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Anemia in pregnancy.

Anemia is one of the most frequent complications related to pregnancy. Normal physiologic changes in pregnancy affect the hemoglobin (Hb), and there is a relative or absolute reduction in Hb concentration. The most common true anemias during pregnancy are iron deficiency anemia (approximately 75%) and folate deficiency megaloblastic anemia, which are more common in women who have inadequate diets and who are not receiving prenatal iron and folate supplements. Severe anemia may have adverse effects on the mother and the fetus. Anemia with hemoglobin levels less than 6 gr/dl is associated with poor pregnancy outcome. Prematurity, spontaneous abortions, low birth weight, and fetal deaths are complications of severe maternal anemia. Nevertheless, a mild to moderate iron deficiency does not appear to cause a significant effect on fetal hemoglobin concentration. An Hb level of 11 gr/dl in the late first trimester and also of 10 gr/dl in the second and third trimesters are suggested as lower limits for Hb concentration. In an iron-deficient state, iron supplementation must be given and follow-up is indicated to diagnose iron-unresponsive anemias.

Anemia↗

Iron and folate status before pregnancy and anemia during pregnancy.

BACKGROUND: A lack of information about the role that iron and folate stores (erythrocyte folate) play on the anemia incidence in pregnant women. OBJECTIVE: To evaluate the predictive value of ferritin and erythrocyte folate before pregnancy in relationship to the incidence of anemia throughout pregnancy. METHODS: Thirty-five non-anemic non-pregnant women were evaluated 1 or 2 months before the pregnancy. After becoming pregnant they were evaluated every 4 weeks starting in the 8th week of pregnancy until 1 month post-partum. Every evaluation included determination of hemoglobin, ferritin and erythrocyte folate. RESULTS: When the women started gestation with an insufficient iron store (<20 microg/l), the trend was to present anemia at significantly earlier gestational ages, in such a way that at week 20 of gestation almost 60% of the women with an inadequate store had anemia and only 25% of the women with an adequate store had this condition. On the other hand, the pregestational erythrocyte folate did not predict anemia incidence. CONCLUSIONS: Pregestational ferritin concentration predicts value of incidence of anemia throughout pregnancy.

Adult↗

Interaction of vitamins with mental performance.

In the presence of a chronically insufficient vitamin supply which was verified by repeated measurements of the vitamin parameters, many unfavorable psychometric findings in the corresponding deficiency groups are observed for the vitamins C, thiamin, riboflavin, cobalamin and folate, depending on the degree of the insufficient vitamin supply. Vitamin supplementation in cases of initially insufficient vitamin supply indicate some effects in the sense of an improvement of behavior and cognitive functions. Supplemental vitamin intake in physiological dosages in addition to a vitamin-sufficient diet did not lead to an improvement of behavior and mental performance.

Adolescent↗

Effects of vitamin B12 and folate deficiencies on DNA methylation and carcinogenesis in rat liver.

Deficiencies of the major dietary sources of methyl groups, methionine and choline, lead to the formation of liver cancer in rodents. The most widely investigated hypothesis has been that dietary methyl insufficiency results in abnormal DNA methylation. Vitamin B12 and folate also play important roles in DNA methylation since these two coenzymes are required for the synthesis of methionine and S-adenosyl methionine, the common methyl donor required for the maintenance of methylation patterns in DNA. The aim of this study was to review the effects of methyl-deficient diets on DNA methylation and liver carcinogenesis in rats, and to evaluate the role of vitamin B12 status in defining carcinogenicity of a methyl-deficient diet. Several studies have shown that a methyl-deficient diet influences global DNA methylation. Evidence from in vivo studies has not clearly established a link between vitamin B12 and DNA methylation. We reported that vitamin B12 and low methionine synthase activity were the two determinants of DNA hypomethylation. Choline- or choline/methionine-deficient diets have been shown to cause hepatocellular carcinoma in 20-50% of animals after 12-24 months. In contrast, the effect of vitamin B12 withdrawal, in addition to choline, methionine and folate, induced hepatocellular carcinoma in less than 5% of rats.

Animals↗

Persistent iron and folate deficiency in a patient with deletional hereditary persistence of fetal hemoglobin; the effect on the relative levels of Hb F and G gamma chains and the corresponding mRNAs.

We describe a Black female who has suffered for many years from an (often) severe anemia (Hb 5-9 g/dl) with iron deficiency (serum Fe 8 microg/dl; TIBC 462 microg/dl; ferritin 7 ng/ml or less) and folate deficiency. The patient had hypermenorrhea which was appropriately treated resulting in an increase in hemoglobin level but not affecting the Fe deficiency. Splenomegaly was present, perhaps resulting from a clay-eating habit, although this was consistently denied. The patient had an alpha-thalassemia-2 (-3.7 kb) trait and a deletional hereditary persistence of fetal hemoglobin (HPFH) (type II) which were inherited from her father. Over the last six years the level of Hb F varied between 8.5 and 16% (25-29% in the father), while the G gamma value was also low (15-22% versus 32-34% in the father). Comparable reductions were seen in the relative levels of gamma-mRNA and G gamma-mRNA. These data support results published by Adams et al who showed a severe reduction in Hb F level in another HPFH heterozygote with Fe deficiency; these investigations suggested that a reduction in alpha-globin synthesis resulted in preferential formation of alpha beta dimers rather than alpha gamma dimers. Our data suggest that the decrease of Hb F and G gamma levels is due to a reduction in gamma-mRNA formation, mainly of the G gamma type, rather than through a posttranslational mechanism alone.

Adult↗

[Nutritional problems in old age (author's transl)].

While age is increasing involutiones specific to age can be proofed at the gastrointestinal tract, which lead to a deceleration but quantitative unchanged adsorption. Wrong nutrition concerning to the take up of fat, carbohydrates, proteins and trace elements can be found in greater age very often. By watching a collective of healthy persons beyond the age of 90 years however it turns out that this group keeps a nearly faultless nutrition. The requirements of lysin, methionin and calcium is a little higher in old age than in younger. By intermitting starvation or addition of antioxidants life can be prolonged in experiments on animals, when this therapy starts already in younger age. Starvation in higher age, however, leads to a shortening of life in experiments on animals.

Age Factors↗

Effects of unilateral ureteric occlusion on renal necrosis occurring in rats fed a methyl-deficient diet.

Wistar male rats were fed from weaning a methyl-deficient diet (groups I and II) or a standard commercial diet (groups III and IV). At the day 3 the left ureter was tied and divided in animals of groups I and III, while those in groups II and IV were sham operated. Rats of all groups were killed on days 8 and 10 to evaluate the incidence and extent of tubular necrosis (day 8) and tubular and cortical necrosis (day 10). The results of this study show that unilateral ureteric obstruction diminishes the incidence, severity and extent of necrosis in the same kidney.

Acute Kidney Injury↗

Review article: the diagnosis and treatment of haematinic deficiency in gastrointestinal disease.

Deficiency of any of the vitamins and minerals essential for normal erythropoiesis (haematinics), including iron, copper, cobalt, vitamins A, B12, B6, C, E, folic acid, riboflavin and nicotinic acid, may be associated with defective erythropoiesis and anaemia. Iron, vitamin B12 and folate are the haematinics for which deficiency states manifest most often clinically and are the focus of this review. The normal absorption of these haematinics and gastrointestinal causes of their deficiency are described. Investigations, including the use of homocysteine metabolite levels and new techniques such as serum transferrin receptor assays, and treatment of haematinic deficiency are discussed in detail.

Deficiency Diseases↗

[Vitamin B12, folic acid and mental function in the elderly].

Elderly people is a vulnerable population group to specific nutrient deficiencies as vitamin B12 and folic acid, which are closely related to mental functions deterioration, especially of cognitive functions. This study was aimed to measure B12 vitamin and folic acid indicators and to establish relationships to mental function. 53 elderly, older than 60 years, living in a geriatric home were assessed. The dietary intake was evaluated by the direct weighed method, serum B12 vitamin and folic acid by radioimmunoanalysis and mental function by Foltein's mini-mental test. Dietary intake for Vit B12 was adequate and deficient for folic acid while serum levels were within normal range. Vitamin B12 levels were at marginal or deficiency values in 26,4% of the elderly and folic acid deficiency was present in 43.4%. 49% of the elderly had mental function alterations and B12 vitamin levels were significantly lower in this group. A positive association between age and mental function (elderly below 80 years had lower risk of mental impairment) and between serum B12 and mental function were found. Elderly were at risk of deficiency for both vitamins and age and mental function were associated to this risk. Further evaluation including other nutrients should be performed.

Age Factors↗