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Prevalence of subclinical vitamin K deficiency in Thai newborns: relationship to maternal phylloquinone intakes and delivery risk
  1. Ampaiwan Chuansumrit1,
  2. Tassanee Plueksacheeva2,
  3. Sansanee Hanpinitsak3,
  4. Siwaponr Sangwarn2,
  5. Suthida Chatvutinun2,
  6. Umaporn Suthutvoravut1,
  7. Yongyoth Herabutya4,
  8. Martin J Shearer5
  1. 1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  2. 2Department of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  3. 3Mother and Child Health Region, Khonkaen, Thailand
  4. 4Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  5. 5Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK
  1. Correspondence to Professor Ampaiwan Chuansumrit, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Bangkok 10400, Thailand; raajs{at}mahidol.ac.th

Abstract

Background Vitamin K deficiency bleeding (VKDB) in infants is a rare but serious worldwide problem, particularly in Southeast Asia. Apart from exclusive breast feeding, little is known of the maternofetal risk factors that predispose infants to VKDB.

Objectives To assess (a) the relationships between functional vitamin K insufficiency in a large cohort of Thai mothers to that of their newborn infants and (b) the importance of delivery risk factors and maternal intakes of vitamin K as determinants of neonatal vitamin K status.

Methods Vitamin K status was assessed by measuring undercarboxylated prothrombin (protein induced by vitamin K absence/antagonist-II (PIVKA-II)) in 683 mothers and in the cord blood of their babies by sensitive immunoassay. Dietary phylloquinone (vitamin K1; K1) intakes were assessed in 106 of these mothers by food frequency questionnaire.

Results Babies were categorised as ‘normal’ (n=590) or ‘high risk’ (n=93) according to birth weight and delivery type. PIVKA-II was detectable (>0.15 arbitrary units (AU)/ml) in 85 mothers (12.4%) and 109 babies (16.0%) with median levels of 0.78 and 1.04 AU/ml in mothers and babies, respectively. ‘High-risk’ babies had a higher median detectable PIVKA-II concentration than ‘normal-risk’ babies (3.1 vs 1.0 AU/ml, p=0.02) and a higher prevalence of clinically relevant (>5.0 AU/ml) concentrations (p=0.006). Mothers with K1 intakes below the US recommended ‘adequate intake’ for pregnancy (<90 µg/day) had a higher prevalence of detectable PIVKA-II (18.8%) than those with adequate intakes (3.3%) (p=0.01).

Conclusions Functional, clinically relevant, vitamin K insufficiency was more common in ‘high-risk’ than ‘normal-risk’ newborns. Vitamin K insufficiency in mothers was linked to lower dietary K1 intakes during pregnancy.

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethical Clearance Committee on Human Rights Related to Researches Involving Human Subjects, Faculty of Medicine, Ramathibodi Hospital, Mahidol University.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

  • Patient consent Obtained.

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