印度南部育龄妇女的贫血状况以及维生素B-12和叶酸水平：评估基于人群的神经管缺陷风险
Anemia and Vitamin B-12 and Folate Status in Women of Reproductive Age in Southern India: Estimating Population-Based Risk of Neural Tube Defects.
作者信息
Finkelstein Julia L, Fothergill Amy, Johnson Christina B, Guetterman Heather M, Bose Beena, Jabbar Shameem, Zhang Mindy, Pfeiffer Christine M, Qi Yan Ping, Rose Charles E, Williams Jennifer L, Bonam Wesley, Crider Krista S
机构信息
Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA.
Arogyavaram Medical Centre, Andhra Pradesh, India.
出版信息
Curr Dev Nutr. 2021 Apr 26;5(5):nzab069. doi: 10.1093/cdn/nzab069. eCollection 2021 May.
BACKGROUND
Women of reproductive age (WRA) are a high-risk population for anemia and micronutrient deficiencies. However, there are few representative population-level data from India, which could help inform evidence-based recommendations and policy.
OBJECTIVE
To conduct a population-based biomarker survey of anemia and vitamin B-12 and folate status in WRA as part of a periconceptional surveillance program in southern India.
METHODS
Participants were WRA (15-40 y) who were not pregnant or lactating. Whole blood (= 979) was analyzed for hemoglobin via a Coulter counter (Coulter HMX). Plasma, serum, and RBCs were processed and stored at -80°C or less until batch analysis. Vitamin B-12 concentrations were measured via chemiluminescence; RBC and serum folate concentrations were evaluated via microbiological assay. Anemia and severe anemia were defined as hemoglobin <12.0 g/dL and <8.0 g/dL, respectively. Vitamin B-12 deficiency and insufficiency were defined as total vitamin B-12 <148 pmol/L and <221 pmol/L, respectively. Folate deficiency and insufficiency were defined as RBC folate <305 nmol/L and <748 nmol/L. A previously developed Bayesian model was used to predict neural tube defect (NTD) prevalence per 10,000 births.
RESULTS
A total of 41.5% of WRA had anemia and 3.0% had severe anemia. A total of 48.3% of WRA had vitamin B-12 deficiency and 74.3% had vitamin B-12 insufficiency. The prevalence of RBC folate deficiency was 7.6%, and 79.3% of WRA had RBC folate <748 nmol/L, the threshold for optimal NTD prevention. Predicted NTD prevalence per 10,000 births based on RBC folate concentrations was 20.6 (95% uncertainty interval: 16.5-25.5).
CONCLUSIONS
The substantial burden of anemia, vitamin B-12 deficiency, and RBC folate insufficiency in WRA in this setting suggests an opportunity for anemia and birth defects prevention. Findings will directly inform the development of a randomized trial for anemia and birth defects prevention in southern India.This study was registered at clinicaltrials.gov as NCT04048330.
背景
育龄妇女是贫血和微量营养素缺乏的高危人群。然而，印度缺乏具有代表性的人群层面数据，这些数据有助于提供循证建议和政策依据。
目的
作为印度南部孕前监测项目的一部分，对育龄妇女的贫血、维生素B-12和叶酸状况进行基于人群的生物标志物调查。
方法
参与者为未怀孕或哺乳的育龄妇女（15 - 40岁）。采用库尔特计数器（库尔特HMX）对979份全血样本进行血红蛋白分析。血浆、血清和红细胞样本经处理后储存在-80°C或更低温度下，直至进行批量分析。通过化学发光法测定维生素B-12浓度；通过微生物学测定评估红细胞和血清叶酸浓度。贫血和重度贫血分别定义为血红蛋白<12.0 g/dL和<8.0 g/dL。维生素B-12缺乏和不足分别定义为总维生素B-12<148 pmol/L和<221 pmol/L。叶酸缺乏和不足分别定义为红细胞叶酸<305 nmol/L和<748 nmol/L。使用先前开发的贝叶斯模型预测每10000例出生中神经管缺陷（NTD）的患病率。
结果
共有41.5%的育龄妇女患有贫血，3.0%患有重度贫血。共有48.3%的育龄妇女存在维生素B-12缺乏，74.3%存在维生素B-12不足。红细胞叶酸缺乏的患病率为7.6%，79.3%的育龄妇女红细胞叶酸<748 nmol/L，这是预防神经管缺陷的最佳阈值。根据红细胞叶酸浓度预测的每10000例出生中神经管缺陷患病率为20.6（95%不确定区间：16.5 - 25.5）。
结论
在这种情况下，育龄妇女中贫血、维生素B-12缺乏和红细胞叶酸不足的负担较重，这表明有机会预防贫血和出生缺陷。研究结果将直接为印度南部贫血和出生缺陷预防随机试验的开展提供信息。本研究已在clinicaltrials.gov注册，注册号为NCT04048330。
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