Anaemia in Pregnancy and Low birth weight babies

Controlled anemia in pregnant mothers and improved birth weight of babies by withdrawing fluoride intake and improving diet : A major breakthrough

Hospitals where the projects were carried out [during (2004 – 2009 continuing)
(1) Deen Dayal Upadhaya Hospital in West Delhi, India (DDU)
(2) Sri Lal Bahadur Sastri Hospital, East Delhi, India (LBS)

In both the hospitals, the pregnant women who attended the Antenatal Clinics are from the lower strata of the socio-economic ladder.

  • In DDU, 2055 pregnant women were scanned
  • In LBS 1036 pregnant women were scanned

Exclusion criteria: The selection of pregnant women were based on all those, who suffer from Diabetes, Tuberculosis, HIV AIDS, Bleeding during pregnancy and High Blood Pressure were excluded

Inclusion criteria: Pregnant women who are anemic with hemolgobin ranging from 11.0 to 5.0 g/dl. Besides urinary fluoride is on the higher side (beyond normal range) i.e. beyond 1.0 mg/L.

The conditions applied for Exclusion and Inclusion were the same in both the hospitals.

Sample Group women were introduced to 2 Interventions.

Intervention I: They were withdrawn from consuming any item containing fluoride, which included drinking water, food and food products and also advised to use toothpaste which has the least fluoride (In India every paste has fluoride – whether fluoridated or not, as fluoride arises as an impurity from raw material used for the manufacture of the paste).

Intervention II: The pregnant women, were provided diet counselling for improving the nutritive value of diet (by consuming dairy products, fruits and vegetables rich in calcium, iron, folic acid, vitamin C, E and other antioxidants).

A little pictorial booklet in Hindi language showing items that they should consume were also provided.

Simple recipes to make soups, salads and sauces with vegetables and fruits were discussed. Also advised to consume less of deep fried food and to reduce the quantity of oil and spices in cooking. Their concepts were changed and encouraged to consume a nutritive diet.

Monitoring: Every visit to Antenatal clinic until delivery, the women were tested for (1) hemoglobin and (2) urinary fluoride. They were able to observe the changes in Hemoglobin due to lowering the urine fluoride content.

The Control Group women were not introduced to interventions I & II, but they were also monitored until delivery

In DDU our 1st series (2004 – 2007)

  • The urinary fluoride reduced form a maximum of 6.25 mg/L to a minimum of 0.25 mg/L prior to delivery .
  • When urinary fluoride reduced, hemoglobin enhanced from 5.7 g/dl to 13.3 g/dl prior to delivery.
  • The reason: Fluoride destroys the microvilli in the intestinal lining; nutrients not absorbed. Upon withdrawal of fluoride and within 10 days microvilli regenerate and nutrients are absorbed which enables hemoglobin biosynthesis. Fluoride also destroys the good microbes which synthesize vitamin B12 required for Hb syntheses. In the absence of fluoride microbes grow better.
  • In 80% of the pregnant women, anemia was rectified through the Interventions introduced, and babies born were of normal birth weight ranging from 2.5 to 3.89 kg.
  • The low birth eight babies (<2.5 kg) were reduced to 20% as opposed to the control group where low birth weight babies were to the extent of 48 %.

In LBS – our 2nd series (2007 – 2009)

  • In LBS we screened 1036 pregnant women
  • Interventions I & II were introduced
  • Urinary fluoride and Hemoglobin tested in pregnant women from the 1st to the last visit prior to delivery
  • In our series, the sample group women attended Antenatal Clinics from a minimum of 3 to a maximum of 7 visits and were able to avail of the benefit of counselling and consultations.
  • Urinary fluoride reduced from a maximum of 4.76 mg/L to a minimum of 0.30 mg/L prior to delivery.
  • Hemoglobin enhanced from 7.2 g/dl to 14.1 g/dl prior to delivery
  • In 92.5% of the pregnant women, anemia was corrected through interventions and babies born with normal birth weight ranging from 2.5 kg to 3.7 kg.
  • The low birth weight babies < 2.5 kg were reduced to 7.5 % as opposed to the Control group [where the normal birth weight babies were 68.6 % and low birth weight babies were 31.4 % with one pre-term still birth]
  • In both the series the funds were utilized for cost of (1) testing fluoride in drinking water, (2) testing of fluoride in urine and (3) testing of hemolgobin and for counselling and (4) personnel employed to conduct the programme.

Concluding remarks.

  • The observations recorded here is a major breakthrough in our understanding of rectifying anemia during pregnancy. This is ever the first time, in any part of the world, 92.5% success achieved in pregnant women where Hb improved by an Intervention study leading to normal birth weight babies.