vitamin-b-12 and Puerperal-Disorders

The authors introduce the subject with physiological comments regarding the ability of r-HuEP to stimulate erythropoietic bone marrow, underlining the need for other molecules to backup the therapy (vitamin B12, folic acid and iron). Subsequently, and in the light of this introduction, they outline the indications for r-HuEPO treatment in specialist fields and the relative contraindications. They then report the results obtained in a group of 24 patients with the relevant indications receiving subcutaneous treatment on alterate days with r-HuEPO in fials of 4000 IU/ml. Basal hemoglobin levels were 6-8 g and treatment was continued until levels of around 10-11 g were reached; tolerance was good in both gynecological and obstetric patients.

Topics: Adult; Anemia; Blood Transfusion; Dose-Response Relationship, Drug; Drug Therapy, Combination; Erythropoietin; Female; Ferrous Compounds; Folic Acid; Genital Diseases, Female; Humans; Pregnancy; Puerperal Disorders; Vitamin B 12

Hyperhomocysteinemia (hyper-Hcy) is a known risk factor for venous thrombosis, but few studies document the risk in puerperal cerebral venous thrombosis (CVT). Nutritional folate and vitamin B(12) deficiency can cause hyper-Hcy and pregnancy may contribute to this deficiency. We studied the association of plasma total homocysteine (tHcy), folate and vitamin B(12) levels with puerperal CVT through a case-control study.. Sixty women with puerperal CVT and 64 healthy puerperal controls were recruited. Plasma fasting tHcy was estimated by high pressure liquid chromatography using coulometric electrochemical detection. Vitamin B(12) and folate were measured by radioimmunoassay. Risk of puerperal CVT was estimated for each of the three variables.. Adjusted odds ratio for the risk of puerperal CVT with hyper-Hcy (>90th percentile) was 10.8 (95% CI: 4.0-29.4; adjusted for vitamin B(12) and folate levels). Low folate and vitamin B(12) levels (<10th percentile) did not increase the risk for puerperal CVT. There was a significant inverse correlation between folate and tHcy levels (rho=-0.471, p<0.001).. Hyperhomocysteinemia is associated with an increased risk of puerperal CVT occurring in Indian women and low folate levels contribute significantly to hyper-Hcy. Regular antenatal folate and vitamin B(12) supplementation is likely to lower puerperal tHcy levels, but its clinical benefit needs to be tested by large therapeutic trials.

Topics: Adolescent; Adult; Confidence Intervals; Female; Folic Acid; Homocysteine; Humans; Intracranial Thrombosis; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Odds Ratio; Prothrombin; Puerperal Disorders; Risk; Risk Assessment; Statistics as Topic; Venous Thrombosis; Vitamin B 12

The presence of autoimmune gastritis was investigated in 54 women with postpartum thyroiditis. Parietal cell antibodies (PCA) specific against H+, K(+)-adenosine triphosphatase (EC 3.6.1.36) were found in 18 women during pregnancy; in 10 of them, a 2-9-fold increase in the PCA level was observed in the postpartum period. At a 5-year follow-up, the initially PCA-positive women still had elevated antibody levels. Hypergastrinemia and low pepsinogen levels were noted in 4 women. In 2 of these women low serum vitamin B12 levels had developed. In 6 of 9 PCA-positive women examined by gastroscopy, biopsy specimens from the gastric body mucosa contained mononuclear cells, mainly T lymphocytes (CD3+) and macrophages (Leu-M3+) combined with an aberrant epithelial expression of HLA-DR. In four patients with chronic gastritis, all parietal cells, as defined by a specific monoclonal antibody, were found to have immunoglobulin G (IgG) deposits by a double-immunostaining method. Three of them had microscopic evidence of atrophy, whereas in 1 patient the body mucosa was intact. In 1 further patient with intact glands at histological examination, the basolateral membrane of some oxyntic glands was coated with IgG. The selective in situ deposition of antibodies associated with histologically intact parietal cells may support the concept that specific autoantibodies participate in the early pathogenesis of parietal cell destruction.

Topics: Adenosine Triphosphatases; Adult; Antibodies; Autoimmune Diseases; Biopsy; Female; Fluorescent Antibody Technique; Follow-Up Studies; Gastric Mucosa; Gastrins; Gastritis; H(+)-K(+)-Exchanging ATPase; Humans; Immunoglobulin A; Immunoglobulin G; Iron; Pepsinogens; Pregnancy; Puerperal Disorders; Thyroiditis, Autoimmune; Vitamin B 12

Topics: Anemia; Female; Humans; Iron; Obstetric Labor Complications; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12

Topics: Female; Humans; Pregnancy; Psychotic Disorders; Puerperal Disorders; Vitamin B 12

Topics: Amblyopia; Female; Humans; Pregnancy; Psychotic Disorders; Puerperal Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia; Bone Marrow; Female; Folic Acid; Humans; Malabsorption Syndromes; Neutrophils; Postpartum Period; Pregnancy; Puerperal Disorders; Vitamin B 12

Topics: Female; Humans; Lactation Disorders; Milk, Human; Pregnancy; Puerperal Disorders; Time Factors; Vitamin B 12

Topics: Anemia, Hypochromic; Drug Combinations; Female; Folic Acid; Humans; Injections, Intramuscular; Iron; Pregnancy; Puerperal Disorders; Sorbitol; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Hypochromic; Bone Marrow Cells; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobins; Hemosiderin; Humans; Iron; Neutrophils; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Transferrin; Venezuela; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Female; Folic Acid; Humans; Pregnancy; Puerperal Disorders; Vitamin B 12

Topics: Anemia, Hypochromic; Female; Folic Acid; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Sorbitol; Vitamin B 12

Topics: Adult; Anemia, Hypochromic; Anemia, Macrocytic; Bone Marrow Examination; Female; FIGLU Test; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Anemia, Macrocytic; Anemia, Pernicious; Blood Transfusion; Female; FIGLU Test; Folic Acid; Folic Acid Deficiency; Hemoglobinometry; Humans; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Reticulocytes; Vitamin B 12

The incidence of megaloblastic anaemia in pregnancy and the puerperium in north Staffordshire has steadily declined as a result of prophylaxis with folic acid. In the presence of advanced folic acid deficiency and with a florid megaloblastic marrow, the anaemia is usually severe, but in many patients the disease is relatively mild and the degree of anaemia is determined more by blood loss or associated iron deficiency than by the megaloblastosis. Microscopic examination of marrow films is still the most reliable method of diagnosis, although estimation of the labile serum folate has produced a 95% correlation with the marrow findings. There are three main factors which operate in the pathogenesis of megaloblastic anaemia in pregnancy and the puerperium. First, the maternal stores of folic acid are used up by the growing foetus, and this process is accelerated in multiple pregnancies, after haemorrhage, or in women with haemolytic anaemia. Secondly, an insufficient intake of folic acid, due to poor diet in pregnancy, plays a part in many cases. The third, and possibly the most important, factor is an absorption defect. Folic acid absorption is usually impaired in established cases, and this can still be demonstrated years later in a majority of patients, when they are neither pregnant nor anaemic. More than 20% of all cases also show abnormal fat absorption. An inherited defect in folic acid absorption may also explain why certain women appear to be constitutionally predisposed to megaloblastic anaemia of pregnancy and the puerperium, as shown by the abnormal blood group distribution in these patients and by the tendency of megaloblastic anaemia to recur not only in subsequent pregnancies, but, as in six of our cases, following other kinds of stress. The significance of commonly associated conditions like pre-eclampsia and infection is still incompletely understood. Although the treatment of megaloblastic anaemia is simple and effective, the main emphasis should be placed on prophylaxis by administering folic acid to all pregnant women.

Topics: Adult; Anemia, Hemolytic; Anemia, Macrocytic; Blood; Blood Group Antigens; Female; Folic Acid; Hemorrhage; Humans; Iron; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Iron-Deficiency; Breast Feeding; Female; Folic Acid; Humans; Postpartum Period; Pregnancy; Puerperal Disorders; Vitamin B 12

Topics: Corrinoids; Dexamethasone; Female; Humans; Neuritis; Pathology; Postpartum Period; Pregnancy; Pregnancy Complications; Puerperal Disorders; Pyridoxine; Thiamine; Vitamin B 12; Vitamin B Complex