Maternal lean body mass may be the major determinant of birth weight: A study from India.

This study explored the relationship of maternal body composition parameters to the birth weight of the offspring. Maternal anthropometric parameters (weight, height) and body composition by dual energy X-ray absorptiometry were measured in 76 women from low-income group during 12-21 days postpartum. The mean+/-s.d. height, weight of the mothers and birth weight of the newborns were 151.5+/-5.29 cm, 46.7+/-6.04 and 2.84+/-0.358 kg, respectively. When the relationship of maternal anthropometric and body composition parameters to the infants' birth weight was studied, maternal lean body mass was found to be the most important determinant of birth weight (R2 (%) = 21.3) (P < 0.001). This study highlights the importance of increasing lean body mass in young women for better pregnancy outcome.

Energy expenditure on household, childcare and occupational activities of women from urban poor households.

This present study attempts to measure the energy cost of activities of women from the poor socio-economic group in India. Women in the age group of 18-40 years (n 98) either working for incomes or classified as homemakers were randomly selected. Time disposition studies were conducted by a 24 h observation of their activities on a typical day. Predominant activities were identified from the activity profiles and standardized for posture and duration. The BMR (Douglas bag method) and energy cost of the activities (Kofranyi-Michaelis meter) were measured by indirect calorimetry. The energy consumption during these activities ranged from 2.94-12.51 kJ/min. The tasks were divided into standard, household, childcare, occupational and other activities. Using the World Health Organization/Food and Agriculture Organization/United Nations University (1985) criteria, attempts were made to categorize the activities into light, moderate and heavy. It was significant that except for walking, the standard activities and occupational work could be classified into the light category (< 2.2 BMR). Most of the household and childcare activities except cooking were classified into the moderate to heavy (2.2-> 2.8 BMR). The energy expenditure of activities did not differ significantly between women with different occupations. This present study provides an important database on energy costs of activities for computing energy requirements of women involved in similar activity patterns.

Effect of dose and formulation on iron tolerance in pregnancy.

BACKGROUND: The National Nutritional Anaemia Prophylaxis Programme (NNAPP) in India was launched in 1971. However, anaemia continues to be a major public health problem. Partial coverage of the population, inadequate dose of the iron supplement, defective absorption due to intestinal infestations and problems with formulation have been recognized as factors responsible for its failure. Therefore, the bioavailability of iron from different formulations containing 60 mg of elemental iron and of tablets with varying doses of elemental iron was undertaken. METHODS: One hundred and fifteen women were randomly allotted to receive different formulations and doses of iron and then undergo iron tolerance tests. They received ferrous sulphate tablets containing 60 mg, 120 mg and 180 mg of elemental iron; formulations containing 60 mg of elemental iron as pure ferrous sulphate salt, ferrous fumarate tablets, ferrous fumarate syrup, excipients added to pure ferrous sulphate salts, powdered ferrous sulphate tablets, iron tablets distributed by the NNAPP and pure ferrous salt in gelatin capsules. RESULTS: The data obtained from 32 subjects were excluded because of non-compliance, intolerance of the medication and lack of results of blood tests. Data from the remaining 83 subjects indicated that increasing the dose of elemental iron from 60 mg to 180 mg improved the bioavailability of iron, but was associated with unacceptable side-effects. Also, liquid formulations of iron had a better bioavailability, with ferrous fumarate syrup and gelatin capsules being the most superior. CONCLUSION: Providing the iron formulation with a high bioavailability should enable the NNAPP to be more successful in decreasing the prevalence of anaemia.

Pharmacokinetics of orally administered norethisterone enanthate in rabbit, monkey, and women.

Norethisterone enanthate (NET-En), an established intramuscular long-acting contraceptive agent, has previously been shown to be effective in inhibiting fertility in two rodent species even 4 days after oral ingestion. Pharmacokinetics of NET and NET-En were studied after oral and intramuscular doses in two animal species and a few women. The results suggest that the NET-En was absorbed within a day in all the species after oral dose. The estimates of relative bioavailability ranged from 13 to 51% in rabbits, monkeys, and women. The elimination half-life was 5-10 days. The presence of the active component, NET, in the circulation over the experimental period of 15 days suggests that NET-En could be useful as a long-acting oral pill. The suppression of progesterone levels during the luteal phase of menstrual cycle in women also supports this finding.

Interaction between vitamin A and iron: effects of supplements in pregnancy.

Very few reports are available on the vitamin A status of Indian pregnant women in the rural population. The present study was carried out to assess the vitamin A status and the effect of vitamin A and iron supplementation in pregnancy on serum vitamin A levels in the rural women. It was observed that serum vitamin A levels showed a marginal decrease with advancing gestation. Though satisfactory as per WHO guidelines, supplementation with 60 mg of iron prevented this decrease. A higher dose of iron (120 mg) actually resulted in a similar vitamin A status as seen in vitamin A supplemented women. If this preliminary study can be confirmed it would appear that interactions between vitamin A and iron in pregnancy have a positive effect on the vitamin A nutriture.

Vitamin A requirements assessed by plasma response to supplementation during pregnancy.

Plasma vitamin A responses were examined in 30 low income pregnant women before and after supplementation with vitamin A. In the groups of women who had an initial (at < 20 weeks) plasma vitamin A of less than 30 micrograms/dl retinol, typical changes representing a peak at mid gestation and a significant decline at term were observed. Supplementation with vitamin A tablets equivalent to 1800 micrograms of retinol daily for 12 weeks was able to raise the plasma vitamin A content at term. On the other hand, those women who had an initial plasma vitamin A concentration of more than 30 micrograms/dl did not show any appreciable changes even with vitamin A supplementation. Consistent beneficial effects of supplementation on maternal and cord vitamin A and maternal hemoglobin and progesterone were noted in our previous studies only when the supplementation lasted for 12 weeks and not after 10 weeks. Using these data with dietary intake obtained from other studies, an attempt was made to estimate the requirements of vitamin A during pregnancy. The approximate requirement of 780 retinol equivalents (RE) obtained, is in agreement with earlier recommendations of FAO and Indian Council of Medical Research (ICMR) Expert Committees, but is higher than the recent ICMR recommendations.

Assessment of vitamin A status in pregnant women as reflected by in vitro destruction of vitamin A by hemolysates and urinary ammonium nitrogen to creatinine ratio.

To investigate the significance of the lowered plasma vitamin A during the last few weeks of pregnancy, the capacity of erythrocyte lysates to destroy vitamin A in vitro and the alteration in ammonium nitrogen to creatinine ratio (Am N/Cr) in random urine samples was followed up at different gestational ages in women from low income groups. One group received no supplementation and the other received supplements of 1800 retinol equivalents (RE) and at most points the number of observations were not less than 12. In the unsupplemented women there was a significant increase in the capacity of erythrocytes to destroy vitamin A in vitro, which reflects an increased oxidative stress as compared to the supplemented group. While differences in mean Am N/Cr did not follow any consistent pattern, there was a strong association between lowered plasma vitamin A (< 35 micrograms/dl) and increased Am N/Cr ratio (> 0.5). This was true only when combined data of both groups were considered till 26 weeks of gestation and not beyond. As expected in supplemented women there was no significant fall in the plasma vitamin A during term. These data reveal that the lowered plasma vitamin A levels are suggestive of greater risk of hypovitaminosis A during pregnancy as indicated by the oxidative stress in erythrocytes.

Effect of vitamin A supplementation on haemoglobin and vitamin A levels during pregnancy.

About 450 pregnant women from a low-income group were recruited to study the effect of vitamin A supplementation on plasma vitamin A levels in the mother and cord and on the birth weights of the neonates. Results showed that supplementation with 1800 micrograms vitamin A/d for more than 12 weeks prevented the decline in plasma vitamin A that otherwise occurs during the last few weeks of pregnancy. This improvement in maternal values for vitamin A at a critical time of development favourably affected availability to the fetus, as reflected by the marked elevation in cord levels. Supplementation for a period of 12 weeks was found to be sufficient, since subsequent discontinuation did not alter the beneficial response. Apart from increasing maternal and cord vitamin A levels, vitamin A supplementation along with iron prevented, in this study, the significant decline in haemoglobin occurring at 26-28 weeks of gestation. The birth weights were not altered by vitamin A supplementation.

Plasma levels of estradiol & progesterone at different gestational ages in Indian women.

Plasma levels of estradiol and progesterone were determined at different gestational ages in Indian pregnant women from the low socio-economic group. The levels of estradiol and progesterone progressively increased with gestation and reached maximum values (14.35 +/- 1.092 and 145.9 +/- 7.69 ng/ml, respectively) by term. Though the estradiol values were comparable to those reported in literature, the term values of progesterone were found to be lower (145.9 +/- 7.69 ng/ml) than those reported from Western countries (160 +/- 7.5 ng/ml) at 34-38 wk of gestation. These low progesterone values may have physiological implication in placental function.

Secular trends in the heights of women from the urban poor community of Hyderabad.

There are very few studies in India that have investigated secular trends in the heights and weights of adult women from the poorer socio-economic groups. Five hundred and twelve pairs of healthy mothers and daughters were enrolled and heights and weights recorded. The heights were not different in the two generations, but the daughters were lighter than the mothers. The number of mothers and daughters with heights under 145 cm were 35 and 34. If height corrections for mother's age is done, then it appears that the trend in this population is towards smaller size.

Serum prolactin levels in undernourished Indian lactating women.

1. Serum prolactin (PRL) levels, both basal and post-suckling peak, were estimated in fifty-seven lactating women. 2. Basal PRL levels were significantly higher in all lactating women irrespective of the duration of lactation as compared to the levels in non-pregnant, non-lactating women. 3. There was significant positive correlation (r 0.69, P less than 0.001) between the basal PRL levels and the post-suckling peak values. 4. After 8 months of lactation, peak post-suckling, PRL levels were not significantly different from basal values. 5. Basal PRL levels were significantly lower (P less than 0.05) in mothers whose infants were being supplemented. 6. PRL levels were not related to the mother's nutritional status as determined by body-weight. 7. The findings suggest that high PRL levels during lactation prolong the duration of lactional amenorrhoea and hence the relative infertility.