Vitamin B12 Deficiency in Pregnancy and Lactation: Is there a Need for Pre and Post-natal Supplementation?

Abstract

This article reviews vitamin B12 (B12) status and deficiency during pregnancy and lactation, its effect on pregnancy, and the health of the offspring, with the aim to underscore the need for a sustainable strategy to improve maternal and infant vitamin B12 status of low and middle income countries. Vitamin B12 is a basic nutrient required for maintenance of normal erythropoiesis, cell reproduction, nucleoprotein and myelin synthesis. B12 deficiency is associated with adverse pregnancy outcomes and neurodevelopmental morbidity during infancy. Very few studies have indicated that B12 deficiency may contribute to altered immune responses in animals and humans. Additionally, no studies have shown modulation of infant motor development in response to maternal B12 supplementation. Despite the high global prevalence of B12 deficiency and its serious effects on pregnant women and offspring, there is still no consensus on the cut-off of biochemical markers (indicator of B12 deficiency) to correctly diagnose B12 deficiency in mother-infant dyad. Also, the optimum dose of B12 to normalize B12 status of mother-infant pairs in a deficient population is not known yet. In addition, markers of other functions such as neurodevelopment, immune response that may be affected by vitamin B12 deficiency should be measured to determine if they respond to supplementation. Thus, there is an urgent need to conduct more trials to find out the optimum dose, to investigate whether intervention with such pre-and post natal vitamin B12 supplementation would improve maternal, neonatal and child health outcomes in population at risk, giving emphasis on neurological processes, immune functions and epigenetic modifications. Other strategies including food based approach also require evidence based results which will help to understand effectiveness of a targeted and well-designed intervention among this population.

Maternal BMI and nutritional status in early pregnancy and its impact on neonatal outcomes at birth in Bangladesh

“…Evidence also suggests that vitamin B12 concentration gradually decline throughout gestation, therefore, it is challenging to assess the prevalence of deficiency in pregnant women. Studies have shown that based on gestational week, prevalence of vitamin B12 deficiency may vary from 5% (< 28 days gestation) to 72% (immediately prior to delivery) worldwide [38]. The JiVitA study in rural north-western Bangladesh found a prevalence of 20% deficiency in early pregnancy [39].…”

Anemia during Pregnancy and Its Prevalence

“…Hypotonic muscles, failure to thrive, cerebral atrophy, and developmental regression are general outcomes of deficiency of vitamin B12. Folic acid supplemented pregnant women with negative B12 balance have increased risk for adverse maternal and infant outcomes (e.g., increased cardiometabolic disease risk) while pregnant women with Low B12 and a normal-to-high range of folate have high insulin resistance and adiposity in the offspring at 5 years of age [15].…”

“…The newborn may create paleness because of low iron stores in the body. [38]. During pregnancy, anemia can cause serious complications maternal as well as in newborn childlike unexpected labor and post-pregnancy anxiety.…”

Defisiensi Vitamin B12: Tinjauan Aspek Fisiologi dan Dampak Spesifik terhadap Ginjal Vitamin B12 Deficiency: Insight of Physiological Aspect and the Specific Impact to the Kidney

“…Defisiensi vitamin B12 utamanya terjadi pada kelompok lanjut dengan laporan sekitar 40% populasi ini terlibat (Tucker et al, 2000). Kelompok yang juga rentan mengalami kondisi ini adalah ibu hamil dan menyusui dengan perkiraan prevalensi 27-46% di negara berkembang (J Siddiqua, 2014).…”