Jitender Nagpal

Background: Vitamin B ₁₂ deficiency is common in populations with limited animal-source foods and has been linked to delayed infant neurodevelopment and adverse pregnancy outcomes. Evidence on the benefits of maternal B ₁₂ supplementation for improving infant neurodevelopment remains mixed, particularly in low-income and middle-income countries where deficiency is prevalent. Methods: This double-blind, randomised controlled trial was conducted in two tertiary maternity care centres in India and Nepal. Pregnant women in their first trimester, following a vegetarian diet, were enrolled and randomised to receive either a daily oral supplement of 250 µg (group A) or 50 µg (group B) of methyl-cobalamin from enrolment to 6 months post partum. The primary outcomes were infant neurodevelopment assessed at 9–12 months using the Development Assessment Scale of Indian Infants and biochemical B ₁₂ status in mothers and infants measured through blood tests. Results: 531 mothers completed the study (group A n=255; group B n=276). There were no significant differences in baseline characteristics between mothers at both centres or in groups A and B. Mental developmental quotients (DQs) were higher in the infants of group A: 103.7 (7.7) than group B: 101.7 (8.8); p=0.008). This corresponds to a mean difference of 7.8 centiles (p=0.007). Mean motor DQs were not significantly different between the groups. Maternal vitamin B ₁₂ levels rose from the first to third trimester in both groups, with a larger increase in group A (104.9 pg/mL (SD 159.1)) than group B (47.5 pg/mL (SD 118.0)), p0.05). Conclusions: Daily supplementation with 250 µg of vitamin B ₁₂ during pregnancy in vegetarian mothers significantly improved infant mental DQ and maternal B ₁₂ status compared with a 50 µg dose.

Background: Assam, India, has the country’s highest maternal mortality ratio (195 per 100,000 live births), mainly due to poor access to and quality of maternal health (MH) care. Many women receive inadequate antenatal and postnatal services, made worse by isolation, socioeconomic barriers, and weak health care infrastructure. Digital tools like mobile messaging and chatbots have improved antenatal care (ANC) and facility-based deliveries in similar settings. The e-SAATHI (Strengthening ANC/PNC via AskNivi Tailored Health Information, Referrals, and Follow-Up) project aims to provide personalized, stage-specific maternal health support through a chat-based system in Assam. Objective: This study assesses the acceptability, feasibility, and effectiveness of the e-SAATHI chatbot in increasing women’s access to MH information and improving ANC and PNC service uptake across public and private facilities. Objectives include increasing ANC/PNC use (eg, ≥4 ANC visits and timely PNC), promoting respectful care, and gathering insights for scaling digital health in high-burden regions. Methods: Phase 1 (0‐3 mo) involves co-designing and pilot testing aligned with World Health Organization and national guidelines. Phase 2 (4‐24 mo) involves enrolling pregnant and postpartum women via health facilities and social media. The chatbot sends 2-3 messages weekly from 10-week pregnancy to 15 weeks postpartum. About 300 health care providers will be trained and engaged for onboarding and feedback. Phase 3 (25‐36 mo) involves scaling up across districts, reaching 225,000 women. Data collection includes interviews, surveys, facility assessments, and chatbot analytics. Qualitative analysis will explore experiences; quantitative data (ANC completion, facility delivery, PNC follow-up, and satisfaction) will compare pre- and post-interventions. Ethical approvals, informed consent, and data confidentiality are observed. Results: The study was funded in September 2022. As of August 2025, 210 facilities have been onboarded, and 201,813 women were enrolled. Chatbot-based data collection began in April 2023 and will continue through the study period. Qualitative and quantitative evaluation data collection started in November 2023 and is expected to complete in June 2027. Interim analyses will be conducted after midline data collection in 2026; final analyses will be performed after endline data collection in 2027. The primary outcome will be the change in the composite quality score of maternal and newborn care. Secondary outcomes will include service uptake indicators, user-reported knowledge and self-care practices, and satisfaction with care. Operational feasibility—including provider integration and barriers such as digital literacy and connectivity—will also be assessed. Ongoing collaborative learning and adapting cycles are expected to capture intervention adaptations and inform optimal strategies for scale-up. Conclusions: e-SAATHI offers a scalable digital approach to improve MH across a variety of sociodemographic, linguistic, and risk settings. By delivering timely, personalized support, the chatbot may enhance health-seeking behavior and outcomes in Assam and in similar low-resource areas globally.

Background: Pregnancy is a crucial stage characterized by an increased demand for various nutrients. The role of micronutrients becomes especially important during pregnancy and infancy to support neurodevelopment. Micronutrient deficiencies are prevalent in low- and middle-income countries due to socioeconomic disparities, limited dietary diversity, and barriers to quality antenatal care. This results in women of reproductive age and developing offspring being disproportionately affected. Despite extensive research, evidence remains fragmented, leading to a lack of comprehensive synthesis. Objective: This scoping review aims to explore the existing evidence on the role of maternal micronutrient status during pregnancy influencing neurodevelopmental outcomes in infants. Additionally, it will assess the prevalence and distribution of specific micronutrient deficiencies and identify their sociodemographic determinants within South Asian countries. Methods: This scoping review uses an iterative, three-step search strategy to identify both published and gray literature. Initially, a targeted search using relevant keywords was developed for PubMed to locate studies investigating maternal micronutrient status or supplementation during pregnancy (women aged 15‐49 y) and associated neurodevelopmental outcomes in offspring up to two years of age. The search was sequentially narrowed by geographic region (South Asian countries), study design, human studies, English-language publications, and clinical trials. In the second stage, this search strategy will be adapted and implemented across additional electronic databases, including MEDLINE, Embase, Google Scholar, Cochrane Library, OpenGrey, JSTOR, and Wiley, as well as trial registries such as ClinicalTrials.gov and PROSPERO. Further, supplementary hand-searching of relevant journals will be conducted. The third step involves applying a snowballing technique to review the bibliographies of initially identified papers. Two reviewers will independently conduct study selection and data extraction using standardized forms. Quality assessment will use Joanna Briggs Institute critical appraisal checklists. Quantitative findings (study characteristics, exposure definitions, outcome measures) will be summarized with descriptive statistics and visualized in structured tables and charts, and qualitative findings will be coded inductively to develop themes pertinent to the review questions. We will integrate evidence through a convergent narrative synthesis to contextualize how maternal micronutrient deficiencies are influenced by sociodemographic factors and how these relate to infant neurodevelopment. The review will adhere to PRISMA-ScR reporting guidelines. Results: The initial database search was completed on July 3, 2025. Title and abstract screening is in progress, and final synthesis and reporting are anticipated by January 2026. Conclusions: This review aims to summarize the available evidence on maternal micronutrients and infant neurodevelopment in South Asia, identify major gaps and inconsistencies in the data, and highlight opportunities for focused research and multisectoral action. The findings will help guide the next phases of the South Asia Collaborative for Maternal Micronutrients and Infant Neurodevelopment (SACMIND) collaborative project, which will include qualitative studies, biomarker assessments, and designing interventions.

Limited evidence exists on how midwives, other healthcare providers, and their local communities in low- and middle-income countries experience the transition to a midwifery model of care. This study aimed to identify opportunities, enablers, and barriers to integrating midwifery into existing public health systems, from the perspectives of key stakeholders representing health systems and communities. We conducted two case studies - community-based and public health facility-based - in Gujarat and Telangana, comprising 63 in-depth interviews and five focus group discussions with 40 participants, including midwives, obstetricians, nurse-midwives, hospital administrators, local women, family members, and community influencers. The ecological systems theory and the quality maternal and newborn care framework guided the framework analysis. Five themes were developed, each aligning with one level of ecological systems theory: 1) Becoming a midwife; 2) Negotiating the full scope of autonomous midwifery practice; 3) Midwives' integration into existing maternity care teams; 4) Building social recognition of midwifery in communities; and 5) Balancing the care context and policy directives. Midwives had to demonstrate professional competence, confidence, and assertiveness to overcome professional challenges and conflicts and gain acceptance. Integrating midwifery into existing health systems depends on midwives' acceptance and perceived trustworthiness by existing health teams/communities and can be facilitated by ongoing support and mentoring of midwives, preparatory sensitisation of other healthcare providers, and building social recognition of midwives in communities. Further research is needed to develop and test interventions that support midwives in fulfilling their potential to improve the care quality for mothers and infants.

B12 deficiency has a higher prevalence in type 2 diabetes mellitus (T2DM) patients. The causes of this observation are poorly understood. Self-imposed (vegan/vegetarian) or advised dietary modification or intake of metformin could be contributing. Hence, we undertook this study to evaluate the dietary intake of Vitamin B12 in diabetes patients in comparison with age-matched healthy controls. Fifty T2DM patients (cases) and 50 age-matched volunteers (controls) aged 35-60 years were enrolled at a tertiary hospital, in New Delhi. Sociodemographic and dietary information was gathered and the average dietary intake of B12 was estimated using the Cobalamin Intake in North Indians-Food Frequency Questionnaire (COIN-FFQ) (developed and validated). Medical records were reviewed for biochemical parameters (HbA1c, lipid profile, and blood sugar) of the last three months. The mean age was 50.66±6.09 years (n=100) and the mean body mass index of 28.49±4.53 kg/m2. The mean intake of dietary B12 was 3.2±1.7 μg/day and 3.8±1.4 μg/day (p=0.047) in diabetes patients and controls respectively. Thirty-six percent of diabetes patients did not meet the currently recommended daily dietary intake of B12 intake (vs. 14% of controls; p=0.011). Diabetes patients have a lower dietary intake of Vitamin B12 attributable to their distinctive dietary pattern. It is necessary to explore the factors leading to lower dietary B12 intake in diabetes patients.