Vitamin B1 Deficiency High Among Pregnant Women in Northeast India: Study

A significant public health concern has emerged from India's Northeast, specifically the Barak Valley region, where a recent government study by the ICMR-National Institute of Nutrition (ICMR-NIN) found that approximately one in five (20.6%) pregnant and lactating women are deficient in Vitamin B1, also known as thiamine. This finding, described by researchers as a 'silent but preventable public health emergency,' challenges the long-held belief that India had largely overcome the problem of thiamine deficiency, which once caused widespread beriberi across Asia. The study, one of the largest community-based surveys on thiamine deficiency in India, involved 1,083 pregnant and lactating women across 120 villages in the Barak Valley. The functional blood tests revealed that a substantial portion of these women lacked sufficient thiamine for their body cells to function correctly. Several dietary and food preparation practices prevalent in the region were identified as primary contributors to this high prevalence. The research highlighted that over 96% of the women in the study consumed polished white rice as their main food source daily. Polished rice loses much of its thiamine content during processing, as the thiamine-rich husk is removed. Furthermore, storing rice for extended periods also diminishes its thiamine levels, with women consuming stored rice being roughly three times more likely to be deficient. The common practice of washing rice two or more times before cooking, a widespread habit in the region, further exacerbates the problem, as thiamine is a water-soluble vitamin that gets washed away with each rinse. Conversely, the study also identified a protective factor: women who regularly consumed fermented fish or fish paste, a traditional food in the region, exhibited lower rates of thiamine deficiency. This suggests that traditional fermented foods could offer natural protection against the deficiency. The implications of maternal thiamine deficiency are severe for both the mother and the developing or breastfeeding infant. Thiamine is crucial for converting food into energy, and its deficiency can lead to a range of cardiac, neurological, and psychological complications in mothers, collectively known as beriberi. For infants, the situation is particularly critical. If a breastfeeding mother is thiamine-deficient, her breastmilk will also be low in the vitamin, posing a life-threatening risk to the newborn who depends entirely on it. Hospital records and outbreak investigations from the Barak Valley indicate that approximately one in five infant deaths in the region are attributed to suspected beriberi, caused by the mother's lack of thiamine. Infantile beriberi can manifest as sudden infant death syndrome (SIDS), behavioral changes, delayed language development, and decreased visual alertness. Dr. Mahesh Kumar Mummadi, the lead investigator and a medical scientist in the Clinical Epidemiology Division at ICMR-NIN, stressed that this deficiency burden is entirely preventable. He advocated for the explicit inclusion of thiamine in India's maternal nutrition strategy, emphasizing that it should no longer be treated as a problem of the past. This call is supported by research indicating that thiamine supplementation for pregnant and postpartum mothers in Northeast India could be highly cost-effective in averting infant deaths. A recent cost-effectiveness analysis from December 2025 highlighted that a routine of 6 months antenatal and 6 months postnatal thiamine supplementation program, delivering 10 milligrams of thiamine daily, is likely to be highly cost-effective, with an incremental cost-effectiveness ratio (ICER) of INR 2386 per life year saved. The need for thiamine increases significantly during pregnancy due to the demands of fetal growth and metabolism. Other studies, such as one conducted in Kashmir, also reveal a high prevalence of thiamine deficiency (38.2%) among pregnant women, linking it to poor nutritional status and adverse perinatal outcomes, including the consumption of white polished rice and interference from beverages like tea. Globally, thiamine deficiency is more predominant in populations whose diets are mainly composed of low-thiamine sources like milled white cereals and polished rice. These findings underscore the urgent need for targeted public health interventions, including nutritional education, promotion of less-processed grains, and potentially fortification or supplementation programs, particularly in vulnerable regions like Northeast India, to safeguard maternal and infant health. The ICMR (2020) provides recommended dietary allowances for Indians, including pregnant and lactating women, emphasizing the importance of adequate thiamine intake.

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