Project Update: Controlled anemia in pregnant mothers and improved birth weight of babies by withdrawing fluoride intake and improving diet
Funds: Provided by donors under Global Giving, USA
Hospitals where the projects were carried out
(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 attend the Antenatal Clinics are from the lower strata of the socio-economic ladder.
In DDU, 2055 pregnant women were scanned
Exclusion criteria: The selection of pregnant women were based on all those, who do not suffer from Diabetes, Tuberculosis, HIV AIDS, Bleeding during pregnancy and High Blood Pressure.
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Intervention I: They were withdrawn from consuming any item containing fluoride, which included drinking water, food and food products and also advised to use toothpaste which has the least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 very effective 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 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 hemoglobin and 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 6.25 mg/L to 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.
• 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.
In LBS – our 2nd series (2007 – 2009)
• In LBS we screened 874 pregnant women
• Interventions I & II were introduced
• Hemoglobin and urinary fluoride 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 4.76 mg/L to 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.
• The Foundation wish to record our deep appreciation for the generous donations made by the donors and the funds have made meaningful life for so many families and their little kids. The withdrawal of fluoride enabled the families to have babies without major deformities viz. mental retardation, dwarfs, bow-leg, knock-knee and deaf mutism.
• If we have the email id of the donors, we would much like to thank them individually.
Our protocol for the work is as follows and all the donors should know about it. Fluoride literally does all the damage to the growing embryo / babies born.
(1) The hospital chosen = “Sri Lal Bahadur Shastri Hospital”. Mainly women of the lower socioeconomic strata visit this hospital
(2) After the Gynecologist & Obstetrician checks the pregnant women- those with pregnancy less than 20 wks, and having no other serious health problems are directed to our staff of the Foundation, occupying a room in the hospital next to the Antenatal Clinic
(3) We check the hemoglobin using a digital equipment and we show the data to the women, and if it is less than 11 gm/dl (i.e. anaemic)– is chosen to our study group (sample group)
(4) We collect the urine of the women for testing for fluoride in the Foundation.
(5) A member of our team (Medical Social worker, would visit the home of the women who have less than 11 gm/dl hemoglobin, the very next day to collect a sample of the drinking water which the family uses for cooking and drinking.
(6) The urine and drinking water samples are tested for fluoride in our Foundation. If fluoride is more than normal permissible limits (urine fluoride 0.1 – 1.0 mg/L; water 1.1 mg/L and above) we would provide counseling and shift them to safer drinking water source.
(7) In counseling focus is to eliminate all fluoride sources (water, food, toothpaste etc) and promote nutritive diet to have adequate Calcium, Iron, Folic acid, Vitamin C, E and Antioxidants, through dairy products, vegetables and fruits.
(8) We explain to them simple recipes, such as vegetable soups, salads, sauces (chutneys), vegetable sandwiches, how to make and how to enjoy good food. It is not necessary to buy expensive food; inexpensive vegetables & fruits which have high nutritive value is what we promote.
(9) We provide to every women a little booklet in local language – how to practise diet improvements.
(10) These women will be retested for (1) hemoglobin (2) urinary fluoride at least 4 more times before she delivers and every time we ensure by counseling that her diet is good. Testing for Hb and urine fluoride is repeated.
(i) 10 – 20 wks pregnancy
(ii) 24 – 28 wks pregnancy
(iii) 32 – 36 wks pregnancy
(iv) 36 – and above wks pregnancy
(11) It is our observations, that every women like to have a healthy baby – born with good intelligence and no deformities.
(12) The women whom we recruit now if under 20 wks pregnancy, would begin to deliver by January 2008 (we shall certainly share our data of the babies born with Ashoka /Donors)
(13) The baby weight will be recorded from the hospital labour room records.
(14) For all our women, on the case history sheet, we stick a big red sticker, that is made clear to everyone and through the sticker we identify our women, when they deliver.
(15) There is a control group, where we do not intervene. They are also women with less than (1) 11 gm/dl hemoglobin and (2) high urinary fluoride, but we do not intervene with our counseling. We keep checking and monitoring them at the same 4 intervals for Hb and urinary fluoride and when delivered, the baby weight is also recorded.
(16) If everything goes well – our Sample group women should deliver babies of 2.5 kg wt and above. This is achieved through withdrawal of fluoride and promotion of nutritive food. The Control group – may deliver babies of less than 2 kg body weight or even less. Some may be an abortion / still birth.
We are attaching a few pictures of the (1) Hospital, (2) Discussion with the hospital authorities and (3) waiting room of the pregnant women.
We have received the wire transfer of funds through Global Giving.
--We are going to deal with children starting with pregnant mother visiting antenatal clinics, who have high fluoride in urine (fluoride poisoned) and due to fluoride poisoning they have very low hemoglobin. If they are unattended to, during pregnancy they would give birth to low birth weight babies who would be defective, deformed & mentally retarded.
--Before the babies are born, the pregnant women visits the Antenatal clinics in a hospital, a minimum of 3 to a maximum of 7 visits, we will monitor their urinary fluoride and hemoglobin. We will be guiding and counseling such mothers to ensure that she consumes a nutritive diet and has a healthy baby born. This is the best we can do to the child and the family.
-- We may provide a 4 monthly report starting from August – September, 07. In our study monthly report does not make sense. The whole excitement is when a health baby with body weight greater than (>) 2.5 kg is born to such mothers. We will be designing a Reporting format as well.
Thank you for the wonderful assistance and we shall also write to the donors who have provided their email id, as we are obliged to inform them, what we shall be doing with their hard-earned money.
Prof.(Dr.) A.K. Susheela
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