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Postpartum thiamine deficiency in a Karen displaced population^1,2,3

¹ From the Shoklo Malaria Research Unit, Mae Sot, Thailand; the Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; the Centre for Tropical Medicine, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, United Kingdom; the Department of Paediatrics, Royal Postgraduate Medical School, Hammersmith Hospital, London; the Institute of Nutrition, Friedrich-Schiller University, Jena, Germany; the Department of Nutrition and Food Sciences, Utah State University, Logan; and the Department of Nutrition, University of Alabama, Birmingham.

Background: Before its recognition, infantile beriberi was the leading cause of infant death in camps for displaced persons of the Karen ethnic minority on Thailand's western border.

Objective: This study aimed to document thiamine status in the peripartum period to examine the current supplementation program and the correlation between the clinical manifestations of thiamine deficiency and a biochemical measure of thiamine status.

Design: Women were enrolled prospectively at 30 wk of gestation and were followed up weekly until delivery and at 3 mo postpartum. Thiamine supplementation during pregnancy was based on patient symptoms.

Results: At 3 mo postpartum, thiamine deficiency reflected by an erythrocyte transketolase activity (ETKA) 1.20% was found in 57.7% (15/26) of mothers, 26.9% (7/26) of whom had severe deficiency (ETKA > 1.25%). No significant associations between ETKA and putative maternal symptoms or use of thiamine supplements were found.

Conclusions: Biochemical postpartum thiamine deficiency is still common in Karen refugee women. This situation may be improved by educating lactating women to reduce their consumption of thiaminase-containing foods and by implementing an effective thiamine supplementation program.

Key Words: Erythrocyte transketolase activity • lactation • postpartum • pregnancy • refugee • thiamine deficiency • thiamine hydrochloride • Karen ethnic minority • Thailand • women

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