Traumatic brain injury associated with increased risk of schizophrenia and bipolar disorder, reveals research

Traumatic brain injury associated with increased risk of schizophrenia and bipolar disorder, suggests a study published in the Psychiatry Research.

The impact of traumatic brain injury (TBI) on subsequent risk of schizophrenia (SCZ) or bipolar disorder (BD) remains contested. Possible genetic and environmental confounding effects have also been understudied. Therefore, we aim to investigate the impact of TBI on the risk of SCZ and BD and whether the effect varies by injury severity, age at injury, and sex. We identified 4,184 SCZ and 18,681 BD cases born between 1973 and 1998 in the Swedish National Registers. Case-control samples matched (1:5) on birth year, sex, and birthplace were created along with a family design study, with cases matched to non-case full siblings. TBI was associated with higher risk of SCZ and BD (IRR=1.33 for SCZ, IRR=1.78 for BD). The association remained significant in the sibling comparison study. Moderate or severe TBI was associated with higher risk for both SCZ and BD compared to mild TBI. Older age at injury was associated with higher risk of SCZ and BD, and the effect of TBI was stronger in women than men. Findings indicate that TBI is a risk factor for both SCZ and BD with differential impact by age, severity and sex and that this association cannot be explained by familial confounding alone.

Reference:

Kai-Yuan Cheng, Natassia Robinson, Alexander Ploner, Ralf Kuja-Halkola, Yasmina Molero, Paul Lichtenstein, Sarah E. Bergen. Impact of traumatic brain injury on risk for schizophrenia and bipolar disorder. Psychiatry Research, Volume 339, 2024,115990, ISSN 0165-1781,

https://doi.org/10.1016/j.psychres.2024.115990.

Keywords:

Traumatic, brain injury, increased risk, schizophrenia, bipolar disorder, study, Head injuries; Psychotic disorders; Family design; Sibling comparison, Kai-Yuan Cheng, Natassia Robinson, Alexander Ploner, Ralf Kuja-Halkola, Yasmina Molero, Paul Lichtenstein, Sarah E. Bergen

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Reduction in microplastic intake could possibly lower blood pressure: Study

Microplastic pollution from the widespread use of microplastics in building materials, packaged food, medical products, and consumer goods, has emerged as a significant global health concern. These tiny particles can penetrate intact cell barriers in the intestines and alveoli, subsequently entering the bloodstream and posing potential health risks. Addressing this issue, a pilot study investigated the impact of reduced plastic consumption on blood pressure.

8 healthy adult participants were instructed to abstain from consuming commercially produced bottled beverages, limiting their primary fluid intake to tap water in this study. Blood pressure measurements were taken on both arms before the intervention, after 14 days, and again after 28 to 30 days of this partial plastic diet. The study aimed to discern any changes in blood pressure attributable to reduced plastic ingestion.

The results revealed marked gender differences in blood pressure responses. Among women, a significant change in systolic blood pressure on the right arm was observed after both 2 and 4 weeks of reduced plastic consumption. Also, the left arm showed no significant changes in blood pressure. These findings suggest a localized impact on systolic blood pressure in women which warrants further investigation.

However, no significant alterations in systolic blood pressure were detected on either arm in men. The high variability across the three male participants might account for the lack of significant changes. When analyzing the entire cohort, no significant differences in systolic blood pressure were evident.

For diastolic blood pressure, the study presented some compelling findings. At the 2-week mark, significant changes were observed in both arms for all participants. This suggests that even a short-term reduction in plastic consumption could influence diastolic blood pressure.

When examining diastolic blood pressure separately by gender, men again showed no significant changes. Also, women experienced a significant decrease in diastolic blood pressure on the left arm after two weeks and a statistically significant decline on the right arm after both two and four weeks. These results highlighted the potential sensitivity of women’s blood pressure to changes in plastic consumption.

As the concern for microplastic pollution and its health implications grows, this study underlines the importance of further research into lifestyle changes that could reduce these risks. Reducing plastic consumption not only benefits the environment but could also have significant health benefits by offering a new perspective on the link between daily habits and cardiovascular health.

Source:

Geppner, L., Grammatidis, S., Wilfing, H., & Henjakovic, M. (2024). First Evidence of the Possible Influence of Avoiding Daily Liquid Intake from Plastic and Glass Beverage Bottles on Blood Pressure in Healthy Volunteers. In Microplastics (Vol. 3, Issue 3, pp. 419–432). MDPI AG. https://doi.org/10.3390/microplastics3030026

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Uterine artery embolization tied to increased reintervention rates compared to myomectomy in treatment of uterine fibroids: Study

Uterine artery embolization tied to increased reintervention rates compared to myomectomy in premenopausal women with uterine leiomyomas: StudyUterine artery embolisation tied to increased reintervention rates compared to myomectomy in premenopausal women with uterine leiomyomas suggests a study published in the Orthodontics and Craniofacial Research.

This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication. Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests. Results: Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002). Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment.

Reference:

Alemran MA, Abbassy MA, Bakry AS, Alsaggaf DH, Abuhaimed TS, Zawawi KH. The effect of salbutamol sulphate inhalation (an anti-asthmatic medication) on the surfaces of orthodontic Archwires. Orthod Craniofac Res. 2024; 27: 447-454. doi:10.1111/ocr.12749

Keywords:

Uterine, artery embolization, increased, reintervention, rates, compared, myomectomy, premenopausal, women, uterine leiomyomas, study, Alemran MA, Abbassy MA, Bakry AS, Alsaggaf DH, Abuhaimed TS, Zawawi KH

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Study: Mycophenolate Mofetil and Steroid as Alternative for Idiopathic Membranous Nephropathy Treatment

India: An article published in The Journal of the Association of Physicians of India found that both mycophenolate mofetil combined with steroids and the modified Ponticelli regimen had similar tolerability and effectiveness. However, the use of MMF was associated with the advantage of reduced steroid exposure.

Membranous nephropathy is responsible for more than 25% of nephrotic syndrome cases in adults, with an overall incidence of 1.2 per 100,000 annually. The peak occurrence is in the fourth and fifth decades of life. About three-quarters of these patients have idiopathic membranous nephropathy, characterized by varying outcomes: one-third experience spontaneous remission, another third continue with persistent proteinuria, and the remaining third advance to severe renal failure.

The modified Ponticelli regimen is commonly used as a first-line therapy for patients with idiopathic membranous nephropathy, though it is known for having a less favorable safety profile. Despite the Kidney Disease Improving Global Outcomes guidelines not recommending the combination of mycophenolate mofetil and steroids, this alternative treatment can be considered due to its higher tolerability and steroid-sparing benefits.

With this reference, Manjuri Sharma, Professor and Head of the Department of Nephrology at Gauhati Medical College and Hospital in Guwahati et. al. conducted a study comparing the safety and effectiveness of the mycophenolate mofetil + steroid regimen with the modified Ponticelli regimen in patients with idiopathic membranous nephropathy.

A randomized, open-label study was conducted involving patients diagnosed with adult-onset nephrotic syndrome and biopsy-confirmed idiopathic membranous nephropathy. Forty-two participants were divided into two treatment groups: mycophenolate mofetil + steroid group (mycophenolate mofetil 1 gram twice daily combined with oral prednisolone 0.5 mg/kg/day; n = 21) and the modified Ponticelli regimen group (which received methylprednisolone 1 gram intravenously for 3 days, followed by alternating monthly cycles of oral prednisolone 0.5 mg/kg/day for the subsequent 27 days, and cyclophosphamide 2 mg/kg/day for 6 months; n = 21). The primary outcome assessed was the change in the urinary protein-to-creatinine ratio.

The key findings of the study were as follows:

  • At six months, both groups showed a significant increase in serum albumin levels and estimated glomerular filtration rate.
  • Both groups demonstrated a notable decrease in 24-hour proteinuria, with the mycophenolate mofetil + steroid group and the modified      Ponticelli regimen group
  • Both groups also exhibited a significant decrease in the urinary protein-to-creatinine ratio.
  • The groups did not show significant differences in these parameters at any of the monthly follow-up visits.
  • The composite remission rates were 61.91% for the mycophenolate mofetil + steroid group and 71.43% for the modified Ponticelli regimen group, with no significant difference between the groups.

Researchers concluded that 62% of patients with idiopathic membranous nephropathy responded positively to first-line therapy with mycophenolate mofetil + steroids. The mycophenolate mofetil + steroids treatment demonstrated similar tolerability and effectiveness compared to modified Ponticelli regimen, with the added benefit of reduced steroid exposure.

Reference

Sharma M, Roy A, Doley PK, et al. Mycophenolate Mofetil with Steroid, a Reasonable Alternative to Current First-line Therapy, for Idiopathic Membranous Nephropathy in Resource-constrained Settings: A Randomized, Open-label Study. J Assoc Physicians India 2024;72(6):15-19.

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Higher TyG Index Linked to Increased Gallstone Risk, Study Finds

China: A recent study published in Scientific Reports found that the risk of gallstones positively correlates with a higher triglyceride-glucose (TyG) index. This suggests that the TyG index can be used as an effective predictor of gallstone risk.

The research indicates that individuals with elevated TyG index values are more likely to develop gallstones, highlighting its potential utility in identifying those at greater risk for this condition. By incorporating TyG index measurements into routine health assessments, healthcare providers could improve early detection and preventive strategies for gallstones.

Gallstones, which are hardened deposits in the gallbladder, can lead to severe abdominal pain and complications if left untreated. While factors such as obesity, diabetes, and high cholesterol levels have long been known to increase the risk of gallstones, the role of the triglyceride-glucose index has not been thoroughly investigated until now.

To fill this knowledge gap, Hongliang Li & Congfeng Zhang from Dandong Central Hospital in Dandong, China, aimed to investigate the relationship between the TyG index and gallstones using data from the National Health and Nutrition Examination Survey (NHANES).

For this purpose, they evaluated the data collected between 2017 to 2020. To assess the relationship between the TyG index and gallstones, the study employed logistic regression analysis, examined participants’ basic characteristics, performed subgroup analysis, and applied smooth curve fitting techniques. The research included 3,870 participants aged 20 and older, among whom 403 reported having gallstones, resulting in a prevalence rate of 10.4%.

The following were the key findings of the study:

  • After adjusting for all confounding factors, the risk of gallstones increased by 41% for each unit increase in the TyG index (OR 1.41).
  • The smooth curve fitting also showed a positive correlation between the TyG index and gallstones.
  • Subgroup analysis revealed a significant positive relationship between the TyG index and the risk of gallstones in those aged < 50 years, women, individuals with total cholesterol levels > 200 mg/dL, individuals with body mass index (BMI) > 25, and individuals without diabetes.

The findings showed a significant correlation between a higher TyG index and an increased risk of gallstones. This association was particularly notable in the following subgroups: individuals under 50 years, women, those with total cholesterol levels exceeding 200 mg/dL, individuals with a BMI over 25, and those without diabetes. Consequently, the TyG index may serve as an effective predictor of gallstone risk in these populations.

The NHANES study used a representative sample and a robust research strategy, but it has limitations. Cross-sectional design restricts causal inference, questionnaire data may involve memory bias and imaging practices might affect gallstone detection.

“Despite these, the study is the first to link the TyG index to gallstones, warranting further investigation through a multicenter cohort study,” the researchers wrote.

Reference:

Li, H., & Zhang, C. (2024). Association between triglyceride-glucose index and gallstones: A cross-sectional study. Scientific Reports, 14(1), 1-8. https://doi.org/10.1038/s41598-024-68841-6

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Air pollution linked to a decrease in IVF birth rate success, new study shows

A pioneering study, presented today at the ESHRE 40th Annual Meeting in Amsterdam, has revealed that exposure to fine particulate matter (PM) prior to the retrieval of oocytes (eggs) during in vitro fertilisation (IVF) can reduce the odds of achieving a live birth by almost 40%.

The study analysed PM10 exposure in the two weeks leading up to oocyte collection, finding that the odds of a live birth decreased by 38% (OR 0.62, 95% CI 0.43-0.89, p=0.010) when comparing the highest quartile of exposure (18.63 to 35.42 µg/m3) to the lowest quartile (7.08 to 12.92 µg/m3).

Conducted over an eight-year period in Perth, Australia, the research analysed 3,659 frozen embryo transfers from 1,836 patients. The median female age was 34.5 years at the time of oocyte retrieval and 36.1 years at the time of frozen embryo transfer. The study examined air pollutant concentrations over four exposure periods prior to oocyte retrieval (24 hours, 2 weeks, 4 weeks, and 3 months), with models created to account for co-exposures.

Increasing PM2.5 exposure in the 3 months prior to oocyte retrieval was also associated with decreased odds of live birth, falling from 0.90 (95% CI 0.70-1.15) in the second quartile to 0.66 (95% CI 0.47-0.92) in the fourth quartile.

Importantly, the negative impact of air pollution was observed despite excellent overall air quality during the study period, with PM10 and PM2.5 levels exceeding WHO guidelines on just 0.4% and 4.5% of the study days, respectively.

Dr Sebastian Leathersich, lead author of the study, explains, “This is the first study that has used frozen embryo transfer cycles to separately analyse the effects of pollutant exposure during the development of eggs and around the time of embryo transfer and early pregnancy. We could therefore evaluate whether pollution was having an effect on the eggs themselves, or on the early stages of pregnancy.”

“Our results reveal a negative linear association between particulate matter exposure during the 2 weeks and 3 months prior to oocyte collection and subsequent live birth rates from those oocytes. This association is independent of the air quality at the time of frozen embryo transfer. These findings suggest that pollution negatively affects the quality of the eggs, not just the early stages of pregnancy, which is a distinction that has not been previously reported.”

Ambient (outdoor) air pollution is one of the greatest environmental risks to health and is estimated to cause over 4 million premature deaths per year worldwide. Exposure to fine particulate matter is associated with a range of adverse health conditions, including cardiovascular and respiratory diseases. In 2021, 97% of the urban EU population was exposed to concentrations of PM2.5 above the WHO annual guideline (5 µg (microgram) /m3). Although epidemiological data show a clear correlation between pollution and poorer reproductive outcomes, the mechanisms remain unclear.

Dr Leathersich furthers, “Climate change and pollution remain the greatest threats to human health, and human reproduction is not immune to this. Even in a part of the world with exceptional air quality, where very few days exceed the internationally accepted upper limits for pollution, there is a strong negative correlation between the amount of air pollution and the live birth rate in frozen embryo transfer cycles. Minimising pollutant exposure must be a key public health priority.”

Professor Dr Anis Feki, Chair-Elect of ESHRE, comments, “This important study highlights a significant link between air pollution and lower IVF success rates, with a notable reduction in live births associated with higher particulate matter exposure before oocyte retrieval. These findings emphasise the need for ongoing attention to environmental factors in reproductive health.”

The study abstract will be published in Human Reproduction, one of the world’s leading reproductive medicine journals.

Reference:

Air pollution linked to a decrease in IVF birth rate success, new study shows, European Society of Human Reproduction and Embryology, Meeting: ESHRE 40th Annual Meeting.

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Polyphenols: Powerful Plant Compounds Combat Chronic Diseases and Boost Health Outcomes, Study Reveals

India: Recent research underscores the powerful role of polyphenols in safeguarding against chronic diseases, highlighting their potential to enhance overall health and prevent a range of long-term conditions. The study was published in Natural Product Research on August 02, 2024.

The study revealed that incorporating polyphenol-rich foods into diets has the potential to markedly enhance health outcomes and reduce the burden of non-communicable diseases (NCDs). This underscores the importance of including these foods in public health strategies and highlights the need for further research to fully harness their benefits.

Polyphenols are a diverse group of naturally occurring compounds found in plants, known for their antioxidant properties. These compounds are abundant in fruits, vegetables, tea, coffee, and red wine. Their ability to neutralize harmful free radicals and reduce oxidative stress has long been linked to various health benefits, but new studies are now revealing their more profound impact on chronic disease prevention.

“Polyphenols also demonstrate significant anti-inflammatory properties by modulating gene expression and reducing inflammation linked to non-communicable diseases (NCDs). Their anticancer effects involve inhibiting the growth of cancer cells and promoting apoptosis through various mechanisms. In cardiovascular health, polyphenols contribute by improving endothelial function, lowering blood pressure, and preventing atherosclerosis,” Geetha Shanmugam, Saveetha Institute of Medical and Technical Sciences, Kancheepuram, Tamil Nadu, India, wrote in her study.

Adding that, “they support metabolic health by enhancing insulin sensitivity and regulating glucose metabolism, which is beneficial for managing diabetes and obesity. These bioactive compounds interact with cellular pathways and the gut microbiota, underscoring their diverse and complex mechanisms of action.”

The study suggests polyphenol-rich foods integration into diets could significantly improve health outcomes and reduce NCD burdens, advocating for their inclusion in public health strategies and further research to optimize their potential.

“As research advances, polyphenols are increasingly recognized as vital components of a healthy lifestyle. Their potent protective effects against chronic diseases make them a key focus in ongoing health studies, promising to offer new avenues for disease prevention and wellness,” the author concluded.

Reference:

Shanmugam, G. (2024). Polyphenols: potent protectors against chronic diseases. Natural Product Research, 1–3. https://doi.org/10.1080/14786419.2024.2386402

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Maxillary sinus membrane thickening and obstruction of ostium associated with presence of peri-implantitis in posterior implants: Study

Maxillary sinus membrane thickening and obstruction of ostium associated with presence of peri-implantitis in posterior implants suggests a study published in the Clinical Oral Implant Research.

The objective of this study is to investigate the association of peri-implantitis (PI) and sinus membrane thickening and to assess the resolution of membrane thickening following intervention (implant removal or peri-implantitis treatment) aimed at arresting PI. Forty-five patients with 61 implants in the posterior maxillary region were retrospectively included in the study. Twenty-four patients were diagnosed with peri-implantitis (PI) and 21 had peri-implant health (PH). Cone-beam computed tomography (CBCT) scans were evaluated to assess maxillary sinus characteristics, including membrane thickening, sinus occupancy and ostium patency. The CBCT scans taken 6 months after intervention aimed at arresting disease (implant removal or treatment of PI) in the PI group were also appraised and compared to baseline scans. Results: At baseline, all parameters evaluating membrane thickness disorders yielded significant differences between groups (p < .001). Patients with posterior maxillary implants diagnosed with PI were 7× more likely to present membrane thickening compatible with pathology when compared to patients with healthy implants (OR = 7.14; p = .005). Furthermore, the likelihood was 6x greater in implants diagnosed with PI to exhibit moderate membrane thickening (OR = 6.75, p = .001). The patients receiving interventions aimed at arresting PI experienced significant enhancement in all radiographic parameters related to the sinus cavity at the 6-month follow-up (p < .001), though these variations were similarly independent of whether treatment consisted of PI treatment or implant removal. Maxillary sinus membrane thickening and the permeability/obstruction of the ostium are frequently associated with the presence of PI in posterior implants. Interventions targeting disease resolution effectively reduce membrane thickness to levels compatible with maxillary sinus health.

Reference:

Pons, R., Giralt-Hernando, M., Nart, J., de Tapia, B., Hernández-Alfaro, F., & Monje, A. (2024). Peri-implantitis and maxillary sinus membrane thickening: A retrospective cohort study. Clinical Oral Implants Research, 35, 757–770. https://doi.org/10.1111/clr.14282

Keywords:

Maxillary, sinus, membrane, thickening, obstruction, ostium, presence, peri-implantitis, posterior, implants, study, Clinical Oral Implant Research, Pons, R., Giralt-Hernando, M., Nart, J., de Tapia, B., Hernández-Alfaro, F., & Monje, A

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Short-Term Vegan Diet Linked to Epigenetic Age Benefits and Lower Calorie Intake, Study Finds

USA: An article published in BMC Medicine revealed that a brief vegan diet can lead to epigenetic age improvements and a decrease in calorie consumption.

The application of epigenetic biomarker proxies (EBPs) underscores their promise in evaluating dietary effects and enabling personalized nutrition approaches for promoting healthy aging, the researchers wrote. 

Geroscience aims to develop interventions that counteract the molecular changes linked to aging. While lifestyle changes, medications, and social factors can influence the aging process, the intricate molecular mechanisms involved necessitate a thorough examination of the epigenetic landscape. The precise effects of a vegan diet on the epigenetic clock and aging predictors, compared to an omnivorous diet, have not been extensively studied, despite their potential impact on aging outcomes.

Varun B. Dwaraka, TruDiagnostic, Inc, 881 Corporate Dr, Lexington et. al. conducted a study to determine the effects of an 8-week plant-based or healthy omnivorous diet on blood DNA methylation in twins. They also aimed to evaluate age-related risk factors and health biomarkers. The uniqueness of this study lies in its twin-pair design, which controls for genetic, age, and sex differences while focusing on diet-induced methylation changes. Notably, this is the first study to examine the impact of epigenetic measures using a twin-pair study design, specifically investigating whether diet influences these measures.

For this study, researchers examined the effects of an 8-week entirely plant-based or healthy omnivorous diet on blood DNA methylation in twin pairs. They assessed various measures of epigenetic age acceleration, including PC GrimAge, PC PhenoAge, and DunedinPACE, alongside system-specific effects on inflammation, heart, hormone, liver, and metabolic functions. Additionally, methylation surrogates for clinical, metabolite, and protein markers were analyzed to identify diet-specific changes.

The main highlights of the research are as follows:

  • The vegan group experienced significant decreases in overall epigenetic age acceleration, aligning with the anti-aging benefits of plant-based diets.
  • Diet-specific changes in methylation surrogates were observed, highlighting the impact of diet on complex trait prediction through DNA methylation markers.
  • An epigenome-wide analysis identified differentially methylated loci unique to each diet, offering insights into the affected pathways.

The researchers concluded that a short-term vegan diet is linked to epigenetic age benefits and reduced calorie intake. The use of epigenetic biomarker proxies underscores their potential for evaluating dietary impacts and aiding in personalized nutrition strategies for healthy aging. Future studies should investigate the long-term effects of vegan diets on epigenetic health and overall well-being, emphasizing the importance of adequate nutrient supplementation.

Reference

Dwaraka, V.B., Aronica, L., Carreras-Gallo, N. et al. Unveiling the epigenetic impact of vegan vs. omnivorous diets on aging: insights from the Twins Nutrition Study (TwiNS). BMC Med 22, 301 (2024). https://doi.org/10.1186/s12916-024-03513-w

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Ferric maltol suitable and convenient treatment option for Iron deficiency anemia during pregnancy: Study

Iron deficiency anemia (IDA) occurs when the body lacks
sufficient iron to generate an adequate number of healthy red blood cells,
crucial for storing and transporting oxygen in the bloodstream. This results in
symptoms like extreme fatigue, weakness, and paleness, as organs and tissues
receive insufficient oxygen. IDA, the most prevalent form of anemia, can stem
from factors such as blood loss, inadequate iron absorption, or insufficient
iron intake.

During pregnancy, IDA is defined as hemoglobin levels below
11 g/dL in the first and third trimesters, and below 10.5 g/dL in the second
trimester. Increased iron requirements during pregnancy, necessary for maternal
blood volume expansion and fetal growth, make diagnosing IDA challenging.
Complications of IDA during pregnancy include premature birth, intrauterine
developmental retardation, and diminished newborn iron storage. Managing IDA
during pregnancy is crucial due to associations with conditions like autism,
abnormal brain structure, and schizophrenia in offspring.

During pregnancy, the demand for iron triples to support
fetoplacental development and maternal adaptation. Dietary modifications
focusing on increased intake of iron-rich foods and interventions improving
iron absorption are crucial. Daily iron requirements rise from 4 to 6 mg/day in
the second trimester to 10 mg/day in the last half of the third trimester.
Thus, daily or intermittent oral supplementation is necessary to prevent IDA.

Recognizing the unmet need for effective and well tolerated
treatments for iron deficiency anemia during pregnancy, there is a push for
alternative oral iron therapies that match the efficacy of IV iron therapy
while offering the convenience of oral administration. New formulations,
including ferric maltol, ferric citrate, polysaccharide–ferric iron complexes,
sodium feredate, and sucrosomial iron, aim to address this need by potentially
improving bioavailability and reducing the risk of gastrointestinal side
effects. One such alternative is ferric maltol (FM), a novel oral iron
formulation designed to enhance the gastrointestinal absorption and
tolerability of oral iron. FM, composed of iron in the stable ferric (Fe3+)
state complexed with trimaltol, a naturally occurring sugar derivative, is a
promising option for effective and convenient treatment of iron deficiency and
iron-deficiency anemia. The ferric and trimaltol complex remains strongly
chelated in the intestinal lumen until absorption, minimizing the risk of
gastrointestinal toxicity. FM is available for treating iron deficiency in
adults, with or without anemia, across diverse populations, including those
with conditions like inflammatory bowel disease (IBD), chronic kidney disease
(CKD), and pulmonary hypertension.

In cases of mild-to-moderate anemia, ferric maltol may serve
as a viable oral treatment option when individuals either cannot tolerate
ferrous preparations or experience suboptimal efficacy after four weeks of
treatment. For moderate anemia, especially in patients with gastrointestinal
intolerance to oral ferrous iron, intravenous iron stands out as the preferred
treatment. In the maintenance therapy of iron deficiency anemia (IDA), ferric
maltol could play a significant role in sustaining the benefits achieved
through intravenous therapy. This form of treatment ensures an adequate supply
of iron to meet the body’s erythropoietic needs, thereby reducing the reliance
on blood transfusions or erythropoiesis-stimulating agents. Additionally,
ferric maltol helps minimize the amount of free iron in the intestinal tract,
reducing the risk of damage to the gut microbiome and preventing the
exacerbation of underlying gastrointestinal diseases.

Ferric maltol (FM) has demonstrated the ability to elevate
serum iron parameters, including ferritin and transferrin saturation (TSAT),
effectively addressing anemia associated with iron deficiency, especially
during pregnancy. Its potential advantages encompass improved iron absorption,
minimized gastrointestinal side effects, and a decreased dosage necessity.
Furthermore, FM facilitates the absorption of iron through the intestinal wall
and its subsequent transfer to transferrin and ferritin. This makes it a
relatively safe and efficient oral iron therapy, potentially more tolerable
than alternative oral iron formulations

Clinical studies have consistently demonstrated the
effectiveness and efficacy of ferric maltol as an oral treatment for iron
deficiency and anemia in patients with various conditions, including IBD, CKD,
and pulmonary hypertension. Ferric maltol has shown significant and sustained
improvements in hemoglobin levels and iron status, with good tolerance
throughout the treatment duration. These studies suggest that ferric maltol is
an effective and convenient treatment option for individuals who seek
long-term, well-tolerated management of iron deficiency anemia, irrespective of
the underlying condition.

The research highlights the importance of a healthy diet and
iron supplementation before or at the beginning of pregnancy. Ferric maltol
offers a convenient alternative to oral treatment, potentially reducing the
need for intravenous iron therapy for iron deficiency anemia during pregnancy.
Clinical trials have consistently demonstrated the effectiveness of ferric maltol
in diverse settings, including IBD, CKD, and pulmonary hypertension, making it
a suitable option for long-term, well-tolerated management of iron deficiency
anemia, especially for patient’s intolerant to other oral treatments or
noncompliant with intravenous therapy

Source: Zinzuwadiya, Modi and Dhande / Indian Journal of
Obstetrics and Gynecology Research 2024;11(2):147–151; https://doi.org/10.18231/j.ijogr.2024.031

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