K. Prema

Immune status of anaemic pregnant women.

Summary. Immune status during the third trimester of pregnancy was investigated in relation to maternal haemoglobin levels. The proportion of T and B lymphocytes showed a tendency to fall in anaemic women which was significant when haemoglobin levels were <8 g/dl. Immunoglobin G showed the opposite trend. There were no alterations in phytohaemag‐glutinin‐induced lymphocyte transformation in relation to haemoglobin concentration.

Nutrition--fertility interaction in lactating women of low income groups.

1. Duration of lactational amenorrhoea and interpregnancy interval were related to maternal body-weight in an urban low-income group population of 2250 women. 2. Breast-feeding practices were similar in all the women, none of whom had received any nutritional intervention. 3. In the study group the mean duration of lactation, lactational amenorrhoea and interpregnancy interval (months) were 20.7, 11.2 and 24.2 respectively. 4. Mean duration of lactation was significantly shorter in women whose body-weights were over 55 kg. Duration of lactational amenorrhoea increased with increasing duration of lactation (r 0.5164). 5. The duration of lactational amenorrhoea showed a progressive fall with increasing body-weight (r --0.8139) even when duration of lactation was kept constant. 6. The mean duration of post-partum amenorrhoea in women who did not lactate remained unaltered irrespective of body-weight. 7. The findings suggest that maternal nutritional status modifies return of menstruation only in lactating women.

Serum copper and zinc in hormonal contraceptive users.

There has been a growing awareness of possible alterations in the trace element profiles of hormonal contraceptive users and their consequences. A study of serum copper and zinc levels in users of combined estrogen-progestogen contraceptives and in users of injectable progestogen was undertaken. Use of combined estrogen-progestogen contraceptives resulted in a significant decrease in serum zinc levels within 3 days and an increase in serum copper levels within 10 days. In users of combined estrogen-progestogen contraceptives the magnitude and time of occurrence of the decrease in zinc levels and the increase in copper levels was unaltered by chemical composition, dosage, route of administration, and duration of use beyond 3 months. With injectable progestogen (norethindrone enanthate, 20 mg/month), a significant decrease in serum zinc levels occurred within 24 hours after injection. Serum copper levels were not altered. With injectable progestogen, the type of drug, the dosage, and the duration of use beyond the 1st month had no effect on the magnitude of the decrease in serum zinc levels.

Oral contraceptive use and vitamin nutrition status of malnourished women--effects of continuous and intermittent vitamin supplements.

Abstract Indian women from a low income group who had used oral contraceptives containing either 30 or 50 μg ethynyl oestradiol and 0.15 mg d -norgestrel for 12 cycles, had significantly elevated urinary excretion of xanthurenic acid after a tryptophan load. A third of the women had pyridoxine deficiency as judged by the erythrocyte asparate aminotransferase (EAspAT) test and the majority of women showed riboflavin deficiency as judged by the erythrocyte glutathione reductase (EGR) test. Administration of multivitamins containing 2 mg riboflavin and 10 mg pyridoxine daily, or twice the dose for only the 7 “non hormone” days in the cycle, corrected the abnormality in tryptophan metabolism. Enzymatic tests showed an improvement with regard to coenzyme saturation, but a number of women continued to be in the deficient range even after 6 months of supplements. This was partly due to increase in apoenzymes EGR and EAspAT. Several women developed glossitis despite the vitamin supplements. The usefulness of routine schedules of vitamin supplements to women using oral contraceptives remains equivocal.

Vitamin supplements to Indian women using low dosage oral contraceptives

Effect of continuous and intermittent vitamin supplements on vitamin status, serum proteins and lipids were examined in Indian women of low-income group, receiving a low-dose oral contraceptive over a period of 3-6 months. To find out non-specific time related changes, vitamin supplemented and unsupplemented control groups of non-OC users were also examined. OC treatment did not change serum chemistry significantly. The significant biochemical changes were: altered tryptophan metabolism and elevated plasma vitamin A levels. Former could be prevented by administering multivitamins containing 10 mg vitamin B6 daily or twice the dose daily for the 7 non-hormone days in the cycle. Vitamin supplements produced significant improvement in pre-existing deficiencies of riboflavin, pyridoxine and folic acid. Continuous supplementation regimen was slightly superior, but more expensive than the intermittent supplementation regimen. In view of the high prevalence of vitamin deficiency among the low-income group women of developing countries, the delivery system for oral contraceptive can be effectively used for giving vitamin supplements as well.

Plasma levels of norethindrone in indian women receiving norethindrone enanthate (20 mg) injectable

Plasma norethindrone (NET) and progesterone were estimated by radioimmunoassay in seven Indian women after intramuscular administration of 20 mg NET enanthate. One subject had intermenstrual bleeding throughout the cycle. Out of the six subjects considered for analysis, three subjects showed ovulation suppression, two had delayed ovulation and the remaining one exhibited normal ovulatory pattern. Post-peak average plasma NET values ranged from 1.0 to 2.1 ng/ml. These values showed a significant positive correlation with the anthropometric indices such as body weight and mid-arm-circumference. The subjects with lower anthropometry showed exponential decline of plasma NET. A possible role for nutritional status of an individual in drug disposition is indicated from this study.

Serum prolactin levels in undernourished Indian lactating women

1. Serum prolactin (PRL) levels, both basal and post-suckling peak, were estimated in fifty-seven lactating women. 2. Basal PRL levels were significantly higher in all lactating women irrespective of the duration of lactation as compared to the levels in non-pregnant, non-lactating women. 3. There was significant positive correlation (r 0.69, P less than 0.001) between the basal PRL levels and the post-suckling peak values. 4. After 8 months of lactation, peak post-suckling, PRL levels were not significantly different from basal values. 5. Basal PRL levels were significantly lower (P less than 0.05) in mothers whose infants were being supplemented. 6. PRL levels were not related to the mothers nutritional status as determined by body-weight. 7. The findings suggest that high PRL levels during lactation prolong the duration of lactional amenorrhoea and hence the relative infertility.

Low dose injectable contraceptive norethisterone enanthate 20mg monthly — II. Metabolic side effects

Metabolic effects of a long-acting low dose injectable contraceptive, norethisterone enanthate 20-mg, monthly injections (Neten-20), was tested in 13 women belonging to the low income groups over a period of 1 year. No change was observed in hemoglobin, hematocrit, glucose tolerance, plasma lipids, iron, calcium, or serum glutamate-oxaloacetate transaminase after treatment. Marginal rise in albumin and fall in some globulin fractions was observed. The slight fall seen in serum alkaline phosphatase could be attributed to a change in lactation status. Vitamin A, pyridoxine and riboflavin status were not altered. A peculiar aberration in the tryptophan-niacin pathway as indicated by rise in kynurenic acid excretion after tryptophan load was observed. This could be corrected by multivitamin therapy. These data suggest that the use of Neten-20 for one year does not lead to adverse metabolic effects analogous to those seen with combination type oral contraceptives.

Serum Copper in Long-Term Users of Copper Intrauterine Devices

A study was undertaken to determine whether long-term use of a copper intrauterine device (IUD) was associated with any alteration in the serum copper levels and thereby whether absorption of copper from the device in utero could result in copper toxicity. Serial estimations in copper IUD wearers showed that there was no alteration in serum copper levels for a period of up to 24 months. The mean range and frequency distribution of serum copper levels in long-term copper IUD wearers was similar to that seen in the normal population. There was no difference in the mean 24-hour urinary copper excretion between the control group and the copper IUD wearers. Data suggest that the copper released from a copper IUD may not be readily absorbed from the uterine fluid. This hypothesis needs verification.

Pharmacokinetics of levonorgestrel in Indian women.

SummaryA low dose combination pill containing levonorgestrel 150 µg and ethynylestradiol 50 µg was administered orally to 13 women. Based on their anthropometric index they were classed as well-nourished (Group A) or undernourished (Group B). Plasma levels of levonorgestrel at various intervals after dosing were analysed by a specific radioimmunoassay and its pharmacokinetic parameters were computed. Peak plasma levels in both groups occurred within 2 h and the absorption half-lives were also similar. The decline in plasma levonorgestrel showed a tri-exponential decline in all Group A women, whereas it was biphasic in most of Group B. The π t1/2 was lower in Group A women and the α-phase was found to be negligible in Group B. A significant positive correlation between elimination half-life (β t1/2) and some of the anthropometric indices suggests a possible role of nutritional status in the metabolic handling of levonorgestrel.