SYNERGISTIC EFFECT OF ASCORBIC ACID AND IRON SUPPLEMENTATION AGAINST POSTPARTUM ANEMIA AND OXIDATIVE STRESS MITIGATION

Khansa; Muhammad imran Hussain; Mubashra Basharat; Saba Akhtar; Munawara Mohamed Yahaya; Noman Aslam; Sahir Shahzad

doi:10.53555/jptcp.v31i3.4977

Khansa
Muhammad imran Hussain
Mubashra Basharat
Saba Akhtar
Munawara Mohamed Yahaya
Noman Aslam
Sahir Shahzad

Keywords

PPA, Hb, Serum iron Level, Serum Ferritin Level, Serum vitamin C, MetHb%, TAC

Abstract

Background & Objective: Postpartum Anemia is a multi-factorial pathogenic condition, which is etiologically determined by decreased blood cells production and decline in antioxidant levels which fail to fulfill body requirements and result in severe health related complications such as postnatal iron deficiency, inflammation, defective erythropoiesis, hemolysis and oxidative stress. Vitamin C decreases oxidative stress as well as enhance absorption of iron from non heme sources and ultimately increases maternal iron stores by converting oxidation state of iron from (Fe3+) ferric iron to (Fe2+) ferrous iron. Aim of this study is; To determine the role of oxidative stress in denouement of anemia and combined effect of vitamin C along with iron supplementation during postpartum anemia on maternal iron status and oxidative stress.

Methods: RCT was conducted in THQ hospital Muridke, Pakistan .40 patients were included and data that was collected included Demographics, PBAC scoring, CBC, Serum iron, Serum Ferritin, Serum vitamin C, MetHb%, TAC and FFQ. Participants were then divided into 2 groups that were observed for 8 weeks. The control group received iron supplementation (iron poly maltose 100g) 1 tablet per day and experimental group received both iron and vitamin C supplementation (iron poly maltose 100g along with chewable vitamin C 500mg), 1 tablet of both supplements per day in a single dose for 8 weeks. After 8 weeks post analysis of above mentioned parameters was done.

Results: Hb, HCT, MCV and MCH level of experimental and control group was found significant (p=0.000 < 0.05). RBCs count in experimental and control group was not significant (P=O.610 >0.05).Results indicated no significant improvement in RBCs count with any supplement. However, Serum iron level, serum ferritin and serum vitamin c levels of experimental and control group was significant (p=0.000 < 0.05). Similarly, MetHb% and TAC level of both groups improved significantly (p=0.000<0.05).

Conclusion: Vitamin C and iron considerably shown pronounced improvement in Hb, HCT, MCV, MCH, Serum iron, TAC and Serum Ferritin levels and decreases MetHb% in women with postpartum anemia. But the improvement in RBCs count was not significant. Improved TAC level and decline in MetHb% after treatment indicate that vitamin c improves oxidantal defense within body.

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References

1. Moya, E, Phiri, N, Choko, AT, Mwangi, MN & Phiri, KS, Effect of postpartum anaemia on maternal health-related quality of life: a systematic review and meta-analysis BMC Public Health, 2022, vol. 22, no. 1.
2. Miller,Iron Deficiency Anemia: a Common and Curable Disease Cold Spring Harbor Perspectives in Medicine, 2013 vol. 3, no. 7.
3. Lakew, Y, Biadgilign, S & Haile, , Anaemia prevalence and associated factors among lactating mothers in Ethiopia: evidence from the 2005 and 2011 demographic and health surveys BMJ Open, D 2015,vol. 5, no. 4, pp. e006001 .
4. World Health Organization.‎Guideline: Iron supplementation in postpartum women. (‎2016) World Health Organization.
5. Yourkavitch, J, Obara, H, Gulnoza Usmanova, Semrau, K, Moller, A-B, Marı́a Nieves Garcı́a-Casal & Jahnavi Daru ‘A rapid landscape review of postpartum anaemia measurement: challenges and opportunities’, BMC Public Health, 2023, vol. 23, BioMed Central, no. 1, viewed 11 October 2023.
6. Halliwell, B , ‘Free radicals, antioxidants, and human disease: curiosity, cause, or consequence?’, The Lancet,1994, vol. 344, no. 8924, pp. 721–724.
7. Allen, LH , ‘Anemia and iron deficiency: effects on pregnancy outcome’, The American Journal of Clinical Nutrition,2000, vol. 71, no. 5, pp. 1280S1284S.
8. Bissinger, R, Bhuyan, AAM, Qadri, SM & Lang, ‘Oxidative stress, eryptosis and anemia: a pivotal mechanistic nexus in systemic diseases’, The FEBS Journal, 2018 vol. 286, no. 5, pp. 826–854.
9. Fibach, E & Rachmilewitz, ‘The Role of Oxidative Stress in Hemolytic Anemia’, Current Molecular Medicine, 2008 vol. 8, no. 7, pp. 609–619..
10. Crichton, RR, Wilmet, S, Legssyer, R & Ward, ‘Molecular and cellular mechanisms of iron homeostasis and toxicity in mammalian cells’, Journal of Inorganic Biochemistry, 2002,vol. 91, no. 1, pp. 9–18.
11. Ho Zoon Chae, Hyung Jung Kim, Sang Won Kang & Sue Goo Rhee‘Characterization of three isoforms of mammalian peroxiredoxin that reduce peroxides in the presence of thioredoxin’, Diabetes Research and Clinical Practice, 1999, vol. 45, Elsevier BV, no. 2-3, pp. 101–112.
12. Hussain, M. I., Ahmed, W., Nasir, M., Mushtaq, M. H., Sheikh, A. A., Shaheen, A. Y., Ali, S., & Iqbal, S. (2019). Immune modulatory and anti-oxidative effect of selenium against pulmonary tuberculosis. Pakistan journal of pharmaceutical sciences, 32(2 (Supplementary)), 779–784.
13. Hussain, M. I., Ahmed, W., Nasir, M., Mushtaq, M. H., Sheikh, A. A., Shaheen, A. Y., & Mahmood, A. (2019). Immune boosting role of vitamin E against pulmonary tuberculosis. Pakistan journal of pharmaceutical sciences, 32(1(Supplementary)), 269–276
14. Nagababu, E, Gulyani, S, Earley, CJ, Cutler, RG, Mattson, MP & Rifkind, ‘Iron-Deficiency Anemia Enhances Red Blood Cell Oxidative Stress’, Free radical research, 2008,vol. 42, no. 9, pp. 824–829.
15. Hanif, N & Anwer, , Chronic Iron Deficiency, PubMed, StatPearls Publishing, Treasure Island (FL), viewed 8 December 2020, .
16. Nishikimi, M, Fukuyama, R, Minoshima, S, Shimizu, N & Yagi, K ‘Cloning and chromosomal mapping of the human nonfunctional gene for L-gulono-gamma-lactone oxidase, the enzyme for L-ascorbic acid biosynthesis missing in man.’, Journal of Biological Chemistry, 1994,vol. 269, no. 18, pp. 13685–13688
17. Padayatty, S & Levine, ‘Vitamin C: the known and the unknown and Goldilocks, Oral Diseases,2016, vol. 22, no. 6, pp. 463493.
18. Kontoghiorghes, GJ, Kolnagou, A, Kontoghiorghe, CN, Mourouzidis, L, Timoshnikov, VA & Polyakov, , ‘Trying to Solve the Puzzle of the Interaction of Ascorbic Acid and Iron: Redox, Chelation and Therapeutic Implications’, Medicines,2020 vol. 7, no. 8
19. Kaźmierczak-Barańska J, Boguszewska K, Adamus-Grabicka A, Karwowski BT. Two Faces of Vitamin C—Antioxidative and Pro-Oxidative Agent. Nutrients. 2020 May 21;12(5):1501.
20. Yang, ZW, Yang, SH, Chen, L, Qu, J, Zhu, J & Tang, Comparison of blood counts in venous, fingertip and arterial blood and their measurement variation, Clinical and Laboratory Haematology,2001 ,vol. 23, no. 3, pp. 155–159.
21. A. L. Amess, ‘Ferritin in iron metabolism. M. Wick, W. Pinggera and P. Lehmann. Springer-Verlag, 1991. No. of pages: 70. DM28’, Hematological Oncology, Wiley-Blackwell ,1993.
22. Kok, DA & Wild,‘SERUM IRON DETERMINATION’, Journal of Clinical Pathology, 1960,vol. 13, no. 3, pp. 241245.
23. Hagel, AF, Albrecht, H, Dauth, W, Hagel, W, Vitali, F, Ganzleben, I, Schultis, HW, Konturek, PC, Stein, J, Neurath, MF & Raithel, Plasma concentrations of ascorbic acid in a cross section of the German population Journal of International Medical Research,2017, vol. 46, no. 1, pp. 16874.
24. Attia, Atef & Ibrahim, Fatma & El-Latif, Noha & Aziz, Samir & Elwan, Azhar & Aboulthana, Wael & Moussa, Sherif & Elalfy, Mohsen. A Simple Accurate Method for Simultaneous Determination of Total Hemoglobin and Its Derivatives in Human and Mice Blood,2016,26. 163–174.
25. Aslan, M, Horoz, M & Celik,‘Evaluation of oxidative status in iron deficiency anemia through total antioxidant capacity measured using an automated method’, Turkish Journal of Hematology, 2011,vol. 28, no. 1, pp. 42–46.
26. Magnay, JL, O Brien, S, Gerlinger, C & Seitz, Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review, BMC Women Health,2020,vol. 20, no. 1.
27. Li, N, Zhao, G, Wu, W, Zhang, M, Liu, W, Chen, Q & Wang, The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia JAMA Network Open, 2020, vol. 3, no. 11, p. e2023644.
28. Wheeler, Assessment and interpretation of micronutrient status during pregnancy Proceedings of the Nutrition Society,2008,vol. 67, no. 4, pp. 437–450.
29. Timoshnikov, VA, Kobzeva, TV, Polyakov, NE & Kontoghiorghes, ‘Redox Interactions of Vitamin C and Iron: Inhibition of the Pro-Oxidant Activity by Deferiprone’, International Journal of Molecular Sciences,2020, vol. 21, no. 11.
30. Saha, L., P Pandhi, Gopalan, S., Malhotra, S. and Pradip Kumar Saha Comparison of efficacy, tolerability, and cost of iron polymaltose complex with ferrous sulphate in the treatment of iron deficiency anemia in pregnant women. PubMed,2007, 9(1), pp.1–1.
31. Mao, X., & Yao, G.Effect of vitamin C supplementations on iron deficiency anemia in Chinese Biomed Environ Sci ,1992,125-9.
32. Imam, M, Zhang, S, Ma, J, Wang, H & Wang, ‘Antioxidants Mediate Both Iron Homeostasis and Oxidative Stress’, Nutrients,2017,vol. 9, no. 7, p. 671.
33. Hunt, JR, Mullen, LM, Lykken, GI, Gallagher, SK & Nielsen, ‘Ascorbic acid: effect on ongoing iron absorption and status in iron-depleted young women’, The American Journal of Clinical Nutrition,1990 vol. 51, no. 4, pp. 649–655.
34. Cook, JD & Reddy, ‘Effect of ascorbic acid intake on nonheme-iron absorption from a complete diet’, The American Journal of Clinical Nutrition, 2001, vol. 73, no. 1, pp. 93–98.
35. Fernández-Gaxiola, AC & De-Regil, ‘Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women’, Cochrane Database of Systematic Reviews, 2019 .
36. Zhao, A, Zhang, J, Wu, W, Wang, P & Zhang, Postpartum anemia is a neglected public health issue in China: a cross-sectional study. PubMed, 2019,vol. 28, National Institutes of Health, no. 4, pp. 793799.

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Published

Mar 29, 2024

DOI https://doi.org/10.53555/jptcp.v31i3.4977

How to Cite

Khansa, Muhammad imran Hussain, Mubashra Basharat, Saba Akhtar, Munawara Mohamed Yahaya, Noman Aslam, & Sahir Shahzad. (2024). SYNERGISTIC EFFECT OF ASCORBIC ACID AND IRON SUPPLEMENTATION AGAINST POSTPARTUM ANEMIA AND OXIDATIVE STRESS MITIGATION. Journal of Population Therapeutics and Clinical Pharmacology, 31(3), 1988–1998. https://doi.org/10.53555/jptcp.v31i3.4977

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Vol. 31 No. 3 (2024): JPTCP

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