Prevalence and Predictors of Functional Vitamin K Insufficiency in Mothers and Newborns in Uganda.
Vitamin K deficiency bleeding (VKDB) in infancy is a serious but preventable cause of mortality or permanent disability. Lack of epidemiologic data for VKDB in sub-Saharan Africa hinders development and implementation of effective prevention strategies. We used convenience sampling to consecutively enroll mothers delivering in a southwestern Uganda Hospital. We collected socio-demographic and dietary information, and paired samples of maternal venous and neonatal cord blood for the immunoassay of undercarboxylated prothrombin (PIVKA-II), a sensitive marker of functional vitamin K (VK) insufficiency. We used univariable and multivariable logistic regression models to identify predictors of VK insufficiency. We detected PIVKA-II of ≥0.2 AU (Arbitrary Units per mL)/mL (indicative of VK insufficiency) in 33.3% (47/141) of mothers and 66% (93/141) of newborns. Importantly, 22% of babies had PIVKA-II concentrations ≥5.0 AU/mL, likely to be associated with abnormal coagulation indices. We found no significant predictors of newborn VK insufficiency, including infant weight (AOR (adjusted odds ratio) 1.85, 95% CI (confidence interval) 0.15-22.49), gender (AOR 0.54, 95% CI 0.26-1.11), term birth (AOR 0.72, 95% CI 0.20-2.62), maternal VK-rich diet (AOR 1.13, 95% CI 0.55-2.35) or maternal VK insufficiency (AOR 0.99, 95% CI 0.47-2.10). VK insufficiency is common among mothers and newborn babies in southwestern Uganda, which in one fifth of babies nears overt deficiency. Lack of identifiable predictors of newborn VK insufficiency support strategies for universal VK prophylaxis to newborns to prevent VKDB.
Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Plot 8-18 Mbarara-Kabale road, P.O. Box 1410, Mbarara, Uganda. boymukedata@gmail.com.
Data
D
Santorino
Department of Medicine and Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, 125 Nashua Street, Boston, MA 02114, USA.
Mark J
MJ
Siedner
Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Plot 8-18 Mbarara-Kabale road, P.O. Box 1410, Mbarara, Uganda.
Juliet
J
Mwanga-Amumpaire
Centre for Haemostasis and Thrombosis, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Martin J
MJ
Shearer
Centre for Haemostasis and Thrombosis, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
Dominic J
DJ
Harrington
Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Plot 8-18 Mbarara-Kabale road, P.O. Box 1410, Mbarara, Uganda.
Unni
U
Wariyar
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009752:Nutritional Status; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology*; D039401:Prenatal Nutritional Physiological Phenomena; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin; D014454:Uganda / Q000453:epidemiology; D014812:Vitamin K / Q000097:blood*; D014813:Vitamin K Deficiency / Q000097:blood / Q000453:epidemiology; D006475:Vitamin K Deficiency Bleeding / Q000097:blood / Q000453:epidemiology*; D055815:Young Adult
D015415:Biomarkers; D011498:Protein Precursors; D014812:Vitamin K; C008208:acarboxyprothrombin; D011516:Prothrombin
bleeding; deficiency; haemorrhage; insufficiency; newborn; prophylaxis; undercarboxylated prothrombin; vitamin K