Vitamin B12 in pregnancy: Maternal and fetal/neonatal effects—A review

Sande, Hans; Jacquemyn, Yves; N, Karepouan; Ajaji, Myriam

doi:10.4236/ojog.2013.37107

Cited by 27 publications

(28 citation statements)

References 19 publications

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“…It is well known from longitudinal studies that there is a progressive decline in vitamin B-12 during the course of pregnancy (31,32), which reaches a nadir toward the end of the third trimester (33). To assess the impact of geography on the worldwide prevalence of vitamin B-12 insufficiency, the broad WHO region classification was used (i.e., Africa, Americas, South East Asia, Europe, Eastern Mediterranean, and Western Pacific) (34).…”

Section: Data Synthesismentioning

confidence: 99%

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

Sukumar

Rafnsson

Kandala

et al. 2016

The American Journal of Clinical Nutrition

104

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Background: Vitamin B-12 and folate are micronutrients essential for normal embryogenesis. Vitamin B-12 insufficiency in pregnancy is high in certain parts of the world, such as India, and although this has been linked to low birth weight (LBW) in these populations, the relation between vitamin B-12 and birth weight (BW) elsewhere is unknown. Objectives: We performed a systematic review to assess 1) the worldwide prevalence of vitamin B-12 insufficiency in pregnancy and 2) its association with BW. Design: A search of 5 electronic databases was performed to identify eligible articles. Random-effects meta-analysis was conducted according to geographic regions and pregnancy trimesters for the prevalence subreview and by categorical measures of BW. Results: A total of 57 and 23 articles were included for the prevalence and BW subreviews, respectively. The pooled estimates of vitamin B-12 insufficiency were 21%, 19%, and 29% in the first, second, and third trimesters, respectively, with high rates for the Indian subcontinent and the Eastern Mediterranean. The large heterogeneity between studies was partially addressed by creating a standardized score for each study (mean vitamin B-12 insufficiency O cutoff value), which internally corrected for geographic region, trimester, and assay type. Twelve of the 13 longitudinal studies included showed a decrease in mean or median vitamin B-12 across trimesters. Pooled analysis showed nonsignificantly lower maternal vitamin B-12 concentrations in LBW than in normal-BW infants and higher odds of LBW with lower vitamin B-12 values (adjusted OR: 1.70; 95% CI: 1.16, 2.50), but studies from India largely contributed to the latter. Conclusions: Our review indicates that vitamin B-12 insufficiency during pregnancy is common even in nonvegetarian populations and that concentrations of vitamin B-12 decrease from the first to the third trimester. There is no consistent association between vitamin B-12 insufficiency and LBW. However, given the long-term risks of LBW, this observation warrants further cohort studies and randomized controlled trials.Am J Clin Nutr 2016;103:1232-51.

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Section: Data Synthesismentioning

confidence: 99%

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

Sukumar

Rafnsson

Kandala

et al. 2016

The American Journal of Clinical Nutrition

104

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“…Despite supplementation, plasma vitamin B-12 decreased from early to late gestation for all 3 micronutrient types in our study. Hemodilution and placental transport of vitamin B-12 to the fetus (18) may be possible explanations for the observed decrease in plasma concentrations of vitamin B-12.…”

Section: Discussionmentioning

confidence: 99%

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

Ziaei

Rahman

Raqib

et al. 2016

The Journal of Nutrition

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Background: The effects of prenatal food and micronutrient supplementation on maternal micronutrient status are not well known.Objective: We compared the efficacy and effectiveness of 3 different micronutrient supplements on maternal micronutrient status when combined with food supplementation.Methods: In the MINIMat (Maternal and Infant Nutrition Intervention, Matlab) trial in Bangladesh, 4436 pregnant women were randomly assigned to daily intake of 3 types of micronutrient capsules: 30 mg Fe and 400 μg folic acid (Fe30F), 60 mg Fe and 400 μg folic acid (Fe60F), or multiple micronutrient supplements (MMNs) combined with early (week 9 of pregnancy) or usual (week 20 of pregnancy) food supplementation in a 2 by 3 factorial design. Plasma concentrations of vitamin B-12, folate, ferritin, and zinc were analyzed before the start of micronutrient supplementation (week 14) and at week 30 of pregnancy in 641 randomly selected women. An electronic monitoring device was used to measure the number of capsules taken. The effectiveness of food and micronutrient regimens as well as efficacy per capsule in maternal micronutrient status were analyzed by ANOVA and general linear models.Results: At week 30 of pregnancy, women in the MMN group had higher geometric mean concentrations of vitamin B-12 than women in the Fe60F group (119 compared with 101 pmol/L, respectively); no other differences in effectiveness of micronutrient and food regimens were observed. A dose-response relation between the number of capsules taken and concentrations of folate and ferritin was observed for all micronutrient supplements. Fe30F had lower efficacy per capsule in increasing ferritin concentrations within the first tertile of capsule intake than did Fe60F and MMNs. Because ferritin reached a plateau for all types of micronutrient supplements, there was no difference between the regimens in their effectiveness.Conclusion: Compared with Fe60F, MMNs produced higher maternal vitamin B-12 and similar ferritin and folate concentrations in Bangladeshi women. The MINIMat trial was registered at isrctn.org as ISRCTN16581394.

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“…Recently Sukumar et al [7] reported that the pooled estimate of maternal vitamin B12 insufficiency during pregnancy across all three trimesters were 21%, 19%, and 29% respectively. The effects of maternal B12 level on birth weight is still controversial, our results showed that the mean maternal vitamin B12 level in mothers with LBW [38] reviewed 29 articles and they concluded that although there is an association between low maternal vitamin B12 and intrauterine growth retardation, but no studies have definitively determined the cut off value for serum vitamin B12 level during pregnancy. Recently, a meta-analysis was done included eighteen studies observed no linear association between maternal B12 levels in pregnancy and birth weight, but B12 deficiency (<148 pmol/L) was associated with a higher risk of LBW in newborns (adjusted risk ratio = 1.15, 95% confidence interval (CI): 1.01, 1.31) [39].…”

Section: Discussionmentioning

confidence: 78%

The Impact of Third Trimester Maternal Serum Vitamin B12 and Folate Status on Fetal Birth Weight. Is Maternal Serum Homocysteine a Predictor of Low Birth Weight Infants?

Youssry¹,

Radwan²,

Gebreel³

et al. 2017

OJOG

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Objective: The aim of this study is to evaluate vitamin B12, folate, and homocysteine status in pregnant women in the third trimester of pregnancy and their relationship to fetal birth weight and their correlation to corresponding neonatal cord blood levels, and in addition, to evaluate the possibility of maternal serum homocysteine level as a predictor of low birth weight infants. Subjects and Methods: In this cross-sectional study, a total of two hundred pregnant women in third trimester (≥28 weeks) were recruited. After a detailed obstetrical and medical history, and clinical assessment, participants were subdivided into two groups: Group (A)-pregnant women who delivered average birth weight (ABW) infants and Group (B) for those who delivered low birth weight (LBW) infants between completed 37 and 42 weeks. Results: Vitamin B12 deficiency was observed in 24.1% of the total cohort. The mean vitamin B12 level was significantly lower in group (B) compared to group (A) (195.2 ± 38.9 vs. 225.9 ± 66.59 respectively P = 0.008). The mean level of homocysteine for women in group (B) was significantly higher than those determined from women in group (A) (9.10 ± 5.9 vs. 7.6 ± 3.83 respectively, P = 0.042). On the other hand, the mean folate levels showed statistically insignificant differences between both groups. The mean cord vitamin B12 level was significantly lower in LBW infants in comparison to ABW infants (277 ± 61.93 vs. 312.03 ± 81.87 respectively, P = 0.015), while the mean level of cord homocysteine for LBW infants was significantly higher than those levels determined from ABW infants (7.9 ± 3.79 vs. 6.6 ± 2.09 respec- deficiency could be significant risk for LBW infants. Hyperhomocysteinemia has been shown to be a predictor for adverse pregnancy outcomes particularly LBW.

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Vitamin B12 in pregnancy: Maternal and fetal/neonatal effects—A review

Cited by 27 publications

References 19 publications

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis

A Prenatal Multiple Micronutrient Supplement Produces Higher Maternal Vitamin B-12 Concentrations and Similar Folate, Ferritin, and Zinc Concentrations as the Standard 60-mg Iron Plus 400-μg Folic Acid Supplement in Rural Bangladeshi Women

The Impact of Third Trimester Maternal Serum Vitamin B12 and Folate Status on Fetal Birth Weight. Is Maternal Serum Homocysteine a Predictor of Low Birth Weight Infants?

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