Nisar Sobia, Kareem Ozaifa, Muzaffer Umar, Tanvir Masood, Ganaie Mohd Ashraf, Ahmed Rabia Nazir
Department of Medicine, Government Medical College, Srinagar, India.
Department of Pharmaceutical Sciences, University of Kashmir, Srinagar, India.
Int J Gynaecol Obstet. 2024 Jan;164(1):157-165. doi: 10.1002/ijgo.14989. Epub 2023 Jul 17.
Pregnancy, a nutritionally demanding situation in terms of macro- and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth.
This prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency-related neuropathy, high-output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine-responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole-blood thiamine levels. Response to intravenous thiamine supplementation was also monitored.
Data of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 μg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high-output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge.
In the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life-saving. There is a need for validated clinical criteria owing to the non-availability of thiamine testing in resource-limited settings.
怀孕是一个对宏量和微量营养素供应在营养方面要求很高的时期，因为母体、胎盘和胎儿的需求增加，这会显著影响硫胺素储备。怀孕和产后期间的硫胺素缺乏表现出多种症状和后果，在我们的人群中是一种相对常见的情况。该研究旨在了解怀孕和产后妇女急性硫胺素缺乏的各种表现和后果，强调早期识别和硫胺素治疗对于预防孕期和产后严重并发症的重要性。
这项前瞻性研究在印度北部的一家三级医疗中心进行，纳入了连续的怀孕和产后妇女，她们表现出与硫胺素缺乏症相符的临床特征，如硫胺素缺乏相关的神经病变、高输出量心力衰竭、射血分数降低的心力衰竭、韦尼克脑病、胃型脚气病和硫胺素反应性急性肺动脉高压。除了记录包括药物摄入、饮食消费和合并症在内的病史外，这些妇女还接受了简短的相关临床检查和实验室评估，包括全血硫胺素水平。还监测了静脉补充硫胺素后的反应。
分析了31名诊断为急性硫胺素缺乏的妇女（12名孕妇，19名产后妇女）的数据，她们的平均年龄为28.88±2.69岁。硫胺素平均水平为1.28±0.44μg/dL，平均血乳酸水平为3.46±3.33。最常见的表现是胃型脚气病（n = 10），其次是双下肢轻瘫（n = 6）、高输出量心力衰竭（n = 6）、急性肺动脉高压、射血分数降低的心力衰竭（各n = 3）和急性意识模糊状态（n = 2）。所有患者对硫胺素激发试验均有反应。
在硫胺素状态临界的情况下，特别是在我们这个硫胺素缺乏流行且孕期和围产期硫胺素需求增加的人群中，这种缺乏会有干性和湿性脚气病的各种严重表现。早期识别临床特征并进行硫胺素治疗可能会挽救生命。由于资源有限的环境中无法进行硫胺素检测，因此需要经过验证的临床标准。
