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OBJECTIVE: To determine relation between schoolchildren's blood pressure, glycated haemoglobin level, and cholesterol concentration and their anthropometry, socioeconomic status, and birth measurements. DESIGN: Retrospective cohort study. SETTING: 27 schools closest to University Hospital of the West Indies, Kingston, Jamaica. SUBJECTS: 2337 children aged 6-16 years who were born at university hospital were recruited, and their birth records were recovered: 1610 had suitable records, 659 had records including birth length, and 610 of these were prepubertal. MAIN OUTCOME MEASURES: Blood pressure, glycated haemoglobin level, serum cholesterol concentration, anthropometry at birth, current anthropometry, and socioeconomic status. RESULTS: Multiple regression analysis showed that children's systolic blood pressure was inversely related to their birth weight (P < 0.0001) and directly related to their current weight. Glycated haemoglobin level was higher in children with thicker triceps skinfolds (P < 0.001) and who had been shorter at birth (P = 0.003). Serum cholesterol concentration was inversely related to current height (P = 0.001) and to length at birth (P = 0.09) and was directly related to triceps skinfold thickness and higher socioeconomic status (P < 0.001). CONCLUSIONS: Blood pressure in childhood was inversely related to birth weight and directly to current weight. Glycaemic control and serum cholesterol were related to short length at birth, height deficit in childhood, and childhood obesity.

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The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C/100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal Day Care Centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0% respectively. The average hemoglobin before the intervention was 10.3 g/dl in the DCC and 10.5 in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children presented an improvement, 41.1% showed changes and only 1.9% became worse. In the BHCU, 11.4% presented better condition, 70.6% remained the same and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition, when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age.

PIP: The impact of the use of fortified powdered whole milk (9 mg of iron and 65 mg of vitamin C per 100 g of milk) on the hemoglobin levels of children under 2 years of age was evaluated, over a period of 6 months, in 107 children enrolled in municipal day care centers (DCC) and in 228 seen at a Basic Health Care Unit (BHCU). Before the beginning of the intervention, 66.4% of the children in the DCC and 72.8% of those seen at the BHCU had hemoglobin levels under 11.0 g/dl. After 6 months of fortified milk intake, these percentages fell to 20.6% and 18.0%, respectively. The average hemoglobin level before the intervention was 10.3 g/dl in the DCC and 10.5 g/dl in the BHCU. After 6 months these increased to 11.6 g/dl in the populations studied. Concerning the nutritional condition, evaluated according to Gomez's criteria, 57% of the DCC children showed improvement, 41.1% showed no change, and only 1.9% grew worse. In the BHCU, 11.4% showed improvement, 70.6% remained the same, and 18% worsened, which demonstrated differences in response regarding improvement of nutritional condition when fortified milk was used in closed and open environments. The authors conclude that the utilization of enriched foods is an excellent alternative in the treatment of iron deficiency in populations of children under 2 years of age. (author's)

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Most micronutrient deficiencies affect relatively few people in the Caribbean; however, many Caribbean residents are affected by anemia that appears due primarily to a lack of dietary iron. While generally substantial, the prevalences of such anemia have differed a good deal from place to place and study to study, observed rates ranging from 27% to 75% in pregnant women, 19% to 55% in lactating women, and 15% to 80% in young children. Severe anemia, defined by a blood hemoglobin concentration below 8 g/dl, has been found in approximately 6% of the pregnant women and 11% of the preschool children in some Caribbean countries. The principal ways of controlling iron deficiency anemia are through food fortification, control of intestinal parasites, direct oral supplementation, and dietary modification. Progress has been made in iron fortification of wheat flour and wheat products (the principal foodstuffs consumed by the general public in most of the English-speaking Caribbean). Data on control of relevant parasites in the Caribbean (primarily hookworm and to a lesser extent whipworm) are limited. Health services throughout the English-speaking Caribbean have been providing direct iron supplementation for pregnant women, but high levels of anemia during pregnancy still exist because of coverage, monitoring, and compliance problems. All the Caribbean countries also have education programs, which mainly advise pregnant women about iron-rich foods and iron absorption inhibitors and enhancers.

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The frequency of viral markers for hepatitis B (HBV) and C (HCV), human immunodeficiency virus-1 (HIV-1) and human T-lymphotropic virus-1 (HTLV-1) was evaluated in 32 Brazilian beta-thalassemia multitransfused patients. Additionally the serum concentrations of ferritin and alanine aspartate transaminase (ALAT) were determined. The results show a high prevalence of markers of infection by HBV (25.0%) and HCV (46.8%) and a low prevalence of markers for HIV-1 and HTLV-1. No correlations were demonstrated between the presence of the hepatitis markers and the number of units transfused or the serum concentrations of ferritin and ALAT.

PIP: In Brazil, clinicians followed 32 transfusion-dependent beta-thalassemia patients, 1-49 years old, at the Regional Blood Center and the Department of Hematology of University Hospital of the School of Medicine of Ribeirao Preto to determine the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), HIV-1, and HTLV-1. They also measured serum levels of ferritin and alanine aspartate transaminase (ALAT) to examine liver iron content and liver damage, respectively. 46.8% tested positive for antibodies to HCV, which was much higher than that of voluntary blood donors of the Regional Blood Center (1.4%) or of other countries. Yet it was about the same as that of multitransfused patients in the UK (23.2%), Italy (92.9%), and Saudi Arabia (33.3%). 3 of these 15 patients also tested positive for HBV markers. 15.5% tested positive only for HBV markers. 37.5% had no hepatitis markers. Hepatitis-positive people were older than those who tested negative for hepatitis (15.2 years vs. 8.5 years; p .05). The number of units of blood transfused and the levels of ferritin and ALAT were not statistically different between the 2 groups (192.1-336 vs. 135.2 and 36.6-52.3 U/l vs. 36.7 U/l, respectively). 75% of the HCV positive patients received more than 100 units of packed red blood cells while only 42% did in the HCV negative group. 2 people tested positive for HIV-1 1 of whom also tested positive for anti-HBs-Ag and the other for HCV antibodies. The HIV-1 cases had become infected before the blood bank began screening for HIV-1 in 1987. None of the patients receiving blood from the center became infected with HIV-1, yet 60% of hemophiliacs treated at the hospital were HIV-1 infected. No one tested positive for HTLV-1, even though all 32 patients had received more than 6250 units of blood not screened for HTLV-1. This reflected the low incidence of HTLV-1 in the general population (0.05%). No one was positive for HBs-Ag or HBe-Ag.

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The objective of this study was to evaluate the benefit of screening for anemia in infants in relation to their previous diet. The iron status of 854 nine-month-old infants on three different feeding regimens and on a regimen including iron dextran injection was determined by analysis of hemoglobin, serum ferritin, and erythrocyte protoporphyrin levels and of serum transferrin saturation. Infants were categorized as having iron deficiency if two or three of the three biochemical test results were abnormal and as having iron deficiency anemia if, in addition, the hemoglobin level was less than 110 gm/L. The prevalence of iron deficiency was highest in infants fed cow milk formula without added iron (37.5%), intermediate in the group fed human milk (26.5%), much lower in those fed cow milk formula with added iron (8.0%), and virtually absent in those injected with iron dextran (1.3%). The corresponding values for iron deficiency anemia were 20.2%, 14.7%, 0.6%, and 0%, respectively. The use of iron supplements is therefore justified in infants fed cow milk formula without added iron, even when there is no biochemical evidence of iron deficiency. The low prevalence of iron deficiency in the group fed iron-fortified formula appears to make it unnecessary to screen routinely for anemia in such infants. These results also support the recommendation that infants who are exclusively fed human milk for 9 months need an additional source of iron after about 6 months of age.

PIP: The objective of this study was to evaluate the benefit of screening for anemia in infants in relation to their previous diet. The iron status of 854 9-month old infants on 3 different feeding regimens and on a regimen including iron dextran infection was determined by analysis of hemoglobin, serum ferritin, and erythrocyte protoporphyrin levels and of serum transferrin saturation. Infants were categorized as having iron deficiency if 2 or 3 of the 3 biochemical test results were abnormal; if the hemoglobin level was 110 gm/L, then a diagnosis of iron deficiency anemia was also made. The prevalence of iron deficiency was highest in infants who were fed cow's milk formula without added iron (37.5%), intermediate in the group fed human milk (26.5%), much lower in those fed cow's milk formula with added iron (8.0%), and virtually absent in those injected with iron dextran (1.3%). The corresponding values for iron deficiency anemia were 20.2%, 14.7%, 0.6% and 0%, respectively. The use of iron supplements is therefore justified in infants who received cow's milk formula without added iron, even when there is no biochemical evidence of iron deficiency. The low prevalence of iron deficiency in the group fed iron-fortified formula appears to make it unnecessary to screen routinely for anemia in such infants. These results also support the recommendation that infants who receive human milk exclusively for 9 months require an additional source of iron after about 6 months of age.

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Menstrual blood loss (MBL) studies are relevant for developing world women as this could be an important cause of anemia. Whenever a contraceptive method is to be used by such women, consideration should be given to the method which least affects the volume of MBL. In 309 women considered as clinically healthy, MBL, serum ferritin, serum iron and hemoglobin levels were measured: a mean MBL of 23 ml was found. Age, weight, height and previous oral contraceptive use did not affect MBL. Higher parity women may have higher MBL levels but their hematologic indices are not altered. While body iron stores (as judged by serum ferritin levels) are depleted in women who bleed more than 60 ml per cycle, clinical anemia may not be present until their blood loss exceeds 80 ml per menstruation. Brazilian women who lose more than 60 ml of menstrual blood associated with multiple pregnancies without adequate iron supplementation may have a depletion of their body iron stores.

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PIP: 107 users of vaginal rings and 74 users of Multiload-375 (ML-375) IUDs aged 18-40 years with more than 1 parity were studied. In the city of Santiago, Chile, 57 patients and at the University of Juiz de Fora, Brazil, 124 users were enrolled. The vaginal ring releases about 20 mcg/day of levonorgestrel (LNG). It was used continuously for 12 months with replacement every 3 months. The ML-375 was used continuously for 24 months or more. Menstrual blood loss (MBL) was determined before insertion; 3, 6, 9 and 12 months after insertion in both groups; and after 24 months in the IUD users. Serum ferritin measurement was done before use: 6 and 12 months after use in the vaginal ring group and 6, 12, and 24 after IUD insertion. Hemoglobin also was measured. It was observed that MBL always increased with IUD use and decreased with vaginal ring use. The measurements concerning IUD were significant in Santiago up to 24 months with a value of MBL of + 17.9 +or- 7.8 ml, while in Juiz de Fora they were significant up to 12 months returning to the value of preinsertion at 24 months (+ 3.1 +or- 4.6 ml). In vaginal ring users a small decrease of MBL was ascertained, but the only statistical difference occurred up to 12 months in Santiago (- 9 +or- 4.4 ml). In IUD use, in inverse correlation to MBL, serum ferritin dropped significantly at 6 months in Chile (- 7.7 +or- 2.9 ng.ml) and 6, 12, and 24-month follow-ups in Brazil (-5.2, -6 and-7.7 ng/ml, respectively). With the vaginal ring serum ferritin did not change significantly. These findings confirm previous research that ML IUDs increased MBL much less than other IUDs causing less change in iron stores even in patients with ferritin lower than 15 ng/ml, considered under the normal value. Yet for users in developing countries, the use of vaginal rings with LNG would be more suitable than the IUD ML-375 because of slighter alterations in the iron balance of the system.^ieng

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Dietary intakes were obtained by 24-h recall from 25 women in the first and third trimesters of pregnancy and 25 women in the first 3 months of lactation from eight towns in the Amazon valley. No consistent differences were found between the towns, so the results have been analysed together. Intakes of iron, free and total folate and zinc were nearly all very low compared with current recommendations. Despite their low intakes, the majority of the women had acceptable values of haemoglobin, haematocrit and MCHC. Serum folate concentrations were almost all extremely low (less than 2.5 ng/ml). The levels of RBC folate were also low, but in general not as severely so as those for serum folate. Serum zinc concentrations ranged from 0.2 to 0.7 microgram/ml, whereas the lower limit of acceptability has been put by various authors as 0.59-0.69 microgram/ml according to the stage of pregnancy. In breast milk, total folate in the majority of women ranged from 25 to 50 ng/ml, the greater part of it being in the free form. Zinc levels in breast milk were within the range 0-2 microgram/ml.

PIP: Dietary intakes were obtained by 24-hour recall from 25 women in the 1st and 3rd trimesters of pregnancy and from 25 women during their 1st 3 months of lactation from 8 towns in the Amazon valley. No consistent differences were found between the towns and therefore the results have been analyzed together. Intakes of iron, free and total folate, and zinc were nearly all very low intakes, the majority of the women had acceptable values of hemoglobin, hematocrit, and MCHC. Serum folate concentrations were almost all extremely low ( 2.5 ng/ml). The levels of RBC folate were also low, but in general not as severely as those for serum folate. Serum zinc concentrations ranged from 0.2-0.7 mcg/ml, whereas the lower limit of acceptability has been put by various authors as 0.59-0.69 mcg/ml according to the stage of pregnancy. In breastmilk, total folate in the majority of women ranged from 25-50 ng/ml, the greater portion of it being in its free form. Zinc levels in breastmilk were within the 0-2 mcg/ml range.

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Epidemiological and clinical studies (Fleming et al. 1985; Perrin et al. 1982) indicate that hemoglobin (Hb) AS individuals have a selective advantage in malarial environments. Thus the high frequency of Hb S in human populations has been attributed to the decreased malarial morbidity and mortality experienced by Hb AS heterozygotes. It has also been suggested that Hb AS women have a higher fertility than that of Hb AA women, thus contributing to the elevated frequency of Hb S in malarial environments (Livingstone 1957). Firschein (1961) demonstrated a significantly greater fertility among Hb AS females, whereas Custodio and Huntsman (1984) documented no fertility differential between Hb AS and Hb AA women. Here I examine the reproductive careers of Hb AA and Hb AS subjects 40 years of age and older from Limon, Costa Rica. The purpose is to determine whether normal homozygotes and heterozygotes have significantly different fertilities. The research shows that these groups do not have significantly different completed family sizes (t = 0.38, ns) or significantly different numbers of pregnancies (t = 0.34, ns), live births (t = 0.36, ns), or abortions (t = 0.20, ns). My results support previous suggestions that differential fertility does not contribute to the maintenance of the Hb S polymorphism.

PIP: The relationship between hemoglobin genotype and differential fertility is examined using data for 137 women aged 40 years or older from Limon, Costa Rica. The results do not demonstrate any reproductive advantage for hemoglobin (HG) AS individuals in an environment affected by malaria.

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The purpose of this study was to assess the nutritional status of low-income Brazilian mothers, who were supplemented with iron and vitamin B12 during pregnancy, in terms of iron, zinc, folate and vitamin B12, in different stages of lactation and to determine the influence of the maternal nutritional status on milk composition. The effect of folate supplementation during pregnancy on folate status of the nursing mothers and milk composition was investigated. The effect of partial weaning on maternal status and milk composition was also studied. In general, the nutritional status of iron, zinc, folate and vitamin B12 of the mothers appears adequate. However, some of the mothers had indices of status lower than normal limits for non-pregnant women. These values, particularly after 30 d post-partum, indicate that these mothers might be at nutritional risk and that the nutrient supplementation received during pregnancy was insufficient to meet demands. There was an increase with the stage of lactation for haematocrit, serum vitamin B12, serum zinc, serum albumin, milk folate and saturation of its binding protein, but there was a decrease for milk protein, total and whey-bound iron and zinc, and lactoferrin. Mothers who took folate supplements during pregnancy had higher serum folate levels immediately after birth than those not taking the supplements but no differences were found at later stages of lactation. Milk composition was not affected. Partial weaning did not affect the maternal nutritional status or the milk composition except for iron which was higher in milk from mothers who were partially breastfeeding.(ABSTRACT TRUNCATED AT 250 WORDS)

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The effects on pregnancy outcome and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in a group of underweight gravidas. These take-home products were distributed during regular prenatal visits. Women in the V-N group had greater weight gain (12.29 vs 11.31 kg, p less than 0.05) and mean birth weights (3178 vs 3105 g, p less than 0.05) than those in the PUR group. Values for various indicators of maternal Fe status were also higher in the V-N group. Compared with self-selected noncompliers, similar in all control variables to compliers, children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g, respectively. Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth.

PIP: The effects on maternal and infant weight gain and maternal iron status of powdered milk (PUR) and a milk-based fortified product (V-N) were compared in underweight women attending prenatal clinics in Santiago, Chile. All pregnant women attending 9 prenatal clinics of the Southeast Health Area, over 18 years old, parity 0-5, nonsmoking, nonalcohol-consuming and underweight (95% of standard) joined the study. They were given either the PUR, powdered milk with 26% milkfat, or V-N, (Vita-Nova Mother-food, Melkunie Holland, Woerden) which contained micronutrients and added vegetable fat, as mandated by law. Those who failed to consume supplements were relegated to the control group. The V-N group had greater weight gain (12.29 vs 11.31 kg, p0.05), mean birth weights (3178 vs 3105 g, p0.05) than the PUR group. Iron status, shown by significantly higher mean hematocrit, hemoglobin, mean corpuscular volume, transferrin saturation and plasma ferritin levels near term, was also better in the V-N group than in the PUR. Other significant differences in favor of the V-N supplement were number of intrauterine growth retarded infants and birth weights under 3001 g. The V-N group had greater fluid retention: the import of this is unknown. The infants of non-compliers had birthweights 258 and 335 g lower than the women consuming PUR and V-N, respectively. The babies of V-N mothers gained 74 g/kg maternal weight gain, higher than many previously reported increments, perhaps due to the micronutrients in the supplement.

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PIP: 3 groups of IUD users participated in a preliminary study to evaluate the effect of calcium lonazolac, a nonsteroid antiinflammatory agent, on excessive menstrual bleeding. All participants were parous women aged 20-30 years in good health. Multiload 250 IUDs were inserted in 15 women averaging 24.5 years of age. They were also supplied with calcium lonazolac tablets in 200 mg doses to be taken continuously 3 times daily. 15 women averaging 26.1 years also had multiload 250 IUDs inserted. They were given the same instructions but their medication was a placebo. A third group of 30 women averaging 26.2 years of age who had experienced heavy bleeding during 6-36 months of IUD use were given 200 mg tablets of calcium lonazolac to be taken 3 times daily. The 30 women used various types of IUDs. All 60 women were provided with sanitary pads to be returned at their regular clinic visits. Hemoglobin and hematocrit levels were also determined at each visit. The method of Hallberg and Nilsson was used to measure menstrual blood loss. There were no significant changes in the volume or duration of bleeding or hemoglobin or hematocrit levels in the 15 women given the drug. The 15 women given the placebo had a significant increase in the quantity of blood loss and a significant increase in the duration bleeding in the 3rd month. The 30 women with histories of heavy bleeding had significant decreases in volume and duration of bleeding. Modifications in hemoglobin were not especially significant, while the hematocrit levels increased in the 2nd and 3rd months. None of the women reported significant side effects except 1 woman with a prior history of gastritis. Her gastric distress was controlled by an antacid after meals for 1 week. Comparison of results between the treated and control groups suggests that calcium lonazolac gives good results. Its use should be evaluated at lower doses with consumption limited to days of bleeding only.^ieng

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PIP: This study presents information about the postpartum sterilization program of a teaching hospital in Nuevo Leon, Mexico, and compares results to data reported in the literature. 147 patients undergoing sterilization between February-August 1984 were included. 6 of the women were under 20 years old, 18 were 21-25, 63 were 26-30, 30 were 31-35, and 30 were 36 or over. 22 had had 1-3 children, 81 had 4-6, 27 had 7-9, and 17 had over 9. 96.6% were married. 92 had never used a contraceptive method, 47 had used pills, 7 had used IUDs, and 1 had used a barrier method. Only 29 had been born in the Nuevo Leon metropolitan area but 126 were current residents. 101 had incomplete or complete primary educations, 8 had secondary educations, 36 were illiterate, and 2 had professional educations. Only 38 had prenatal health care preceding the delivery. Hemoglobin levels in 20 cases were less than 9.0, 28 were 9.1-10.0, 45 were 10.1-11.0, 34 were 11.1-12.0, and 20 were 12.1 or above. 17.6% of patients required preoperative transfusions of packed blood. The indication for sterilization was multiparity in 96.6% of cases. 13 patients had epidural anesthesia during delivery, 1 had a subarachnoid block, and 133 had no anesthesia. 139 had epidural blocks during the sterilization operation, 6 had subarachnoid blocks, and 2 had general anesthesia. There was 1 case of cardiorespiratory arrest but recovery was satisfactory. The only obstetric complication was 1 perforation of the jejunum, which was repaired. There were no other cases of pre- or postoperative complications except for 21 cases of difficulty in providing epidural anesthesia. The Pomeroy technique was used in 139 sterilizations, fimbriectomy in 5, and salpingectomy in 5. Umbilical hernioplasties were done in 3 patients without complications. The interval between surgery and leaving the hospital was between 12-24 hours in 83.7% of cases. The interval between delivery and sterilization was 12-24 hours in 71.4% of cases. Only 9 cases required more than 4 days of hospitalization. The immediate postpartum is not considered the optimal moment for female sterilization because of the increased vulnerability of the patient. The experience with this series suggests that for some patients, tubal sterilization by minilaparotomy in the immediate postpartum is a valuable method because it meets the demand for definitive contraception among high parity women of low socioeconomic level and with limited access to medical care. It requires only brief hospitalization and involves very low rates of morbidity.^ieng

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PIP: A sample of 1003 records of surgical sterilizations was studied from among the 9400 performed between July 1972-June 1982 at a university hospital in Nuevo Leon, Mexico. 12 patients were aged 15-19, 104 were 20-24, 244 were 25-29, 291 were 30-34, 267 were 35-39, and 85 were 40-45. Not all patients met the recommended conditions of being at least 25 years old and/or having at least 3 pregnancies. 11.6% of the patients were sterilized because of psychiatric problems, multiparity, 2 previous cesarean sections or on request of the spouse. 95.5% of the women were married, 2.1% were single, 1.6% lived in free union and .8% were widowed. 14.0% were illiterate, 57.7% had incomplete primary educations, 19.3% had completed primary school, 2.5% had incomplete secondary or technical schooling, and .3% had professional studies. 27 women had had 0-2 pregnancies, 336 had 3-5, 336 had 6-8, 198 had 9-11, and 106 had 12 or more. The maximum number of pregnancies was 20 and the average was 7.1/woman. 6 women had preoperative hemoglobin levels of 6.0 g or less, 12 had 7.0 g, 44 had 8.0, 119 had 9.0 g, 756 had 10.0, and 566 had 11.0 g or higher. Transfusions were given to all women with less than the minimum level of 10.0 g. 460 of the operations were postpartum, 334 were transcesarean, and 209 were interval procedures. 696 operations were done by the Pomeroy method, 52 by modified Pomeroy, 27 by fimbriectomy, 16 by salpingectomy, and 2 by the Uchida method. Among laparoscopic methods, 82 were done by cauterization and 128 with Yoon rings. 392 postpartum and 286 transcesarean operations were performed using the Pomeroy technique, while 82 interval sterilizations were done using cauterization and 107 using Yoon rings. Epidural anesthesia was used in 457 postpartum and 325 transcesarean procedures, while general anesthesia was used in 175 interval sterilization. There were few transoperative complications. There were 2 cases of failure to achieve salpingoclasy, 4 cases of hemorrhage, 1 case of burning of the visceral wall, 1 case of anesthetic accident, and 12 cases of other complications. Among postoperative complications there were 15 cases of abdominal pain, 1 each of fever and infection, and 1 of other complication. There was 1 pregnancy among the 1003 cases. All the procedures were performed by physicians in training.^ieng

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PIP: The authors present a review of the medical literature about the effect of oral contraceptives (OCs) on the metabolism of hydrocarbonates, serum iron, vitamins, folic acid, hemoglobin, and hematocrit. This is the 1st Brazilian study clinical about these phenomena. This study examined 21 patients taking OCs for 1 or more years. These female patients followed a regimen of vitamin-mineral supplementation over the course of 2 months when new clinical and laboratory controls were made. Of 21 patients, 18 had adverse symptoms and 3 were asymptomatic. Of the 18 symptomatic, 10 found relief from disturbances. There was also a statistically significant increase in serum folic acid levels. There wre no statistically significant alterations of hematocrit or serum iron in accordance with the literature. (author's)^ieng

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PIP: This study investigates the prevalence of anemia in a group of 500 women requesting contraception for the first time at the Health Center in Durango, Mexico. 92% of women were between 15-34, with the majority in the age group 20-24; most had parity 1-4. The average hemoglobin level was 13.04 g/dl, with SE of 0.08. There were 70 anemic women with hemoglobin level below 12 g/dl, which gave a percentage of 14%. 90% of anemic women presented iron deficiency. 16.8% of the total number of women were within the 1st 6 weeks postpartum or postabortion; of these 32% were anemic. Of the 82.4% of women beyond this period of time only 10.4% were anemic. There was no increase in the prevalence of anemia in women with higher parity; among the 174 obese women the percentage of anemia was 86%. The relatively high prevalence of anemia in women seeking contraception compels the doctor to consider very seriously the type of contraception to be prescribed. In Mexico there is an important difference in the geographic distribution of anemia, which seems to be most common in the province of Yucatan, and which is probably caused by alimentary iron deficiency.^ieng

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Total energy expenditures and intakes were simultaneously assessed in 18 free-ranging lactating women (10 months postpartum) and compared to six similarly-sized, nonlactating, nonpregnant but multiparous women living in the same rural villages in the Guatemalan highlands. Energy intakes were estimated by the 24-hr recall method for each of 4 consecutive days. Energy expenditures were determined for 2 days by monitoring heart rate throughout the day and relating heart rate to oxygen consumption by individually-determined regression lines. The mean energy intake for the 4 consecutive days was estimated to be 1929 +/- 360 kcal/day (39.2 kcal/kg per day) for the lactating group; and 1876 +/- 404 kcal/day (38.3 kcal/kg per day) for the nonlactating group. The 2-day mean energy expenditures were estimated to be 2007 +/- 292 kcal/day for the lactating women (41.8 kcal/kg per day) and 1966 +/- 382 kcal/day for the lactating women (40.1 kcal/kg per day). The way of life of both groups was judged "moderately active" by 1973 FAO/WHO classifications. Most of the lactating women had been losing weight progressively during the past 6 months. Over the 10-week period prior to our measurnth) (P less than 0.01) than in the nonlactating group (-35 g/month) (ns). The high correlation (r = 0.87) between weight loss and the reduction in the sum of the three skinfolds suggested adipose tissue loss. There were no significant differences between the two groups in terms of daily energy intake, daily energy expenditure, the energy cost of specific activities throughout the day. The slope of the heart rate/oxygen consumption regressions suggest adequate cardiorespiratory fitness. This study suggests that the energy cost of lactation was met to a greater extent by fat loss than by either increased energy intake, reduced energy expenditure, or both.

PIP: Total energy expenditures and intakes were simultaneously assessed in 18 lactating women (10 months postpartum) and compared to 6 similarly-sized nonlactating, nonpregnant but multiparious women living in the same rural villag in the Guatemalan highlands. Energy intakes were estimated by the 24-hour recal method for each of 4 consecutive days. Energy expenditures were determined for 2 days by monitoring heart rate throughout the day and relating heart rate to oxygen consumption by individually-determined regression lines. The mean energy intake for the 4 consecutive days was estimated to be 1929 + or 360 kcal/day (39.2 kcal/kg/day) for the lactating group and 1876 + or - 404 kcal/day (38.3 kcal/kg/day) for the nonlactating group. The 2-day mean energy expenditures were estimated to be 2007 + or - 292 kcal/day for the lactating women (41.8 kcal/kg/day) and 1966 + or - 382 kcal/day for the nonlactating women (40.1 kcal/kg/day). The way of life of both groups was judged as moderately active by 1973 FAO/WHO classifications. Most of the lactating women had been losing weight progressively during the past 6 months. Over the 10-week period prior to our measurements, the mean weight loss was more than 10 times greater in the lactating group (-369 g/month) (P 0.01) than in the nonlactating group (-35 g/month) (ns). The high correlation (r=0.87) between weight loss and the reduction in the sum of 3 skinfolds suggested adipose tissue loss. There were n significant differences between the 2 groups in terms of daily energy intake; daily energy expenditure; energy cost of specific activities; or in the pattern of activites during the day. The slope of the heart rate/oxygen consumption regressions suggest adequate cardiorespiratory fitness. This study indicates that the energy cost of lactation was met to a greater extent by fat loss than by either increased energy intake, reduced expenditure, or both.

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PIP: 65 patients of gestational age 35.4 weeks, and of average age 27.7 were investigated during postpartum after delivery of stillborn babies, to measure hemoglobin, serum assay of iron, total iron binding capacity (TIBC), folates level, and vitamin B 12 level. Comparison with a series of 270 women in their third trimester of pregnancy showed that the first group of patients had lower mean hemoglobin level, lower serum iron level, lower TIBC, and lower serum folate level. There was no difference in transferrin saturation, and serum vitamin B 12 was higher. The percentage of anemic women was 50% versus 20% in the larger group; however, there was no difference in the prevalence of iron deficiency. There also was a direct correlation with B12 and serum folate. Further studies are needed to validate these findings.^ieng

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PIP: This work analyzes the possible causes of anemia in 2 groups of pregnant women observed in 2 different hospitals in Mexico City; 1 group of 216 patients, and another group of 121 women who were already in labor. Women in the first group were short, of low schooling, high gestation and parity, and high incidence of previous fetal losses. Women in the second group were taller, slightly better educated, but still with high gestation and parity, and high incidence of fetal lossed. Hematological data collected included hemoglobin level, packed cell volume, RBC folates, serum assay of iron, total iron binding capacity, and albumin. 23% of patients in the first group, and 17% in the 2nd. group were found to be anemic; the percentage rose to 49% and 35% respectively if patients with low hemoglobin level were also considered to be anemic. The principal finding of the study was that iron deficiency was present in 53% of cases of anemia, and that it was probably to be ascribed to nutritional deficiencies.^ieng

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PIP: Hematological status of pregnant women from low and middle economic classes before and after similar hematinic therapy were compared. Subjects were 88 economically indigent and 88 middle-class women. Both groups came from the same ethnic background. Before treatment mean values for hemoglobin and nutrients were significantly lower in the poor pregnant women, except for serum folate which was similar. The only parasitic infestations found were whipworm (Trichuris trichiura) in 10% of the poor group and 2% of the middle-class group. Treatment of 40 poor and 33 middle-class patients was with oral doses of 130 mg of ferrous fumarate. The other 48 poor and 55 middle-class patients also received 2.5 mg of folic acid orally daily. At term, after treatment, there was still a statistically but lesser difference between the 2 groups, with the exception of serum iron. Total iron binding capacity was similar in both groups. The frequency of preeclampsia was 4% in the middle-class and 5% in the poor patients. At term, despite the iron dosage, anemia frequency and iron deficiency remained the same in both groups. Those taking folic acid improved so that the 2 classes were equal. Low serum folate levels for those of the middle class not taking folic acid were 25%. It is concluded that all pregnant women in this population should receive both iron and folic acid supplementation throughout pregnancy. For women with an iron deficiency at the beginning of pregnancy, 120 mg/day was not enough. There was the possibility of impaired iron absorption in these patients.^ieng

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