Prevalence and Management of ß-Thalassemia in India.

India bears a huge burden of hemoglobinopathies, and the most prevalent is thalassemia. The different types of thalassemia include minor, major and intermedia, based on the α/ß-globin chain inequality. This review aimed to understand the current prevalence of thalassemia in different regions of India and communities affected by it, along with the management of ß-thalassemia major (ß-TM) and ß-thalassemia (ß-thal) minor patients. A comprehensive electronic search for relevant articles was conducted using two databases, i.e. PubMed and Science Direct. Articles published in English from India between January 2009 and September 2021 were included. Studies from other countries, genetic and molecular characterization studies, and articles published in other languages were excluded. The prevalence of ß-thal trait in Central India ranged between 1.4 and 3.4%, while 0.94% ß-TM was reported among the patients with anemia. In South India, the prevalence of ß-thal trait was between 8.50 and 37.90% and ß-TM was reported to be between 2.30 and 7.47%. Northern and Western Indian states had a higher thalassemic burden. In Eastern India, tribal populations had a higher prevalence of ß-thal trait (0.00-30.50%), ß-TM (0.36-13.20%) and other hemoglobinopathies [Hb E (HBB: c.79G>A)/ß-thal] (0.04-15.45%) than nontribal populations. Additionally, scheduled castes, scheduled tribes and other backward classes of low socioeconomic status and low literacy rates were affected by ß-thal. Almost all Indian states reported ß-thal; however, it is mostly concentrated in eastern and western parts of the country. Well-integrated strategies and effective implementation are needed at State and National levels to minimize the burden of ß-thal.

Effects of anemia at different stages of gestation on infant outcomes.

OBJECTIVES: Maternal anemia is a public health challenge worldwide. The present study aims to explore the effects of maternal anemia at different stages of gestation on postnatal growth and neurobehavioral development in infants. METHODS: A cohort of pregnant Indian women were followed from 13 to 22 wk gestation (i.e., second trimester; n = 211), 29 to 42 wk gestation (i.e., third trimester; n = 178); their infants were followed to ∼3 wk (n = 147) postpartum. Data collected included information on sociodemographic and health-related factors, including anemia (i.e., low hemoglobin status), maternal and infant anthropometric data, and infant neurobehavioral data. A mixed logistic regression model was used to examine the impact of anemia during pregnancy on maternal and infant outcomes (i.e., anthropometric growth parameters and infant neurobehavioral development). RESULTS: The prevalence of maternal anemia was 41% and 55% (P < 0.001), and iron deficiency anemia was 3.6% and 5.6%, respectively, in the second trimester and third trimester. Infants of pregnant women who were not anemic in the second trimester were 0.26 standard deviations (SD) heavier (P = 0.029), 0.50 SD taller (P = 0.001), and had 0.26 SD larger head circumference (P = 0.029) compared with infants of anemic pregnant women. Infants of pregnant women who were not anemic in the third trimester had orientation scores 3.88 higher (P = 0.004) than infants of women who were anemic. CONCLUSIONS: Our findings indicate that maternal anemia in the second trimester of gestation influences postnatal infant growth and underscores the necessity of alleviating anemia in young women in the early stages of gestation.

Dietary and non-dietary factors associated with serum zinc in Indian women.

Women in low-income settings, common in India, are at risk of inadequate zinc intake due to poor diet quality and low consumption of flesh foods rich in zinc. The aims of this study were to assess the prevalence of zinc status of non-pregnant rural and tribal women living in central India and to identify dietary and non-dietary factors associated with the biochemical zinc status of these women. Rural and tribal non-pregnant women 18-30 years of age were selected using proportion to population sampling near Nagpur, Maharashtra, India. Sociodemographic, biochemical (serum zinc), clinical, and dietary data (1-day interactive 24-h recall) were collected. The mean age of women (n = 109; rural = 52; tribal = 56) was 23.2 years and mean BMI was 17.9 kg/m(2). The majority of the participants identified as being non-vegetarian (72 %). The mean ± SD serum zinc concentration was 10.8 ± 1.6 µmol/L, and 52 % of participants had a low serum zinc concentration according to the International Zinc Nutrition Consultative Group (IZiNCG). The median (first and third quartile) energy, zinc intake, and phytate/zinc molar ratio was 5.4 (4.2, 6.7) MJ/day, 5.3 (3.8, 7.0) mg/day, and 26 (22, 28), respectively. Zinc intakes were well below IZiNCG recommendations for dietary zinc of 9 mg/day for non-pregnant women aged 14-18 years and 7 mg/day for non-pregnant women aged ≥ 19 years. Using linear regression analysis to identify non-dietary and dietary factors associated with serum zinc, a significant association was only found for current lactation (p = 0.012) and energy intake (p < 0.001). Diets low in energy with poor bioavailability of dietary zinc are likely to be the primary cause of the high proportion of Indian women with zinc deficiency.

Iron status of pregnant Indian women from an area of active iron supplementation.

OBJECTIVE: The aim of this study was to investigate the iron status of pregnant tribal women from Ramtek, Nagpur, Maharashtra, India using a combination of indices. METHODS: A community-based observational study was conducted to assess iron status using a convenience sample of pregnant Indian tribal women from Ramtek. Pregnant women were recruited at 13 to 22 wk gestation (first visit; n = 211) and followed to 29 to 42 wk gestation (second visit; n = 177) of pregnancy. Sociodemographic and anthropometric data; iron supplement intake; and blood samples for estimating hemoglobin (Hb), serum ferritin (SF), soluble transferrin receptor (sTfR), and C-reactive protein (CRP) were obtained. RESULTS: The mean (SD) Hb concentration at recruitment was 106 (15) g/L and 106 (14) g/L at the second visit; 41% of the women at recruitment and 55% at second visit were anemic (14% higher, P < 0.001). No women at recruitment and 3.7% at second visit had SF concentration < 15 ng/mL; and 3.3% at recruitment and 3.9% at the second visit had sTfR > 4.4 ng/mL (0.6% higher, P = 0.179). Almost 62% and 71% of pregnant women used iron supplements at both visits, respectively. Iron supplement intake > 7 d in the preceding month improved the Hb concentration by 3.23 g/L and reduced sTfR concentration by 13%; women who were breastfeeding at the time of recruitment had 11% higher SF concentration. CONCLUSIONS: The iron indices suggest that pregnant tribal women of central India, although anemic, had good iron status. Use of iron supplements > 7 d in the preceding month improved iron status; however, non-iron-deficiency anemia persisted in this group.

The effect of maternal iodine status on infant outcomes in an iodine-deficient Indian population.

BACKGROUND: An adequate intake of iodine during pregnancy is essential for the synthesis of maternal thyroid hormones needed to support normal fetal development. This study aimed to assess the iodine status of pregnant tribal Indian women and their infants and to determine the impact of maternal iodine status on infant growth and behavior. METHODS: A prospective, observational study was undertaken to assess the iodine status of tribal pregnant Indian women living in Ramtek, northeast of Nagpur, India. Pregnant women were recruited at 13-22 weeks gestation (n=220), visited a second time at 33-37 weeks gestation (n=183), and again visited at 2-4 weeks postpartum with their infants. Sociodemographic, anthropometric, and biochemical data, including household salt, blood, and urine samples were obtained from pregnant women. Urine samples, anthropometric, and neonatal behavioral data were collected from infants. RESULTS: The median urinary iodine concentration (MUIC) at recruitment (mean gestation=17.5 weeks) of mothers was 106 µg/L, which declined to 71 µg/L at the second visit (mean gestation=34.5 weeks) similar to the postpartum MUIC of 69 µg/L, indicating that these women were iodine deficient. Infant (mean age=2.5 weeks) MUIC was 168 µg/L. Median maternal thyroid stimulating hormone (TSH) and free thyroxine (FT(4)) concentrations at first and second visits were 1.71 and 1.79 mIU/L and 14.4 and 15.4 pmol/L, respectively; 20.0% of women at first visit had TSH >97.5th percentile and 1.4% had FT(4) <2.5th percentile. Salt iodine concentration was a significant predictor of maternal UIC (p<0.001), and postpartum maternal UIC was a significant predictor of infant UIC (p<0.001). For every pmol/L increase in maternal FT(4) concentration at first visit, both infant weight-for-age Z-score and length-for-age Z-score increased by 0.05 units. There was no relationship between maternal UIC, FT(4), or TSH at first visit and neonatal behavior. CONCLUSIONS: Despite three quarters of the women in this study having access to adequately iodized salt (i.e., >15 ppm), these pregnant tribal Indian women were iodine deficient. Increasing the iodine content of salt deemed adequately iodized and iodine supplementation are two strategies that might improve the iodine status of these pregnant women and, consequently, the growth of their infants.

Concurrent micronutrient deficiencies are prevalent in nonpregnant rural and tribal women from central India.

OBJECTIVE: The existence of concurrent micronutrient deficiencies in Indian women of reproductive age has received little attention. This study aimed to comprehensively assess the micronutrient status of nonpregnant rural and tribal women 18-30 y from central India. METHODS: Participants (n = 109) were randomly selected using a stratified (rural-tribal) proportionate-to-population size cluster sampling method from 12 subcenters in Ramtek block, Nagpur. Sociodemographic, anthropometric, dietary, and biochemical data, including blood and urine samples, were obtained. RESULTS: Tribal and rural women had similar sociodemographic characteristics and anthropometric status; 63% of women had a body mass index <18.5 kg/m(2). The median urinary iodine concentration was 215 µg/L (IQR: 127, 319). The mean (SD) concentration of hemoglobin, serum zinc, retinol, and folate was 112 (13) g/L, 10.8 (1.6) µmol/L, 1.2 (0.3) µmol/L, 18.4 (8.4) nmol/L, respectively, with a geometric mean serum vitamin B(12) concentration of 186 pmol/L. The percentage of women with low values for hemoglobin (<120 g/L), serum zinc (<10.7 µmol/L), vitamin B(12) (<148 pmol/L), retinol (<0.7 µmol/L), and folate (<6.8 nmol/L) was 66%, 52%, 34%, 4%, and 2%, respectively. Tribal women had a higher prevalence of zinc deficiency (58% versus 39%, P = 0.054) and concurrent deficiency of any two micronutrients (46% versus 26%; P = 0.034), including zinc and anemia (38% versus 21%, P = 0.024). CONCLUSION: Zinc, vitamin B(12), and iron constitute the principal micronutrient deficiencies in these women. Existing supplementation programs should be extended to include 18- to 30-y-old nonpregnant women as the majority of childbearing occurs within this timeframe.