Vitamin B-12 Supplementation during Pregnancy and Early Lactation Increases Maternal, Breast Milk, and Infant Measures of Vitamin B-12 Status

Duggan, Christopher; Srinivasan, Krishnamachari; Thomas, Tinku; Samuel, Tinu Mary; Rajendran, Ramya; Muthayya, Sumithra; Finkelstein, Julia L.; Lukose, Ammu; Fawzi, Wafaie W.; Allen, Lindsay H.; Bosch, Ronald J.; Kurpad, Anura V

doi:10.3945/jn.113.187278

Cited by 131 publications

(152 citation statements)

References 34 publications

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“…Evidence is limited or conflicting to support the role of maternal vitamin B-12 status in other perinatal outcomes. Only 1 randomized trial was conducted to date to examine the effects of vitamin B-12 supplementation during pregnancy, and it was not designed to examine the effects of vitamin B-12 on pregnancy outcomes (67).…”

Section: Discussionmentioning

confidence: 99%

“…The burden of vitamin B-12 deficiency is particularly high in resource-limited settings in Latin America (;40%) (62), Sub-Saharan Africa (70%) (63,64), and South Asia (70-80%) (65,66). For example, in a randomized trial of vitamin B-12 supplementation in Bangalore, India, 51% of pregnant women were vitamin B-12 deficient (vitamin B-12: <150 pmol/L) and 42% had impaired vitamin B-12 status (vitamin B-12: <150 pmol/L; MMA: >0.26 mmol/L) at their first prenatal visit (67).…”

Section: Nutrient-nutrient Interactionsmentioning

confidence: 99%

“…In the first randomized trial of vitamin B-12 supplementation (50 mg/d vitamin B-12 and iron-folic acid, compared to iron-folic acid alone) in 366 pregnant women in Bangalore, India, 51% of women were vitamin B-12 deficient (<150 pmol/L) and 42% had impaired vitamin B-12 status (vitamin B-12: <150 pmol/L; MMA: >0.26 mmol/L) at their first prenatal visit (67). Infants born to vitamin B-12-deficient mothers were 1.6 times more likely to be vitamin B-12 deficient (<150 pmol/L) (P < 0.01) at 6 wk of age compared to infants born to vitamin B-12 replete mothers (31).…”

Section: Literature Reviewmentioning

confidence: 99%

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Vitamin B-12 and Perinatal Health

Finkelstein

Layden

Stover

2015

Advances in Nutrition

133

104

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Vitamin B-12 deficiency (<148 pmol/L) is associated with adverse maternal and neonatal outcomes, including developmental anomalies, spontaneous abortions, preeclampsia, and low birth weight (<2500 g). The importance of adequate vitamin B-12 status periconceptionally and during pregnancy cannot be overemphasized, given its fundamental role in neural myelination, brain development, and growth. Infants born to vitamin B-12-deficient women may be at increased risk of neural tube closure defects, and maternal vitamin B-12 insufficiency (<200 pmol/L) can impair infant growth, psychomotor function, and brain development, which may be irreversible. However, the underlying causal mechanisms are unknown. This review was conducted to examine the evidence that links maternal vitamin B-12 status and perinatal outcomes. Despite the high prevalence of vitamin B-12 deficiency and associated risk of pregnancy complications, few prospective studies and, to our knowledge, only 1 randomized trial have examined the effects of vitamin B-12 supplementation during pregnancy. The role of vitamin B-12 in the etiology of adverse perinatal outcomes needs to be elucidated to inform public health interventions. Adv Nutr 2015;6:552-63.

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Section: Discussionmentioning

confidence: 99%

Section: Nutrient-nutrient Interactionsmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

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Vitamin B-12 and Perinatal Health

Finkelstein

Layden

Stover

2015

Advances in Nutrition

133

104

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“…However, the methods used for micronutrient analyses in human milk were rarely described sufficiently and were sometimes unsuitable for the complex human-milk matrix (8); in some cases, the results obtained with different methods were not comparable (3, 9, 10). We reported several validated methods for accurately analyzing multiple vitamins in human milk (11–13), which have now been used in various studies (14–21). Given the undeniable importance of adequate micronutrient supply for an infant’s growth and development, we still have only very limited knowledge about the extent to which micronutrient concentrations in breast milk are sufficient to meet an infant’s requirements.…”

Section: Introductionmentioning

confidence: 99%

Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation

Hampel

Shahab‐Ferdows

Islam

et al. 2017

The Journal of Nutrition

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Background: Human milk is the subject of many studies, but procedures for representative sample collection have not been established. Our improved methods for milk micronutrient analysis now enable systematic study of factors that affect its concentrations.Objective: We evaluated the effects of sample collection protocols, variations in circadian rhythms, subject variability, and acute maternal micronutrient supplementation on milk vitamin concentrations.Methods: In the BMQ (Breast-Milk-Quality) study, we recruited 18 healthy women (aged 18–26 y) in Dhaka, Bangladesh, at 2–4 mo of lactation for a 3-d supplementation study. On day 1, no supplements were given; on days 2 and 3, participants consumed ∼1 time and 2 times, respectively, the US-Canadian Recommended Dietary Allowances for vitamins at breakfast (0800–0859). Milk was collected during every feeding from the same breast over 24 h. Milk expressed in the first 2 min (aliquot I) was collected separately from the remainder (aliquot II); a third aliquot (aliquot III) was saved by combining aliquots I and II. Thiamin, riboflavin, niacin, and vitamins B-6, B-12, A, and E and fat were measured in each sample.Results: Significant but small differences (14–18%) between aliquots were found for all vitamins except for vitamins B-6 and B-12. Circadian variance was significant except for fat-adjusted vitamins A and E, with a higher contribution to total variance with supplementation. Between-subject variability accounted for most of the total variance. Afternoon and evening samples best reflected daily vitamin concentrations for all study days. Acute supplementation effects were found for thiamin, riboflavin, and vitamins B-6 and A at 2–4 h postdosing, with 0.1–6.17% passing into milk. Supplementation was reflected in fasting, 24-h postdose samples for riboflavin and vitamin B-6. Maximum amounts of dose-responding vitamins in 1 feeding ranged from 4.7% to 21.8% (day 2) and 8.2% to 35.0% (day 3) of Adequate Intake.Conclusions: In the milk of Bangladeshi mothers, differences in vitamin concentrations between aliquots within feedings and by circadian variance were significant but small. Afternoon and evening collection provided the most-representative samples. Supplementation acutely affects some breast-milk micronutrient concentrations. This trial was registered at clinicaltrials.gov as NCT02756026.

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“…2017; 27(5):e12898. metabolic and neurological problems starting with the intrauterine period and especially low birth weight in the newborn (22,23).…”

Section: Discussionmentioning

confidence: 99%

How Does B12 Deficiency of Mothers Affect Their Infants?

et al. 2017

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Background: Vitamin B12 cannot be synthesized in the body and it is essential for growth and development in humans. Objectives: To evaluate the vitamin B12 levels between the mothers and their infants who presented to the Pediatric Hematology outpatients department due to the symptoms of vitamin B12 deficiency. We also compared the effects of low B12 levels in both the mother and the child, compared to the effects of normal B12 levels in the mother and low levels in the child. Methods: We enrolled 303 children aged 2 -18 months between January 2013 and September 2015. Patients with a vitamin B12 level < 200 pg/mL in both the mother and the child and patients with a B12 level that was low in the child and normal in the mother were compared. Results: The birth weight of the children was low in the group where the B12 level of both the mother and the child (n = 163) was low and presentation to the clinic with neurologic signs and symptoms such as tremor, restlessness, seizure, hypotonia, and macrocephaly not related to another etiologic reason was common (P < 0.05). A remarkable finding was the simultaneous low levels of vitamin B12 in the mother in 55 of the 69 children who presented with neurological symptoms (P < 0.05). A generalized or focal epileptic pathology was found in the EEGs and MR images including retardation in myelination, demyelination, atrophic findings or ventricular dilatation in children whose mothers have B12 deficiency simultaneously. Conclusions: It is difficult to explain such complicated clinical pictures due to malnutrition especially in developing countries. Detecting and treating vitamin B12 deficiency early in mother and child is very important in prevention of potential irreversible neurological problems.

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Vitamin B-12 Supplementation during Pregnancy and Early Lactation Increases Maternal, Breast Milk, and Infant Measures of Vitamin B-12 Status

Cited by 131 publications

References 34 publications

Vitamin B-12 and Perinatal Health

Vitamin B-12 and Perinatal Health

Vitamin Concentrations in Human Milk Vary with Time within Feed, Circadian Rhythm, and Single-Dose Supplementation

How Does B12 Deficiency of Mothers Affect Their Infants?

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