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Vitamins and plant ingredients

Vitamin B12 status in pregnant women and their infants in South India

European Journal of Clinical Nutrition volume 71, pages 1046–1053 (2017)Cite this article

Subjects

Abstract

Background/Objectives:

Vitamin B12 deficiency during pregnancy has been associated with increased risk of adverse perinatal outcomes. However, few studies have investigated the burden and determinants of vitamin B12 status in young infants. This study was conducted to determine the associations between maternal and infant vitamin B12 status.

Subjects/Methods:

Pregnant women participating in a vitamin B12 supplementation trial in Bangalore, India, were randomized to receive vitamin B12 (50 μg) or placebo supplementation daily during pregnancy through 6 weeks postpartum. All women received 60 mg of iron and 500 μg of folic acid daily during pregnancy, as per standard of care. This prospective analysis was conducted to determine the associations between maternal vitamin B12 biomarkers (that is, plasma vitamin B12, methylmalonic acid (MMA) and tHcy) during each trimester with infant vitamin B12 status (n=77) at 6 weeks of age.

Results:

At baseline (⩽14 weeks of gestation), 51% of mothers were vitamin B12 deficient (vitamin B12<150 pmol/l) and 43% had impaired vitamin B12 status (vitamin B12<150 pmol/l and MMA>0.26 μmol/l); 44% of infants were vitamin B12 deficient at 6 weeks of age. After adjusting for vitamin B12 supplementation, higher vitamin B12 concentrations in each trimester were associated with increased infant vitamin B12 concentrations and lower risk of vitamin B12 deficiency in infants (P<0.05). After adjusting for vitamin B12 supplementation, infants born to women with vitamin B12 deficiency had a twofold greater risk of vitamin B12 deficiency (P<0.01). Higher maternal folate concentrations also predicted lower risk of vitamin B12 deficiency in infants (P<0.05). Impaired maternal vitamin B12 status, which combined both circulating and functional biomarkers, was the single best predictor of infant vitamin B12 status.

Conclusions:

Impaired maternal vitamin B12 status throughout pregnancy predicted higher risk of vitamin B12 deficiency in infants, after adjusting for vitamin B12 supplementation. Future interventions are needed to improve vitamin B12 status periconceptionally, and to ensure optimal vitamin B12 status and health outcomes in pregnant women and their children.

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Acknowledgements

We thank the mothers and children, and field teams, including physicians, nurses, midwives, research, laboratory and administrative staff, who made this study possible; and St. John’s Medical College, Bangalore, India for its institutional support. This study was supported by grants from the National Institutes of Health (NICHD R03HD054123 and K24DK104676); and the Indian Council of Medical Research (ICMR: 5/7/192/06-RHN).

Author contributions

The authors’ responsibilities were as follows: CD, KS, AVK and JLF designed the research; all the authors conducted the research; JLF conducted the data analysis and wrote the initial draft of the manuscript; and CD had the primary responsibility for the final content. All authors contributed to the interpretation of the data and in the development of this manuscript, and read and approved the final version.

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Authors and Affiliations

  1. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

    J L Finkelstein

  2. Division of Nutrition, St. John's Research Institute, Bangalore, India

    J L Finkelstein, A V Kurpad & C Duggan

  3. Department of Physiology, St. John's Medical College, Bangalore, India

    A V Kurpad

  4. Division of Epidemiology, Biostatistics and Population Health, St. John's Research Institute, Bangalore, India

    T Thomas

  5. Division of Mental Health and Neurosciences, St. John's Research Institute, Bangalore, India

    K Srinivasan

  6. Department of Psychiatry, St. John's Medical College, Bangalore, India

    K Srinivasan

  7. Department of Nutrition, Harvard T.H. Chan School of Public Health and Center for Nutrition, Boston Children's Hospital, Boston, MA, USA

    C Duggan

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  1. J L Finkelstein
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Correspondence to C Duggan.

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Finkelstein, J., Kurpad, A., Thomas, T. et al. Vitamin B12 status in pregnant women and their infants in South India. Eur J Clin Nutr 71, 1046–1053 (2017). https://doi.org/10.1038/ejcn.2017.29

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