Journal Club Presentation

By Dr Monisha Mary P
 Unlocking the mystery of the role of Vitamin D
in iron deficiency anemia in antenatal women: a case-
control study in a tertiary care hospital
in New Delhi

2
 Reasons for Article Selection

Case-Control Clinical Prevalence

Study Relevance

3
 Information on the Journal

Journal name Open access Indexing

Bio Med Central article
PubMed, MEDLINE,
Pregnancy and
EMBASE, Scopus,
Childbirth
Cinahl, Google Scholar

Impact Factor Received on Accepted on

3.1 3 July 2023 3 October 2023

4
 Information on the authors
Tanishq Hitesh Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi 110085,
India.

Ritu Khatuja Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar
Medical College and Hospital, Delhi 110085, India.

Poonam Agrawal Department of Biochemistry, Dr. Baba Saheb Ambedkar Medical College
and Hospital, Delhi 110085, India.

Deepak Dhamnetiya Department of Community Medicine, Atal Bihari Vajpayee Institute of

Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi, New
Delhi 110001, India

Ravi Prakash Jha Department of Community Medicine, Dr. Baba Saheb Ambedkar Medical
College and Hospital, Delhi 110085, India

Prachi Renjhen Department of Obstetrics and Gynaecology, Dr. Baba Saheb Ambedkar
Medical College and Hospital, Delhi 110085, India.

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Contents

 Article Presentation

 Critical appraisal

6
 Background

Vitamin D Deficiency Anemia

Affects 50% to 94%of the Affects approximately 50%
Indian population of pregnant women

Interplay Between
Study Rationale
Vitamin D and Iron
Metabolism
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 Aims and objectives

Primary Objective

• To assess the association of

Vitamin D levels between

iron-deficient
anemic and non anemic
pregnant pregnant women
women

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 Aims and objectives

Secondary Objectives
• To assess the association of • To assess the association of
various socio-demographic anthropometric and biochemical
factors among the study parameters with iron deficiency
subjects. anemia among the study subjects.

• To assess the association of

selected maternal characteristics
with iron deficiency anemia
among the study subjects.

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 Design and Study Population

Study Design Study population Study Duration

01 02
03

Hospital 28th August

Pregnant 2022 to 15th
based case- women October
control study 2022

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 Methodology

Study setting Hospital Place

Maternity Ward/Antenatal Dr. Baba Saheb

Clinic of the Delhi
Department of Obstetrics
Ambedkar Medical
and Gynaecology College and Hospital

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 Eligibility Criteria

Inclusion Criteria

• Primigravida women -18 to 30 years

• Confirmed singleton uncomplicated

pregnancy at or after 28 weeks of gestation

• Willing to provide consent

• No history of blood transfusion during the

current pregnancy.

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Exclusion Criteria • Active comorbid diseases

• Anemia types other than iron deficiency

anaemia

• Taking Vitamin D supplements during

pregnancy

• Thalassemia, sickle cell anemia, hemolytic

anemia.

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 Sample size calculation

1 2 3 4

Proportion of
Vitamin D 95% level of
Fleiss
Deficiency confidence and 31 cases
formula
80% power 31 controls

Non-anemic Anemic
pregnant pregnant
women: 40% women: 75% 14
 Methodology

Enrollment Exclusion Final Sample

48 antenatal
It’s awomen
cold place
48
with diagnosed iron
deficiency anemia
(mild to moderate)
107 pregnant 13 94
women

Antenatal check-up
Incomplete Case group
or delivery medical
records Control group 46 46 antenatal women with
Thorough history normal hemoglobin levels
and examination Hemolyzed
samples
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Information and Sample Collection

History & Examination Socio & demographic

Data Collection Pre-validated form

Blood Collection 5 ml venous blood

Serum Processing Centrifuge

Vitamin D Standard parameters

Measurement

Other Blood Tests

25(OH) D levels &
Data Analysis anemia association
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 Criteria for Classification

Anaemia in Pregnant Women (ICMR

Guidelines) Vitamin D Levels

Normal: Hb ≥ 11 g/dl
Deficiency: ≤ 20 ng/ml

Mild Anemia: Hb 10-10.9 g/dl

Insufficiency: 20-29.9 ng/ml

Moderate Anemia: Hb 7-9.9 g/dl

Sufficient/Normal: ≥ 30 ng/ml

Severe Anemia: Hb less than 7 g/dl

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 Statistical Analysis

1.Data Entry & Cleaning

2.Differences in Maternal
Characteristics & Vitamin
• Customized Excel Sheet
Customized Excel Sheet D Concentrations
Data Entry & Cleaning

• Categorical Variables: χ²
test
• Vitamin D
Concentrations: Mann-
Whitney test
3.Analysis Software • Strength of Association:
Odds Ratio
• SPSS v27.0 (trial version)
p ≤ 0.05 considered statistically
significant

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Results Section

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21
22
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24
25
Discussion

26
 Discussion

Vitamin D Deficiency in
Pregnancy Findings

Linked to various health issues; Lower Vitamin D in anemic women (mean:

global concern. 19.61 ng/ml vs. 29.43 ng/ml).Strong
association of low Vitamin D with anemia
Mechanisms
High Prevalence of
Calcitriol Role Vitamin D Deficiency
Vitamin D Receptors
75% in case group; 52.2% in control
group. Factors: Low sun exposure, dark
skin, dietary habits, pollution
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 Discussion

Risk Factors for Maternal Anemia

Education & Socioeconomic Status

Milk Consumption

Intervention &
Future Research
Iron and Folic Acid (IFA) Supplementation
Anemia Mukt Bharat

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 Limitations

Small sample size, Future studies should

lack of iron status consider more markers
information and larger populations

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 Conclusion

Key Recommendations Current Vitamin D Future

Findings Practices supplementation Directions
not routine in
Indian antenatal
care
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 Other Information

Acknowledge Competing
ments Funding Data IEC
interests

ICMR None ICMR STS-2022 (IRRC-5/2022) No competing

Registry interests

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 Critical
Appraisal

Appraisal tool for Case Control Study (STROBE)

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 Title

Unlocking the mystery of the role of Vitamin D in iron

deficiency anemia in antenatal women:
a case-control study in a tertiary care hospital
in New Delhi

Population
Exposure Outcome The study design Antenatal
Vitamin D iron deficiency case-control women
levels anemia
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 The Abstract

Background Methods
Background

Results Conclusion Keywords

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40
 Introduction

• Background of Vitamin D and Anemia

• Scientific background for the interplay
• Rationale for the investigation

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 Aims and Objectives

• Stated specific objectives for clarity and accuracy

• Primary and Secondary objectives

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 Eligibility Criteria

Inclusion Criteria Exclusion Criteria

• Primigravida Women • Active Comorbid Diseases
• Age Range • Anemia Types
• Gestational Age • Vitamin D Supplementation
• Consent • Gastrointestinal Conditions
• Blood Transfusion History • Chronic Haematological
Diseases

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 Methods

● Study Design Clarity ● Case control ratio

● Study setting ● Case 48
● Participant Selection ● Control 46
● Data Collection Methods
● Sample Size

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 Statistical Analysis

• Chi square test

• Independent Sample Mann Whitney U Test
• Pearson's Correlation Coefficient (r)

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 Results

 Reported numbers of individuals at each stage of the study

 The number of participants with missing data of study

participants

 Outcome Measures: Key outcomes included haemoglobin levels

and Vitamin D levels

 Additional Analyses- confounder adjustments

 Not mentioned the applicability / implications of the study

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 Results

Table 1 and Table 3

Taken
Iron and folic acid supplementation – Present
Not taken
Absent
 Discussion
Several studies reported low maternal vitamin D levels may Compared the
be a risk factor for gestational anemia. results with other
studies

There are various possible explanations for the link

between vitamin D deficiency and maternal anemia.. Scientific
explanation

The rationale might be owing to insufficient sun exposure.

Rationale

We also accounted for several parameters as a risk factor for Education and
maternal anemia. socioeconomic
status
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 Limitations and Biases

Limitations Small sample size

Potential biases Potential markers

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 Ethical Considerations

● Ethical approval obtained for the study

● Informed consent was obtained

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Reproducibility and Data Availability

• Datasets can be
accessible to interested
researchers

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 Other Information

01 Funding
02 Declarations

03 Abbreviations

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REFERENCES

● 34 references in Vancouver style.

54
Thank you