Anaemia affects 42% of pregnancies worldwide and is associated with a number of adverse maternal and neonatal pregnancy outcomes including postpartum haemorrhage, preterm delivery, stillbirth and reduced offspring birthweight. (1,2) Whilst iron deficiency is the most common nutritional cause of anaemia in pregnancy, low status of the B vitamin, riboflavin, may also be implicated due to its role in iron metabolism, (specifically in the flavin-dependent release of stored iron for erythropoiesis), but this is rarely investigated in human studies. (3) Low or deficient riboflavin status occurs more commonly among women of reproductive age than is generally recognised, and studies to date investigating the association between riboflavin status and haemoglobin (Hb) in pregnancy have been largely confined to low-middle income populations. (4) The aim of this study was to examine the associations of riboflavin with Hb, and to determine the role of riboflavin as a predictor of anaemia during pregnancy.Data for this analysis were obtained from healthy pregnant women in Northern Ireland and the Republic of Ireland, enrolled on the ongoing Optimal Nutrition for the Prevention of Hypertension in Pregnancy using a Personalised Approach (OptiPREG) study. Detailed health, dietary and lifestyle information, along with a blood sample for analysis of B vitamin biomarkers and haematological measures, were obtained from all participants at the 12th gestational week (GW) (n = 2,153) and at the 36th GW (in a subset of mothers; n = 372). Riboflavin status was determined by the functional assay, erythrocyte glutathione reductase activation coefficient (EGRac), whereby higher values indicate lower riboflavin status.Biomarker analysis showed that 68% of pregnant women had low or deficient riboflavin status. Linear regression analysis found riboflavin status to be a significant determinant of Hb at the 12th GW (β=−0.128, P = 0.001), whilst the odds of developing anaemia at the 12th GW increased with decreasing riboflavin status (β=2.4, OR:10.9, CI:2.2-53.3, P = 0.003). Hb was 0.32g/dl lower at 12th GW (P = 0.026), and 0.64g/dl lower at the 36th GW (P = 0.036), among riboflavin deficient (EGRac ≥ 1.4) women compared to women with optimal riboflavin status (EGRac ≤ 1.26), after controlling for known confounders. Furthermore, among women with riboflavin deficiency, compared to those sufficient in riboflavin at the 12th GW, a significantly higher percentage went on to develop anaemia by the 36th GW (4.6% vs 10.6%, P = 0.032).Riboflavin deficiency is more common in pregnancy than previously recognised. Maintenance of an optimal riboflavin status in pregnancy, through improved diet or supplementation, may improve Hb concentrations and reduce the risk of anaemia, however randomised trials with riboflavin are required, including the ongoing OptiPREG intervention study.

Although rare, pregnancy can still occur after both tubal sterilization and endometrial ablation. The resulting pregnancy is often complicated by ectopic pregnancy, miscarriage, and adherent placenta. Endometrial ablation is not a contraceptive.

No abstract

AbstractThe common C677T polymorphism in the MTHFR gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase is implicated in hypertension and hypertension in pregnancy. Hypertension affects up to 15% of all pregnancies and has been identified as a leading cause of maternal and neonatal morbidity and mortality worldwide. We previously reported higher systolic and diastolic blood pressure (BP) in non-pregnant women with the variant MTHFR 677TT genotype compared to CT/CC genotypes. In addition, randomised controlled trials (RCTs) in non-pregnant hypertensive adults from our Centre demonstrated that supplemental riboflavin (co-factor for MTHFR) lowers BP specifically in those with the TT genotype. However, the role of this common folate polymorphism and its interaction with riboflavin during pregnancy remains unclear. The aim of this study was to investigate the impact of MTHFR genotype and riboflavin status on BP in pregnancy. Data were generated from the ongoing Optimal Nutrition for the Prevention of Hypertension (OptiPREG) project. Pregnant women were recruited at the end of the first trimester from antenatal clinics in Northern Ireland and in the Republic of Ireland. Participants were screened for MTHFR genotype and BP was measured according to current clinical guidelines. Biomarker status of riboflavin was determined using the erythrocyte glutathione reductase activation coefficient (EGRac), a functional assay with higher EGRac values representing a lower status. Overall, 117 (11.6%) participants were identified with the variant MTHFR 677TT genotype. Both systolic and diastolic BP decreased from 8th to 16th gestational week (GW), however, this typical BP pattern was not observed in the TT genotype group. After adjusting for maternal age, GW and body mass index, women with the TT genotype at 12th GW had higher mean systolic (P 0.035) and diastolic (P 0.034) BP. When the results at the 12th GW were stratified by riboflavin status, the BP phenotype owing to this polymorphism was evident only among women with lower status (i.e. EGRac > 1.30), with mean (SEM) systolic BP of 120.4 (3.1) mmHg compared to 112.6 (2.5) mmHg in those with higher status (EGRac ≤ 1.30) within the TT genotype group; in contrast, low versus high riboflavin status had no impact on BP in CT/CC genotype groups. These results suggest that MTHFR genotype influences BP during pregnancy and that riboflavin can exert an important modulating effect on BP in women with TT genotype. An RCT is required to fully investigate the role of MTHFR genotype and its interactive effect with riboflavin in BP during pregnancy.

A case of a 42-year-old woman, Para 3 who had an unplanned pregnancy despite bilateral tubal ligation for contraception, and Novasure® endometrial ablation for persistent Heavy Menstrual Bleeding (HMB). The pregnancy was complicated by missed miscarriage at 14 weeks and placenta accreta. This is an uncommon event.