of high blood pressure after 20 weeks of gestation in women with previously normal blood pressure. To the best of our knowledge, no study has been conducted in our country to investigate the association between this pregnancy problem and iron-folic acid supplementation. The aim of this study was to determine the association between iron-folic acid supplementation and pregnancy-induced hypertension (PIH) in pregnant women at public hospitals in the Wolaita Sodo zone.MethodsAn institution-based case–control study was conducted among pregnant women who visited public hospitals in the Wolaita Sodo zone from March 3, 2022, to August 30, 2022. A consecutive sampling method was used to select the study participants. The total sample size was 492, of which 164 were cases and 328 were controls. The data were collected by conducting face-to-face interviews and measurements. The data were entered into EpiData version 4.6 and exported to STATA 14 for analysis. Those variables with a p-value less than 0.05 were considered statistically significant. Descriptive statistics and odds ratios were presented using texts, tables, and figures.ResultsA total of 471 women participated in this study, yielding a response rate of 96%. The cases had a mean age of 25 ± 4.43, while the controls had a mean age of 25 ± 3.99. The mean age at first pregnancy among cases was 20 ± 2.82 and among controls was 20 ± 2.97. The average number of deliveries for cases and controls was 1.97 ± 1.41 and 1.95 ± 1.38, respectively. There is no significant association between iron-folic acid supplementation and PIH. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it (AOR = 3.65; 95% CI: 1.0–12.9). Eating kocho (AOR = 14.4; 95% CI: 1.2–16.7) was positively associated with PIH.ConclusionsThere is no association between iron-folic acid supplementation during pregnancy and pregnancy-induced hypertension. Pregnant women with high hemoglobin levels had higher odds of PIH as compared to those without it. There is an association between kocho consumption and PIH. More research should be done using stronger designs.

Assessing the coverage of full antenatal care among adolescent mothers from scheduled tribe and scheduled caste communities in India

BackgroundThe persistently high rates of maternal mortality and morbidity among historically marginalised social groups, such as adolescent Scheduled Castes (SCs) and Scheduled Tribes (STs) in India, can be attributed, in part, to the low utilisation of full antenatal healthcare services. Despite efforts by the Indian government, full antenatal care (ANC) usage remains low among this population. To address this issue, it is crucial to determine the factors that influence the utilisation of ANC services among adolescent SC/ST mothers. However, to date, no national-level comprehensive study in India has specifically examined this issue for this population. Our study aims to address this research gap and contribute to the understanding of how to improve the utilisation of ANC services among adolescent SC/ST mothers in India.Data and methodsData from the fourth round of the National Family Health Survey 2015–16 (NFHS-4) was used. The outcome variable was full antenatal care (ANC). A pregnant mother was considered to have ‘full ANC’ only when she had at least four ANC visits, at least two tetanus toxoid (TT) injections, and consumed 100 or more iron-folic acid (IFA) tablets/syrup during her pregnancy. Bivariate analysis was used to examine the disparity in the coverage of full ANC. In addition, binary logistic regression was used to understand the net effect of predictor variables on the coverage of full ANC.ResultsThe utilisation of full antenatal care (ANC) among adolescent SC/ST mothers was inadequate, with only 18% receiving full ANC. Although 83% of Indian adolescent SC/ST mothers received two or more TT injections, the utilisation of the other two vital components of full ANC was low, with only 46% making four or more ANC visits and 28% consuming the recommended number of IFA tablets or equivalent amount of IFA syrup. There were statistically significant differences in the utilisation of full ANC based on the background characteristics of the participants. The statistical analysis showed that there was a significant association between the receipt of full ANC and factors such as religion (OR = 0.143, CI = 0.044–0.459), household wealth (OR = 5.505, CI = 1.804–16.800), interaction with frontline health workers (OR = 1.821, CI = 1.241–2.670), and region of residence in the Southern region (OR = 3.575, CI = 1.917–6.664).ConclusionIn conclusion, the study highlights the low utilisation of full antenatal care services among Indian adolescent SC/ST mothers, with only a minority receiving the recommended number of ANC visits and consuming the required amount of IFA tablets/syrup. Addressing social determinants of health and recognising the role of frontline workers can be crucial in improving full ANC coverage among this vulnerable population. Furthermore, targeted interventions tailored to the unique needs of different subgroups of adolescent SC/ST mothers are necessary to achieve optimal maternal and child health outcomes.

Severe Hematologic Abnormality Associated with an Inborn Error of Immunity (IEI)

Genetic sequencing improves our recognition of IEI's through genotype/phenotype correlations; however, variants of uncertain significance (VUSs) remain an obstacle. Functional assays provide avenues to identify variant pathogenicity but are infrequently commercially available, resulting in delayed diagnosis. We report the case of one such experience, and utilization of research-based functional testing to help characterize variant pathogenicity.A 20-year-old male patient with celiac disease came to medical attention after developing profound fatigue with pancytopenia: white blood cell count (4,400cells/mL), hemoglobin (8.4 g/dL), and platelets (18,000cells/mL). Evaluation included normal iron studies, folate, B12, copper levels, lactate dehydrogenase and haptoglobin, and low immunoglobulin levels (IgG 122 mg/dL; IgM 7 mg/dL; IgA 12 mg/dL). Infectious evaluation was negative including CMV, EBV, HHV-6, and Parvovirus. Bone marrow biopsy confirmed hypocellular marrow consistent with aplastic anemia. Hematologic testing was unremarkable (karyotype, myelodysplastic mutation sequencing, telomere length, leukemia flow cytometry immunophenotyping, and T-cell clonality).Lymphocyte flow cytometry showed severe lymphopenia: absolute lymphocyte count (268cells/mL), CD3+ (222cells/mL;83%), CD4+ (107cells/mL;40.1%), CD8+ (88cells/mL;32.9%), CD45RA+/CD4+/CD62L+ (15cells/mL;14.4%), and CD19+ (3cells/mL;1.3%). T-cell proliferation to phytohemagglutinin and tetanus was normal, and antibody titers were protective. Infection history was unremarkable. A primary immunodeficiency next generation sequencing panel uncovered a VUS in CTLA-4, c.385T> A (p.Cys129Ser) for the patient and his father (received biologic therapy for rheumatologic disease). Without commercially available transendocytosis assays, the patient and paternal samples were sent for research analysis. Testing demonstrated reduced CD4+ & CD8+ naïve T-cells with increased memory T-cells, and CD80-GFP transendocytosis assay showed reduced GFP uptake by C129S variant-expressing cells relative to wild-type CTLA-4. The clinical and immune phenotype were highly suggestive of CLTA-4 haploinsufficiency. Despite conventional immunomodulatory/immunosuppressive treatment with calcineurin inhibitors, corticosteroids and high-dose IVIG, only a partial response was achieved. Abatacept trial was considered, but haploidentical transplant was elected due to clinical severity, and he no longer requires repetitive transfusions. Our case outlines a novel CTLA-4 variant resulting in CLTA-4 haploinsufficiency presenting as aplastic anemia and hypogammaglobulinemia/CVID. The absence of easily accessible testing for CTLA-4 resulted in delayed functional evaluation, prolonging consideration for abatacept. Fortunately, the patient has benefited from hematopoietic stem cell transplant, which remains the mainstay curative therapy for severe disease. [Display omitted] [Display omitted]