Maternal prenatal vitamin B12 intake is associated with speech development and mathematical abilities in childhood

Prenatal vitamin utilization and its determinants among pregnant women in south Gondar zone: multicenter cross-sectional study

Background

Prenatal vitamin and mineral supplements are commonly advised as clinical practice standard of care. In spite of Ethiopian government focus on maternal nutrition programmes targeting pregnant and lactating women, Micronutrient deficiencies are still quite common and are regarded as a serious public health issue and also little is known regarding utilization and barriers to prenatal vitamin use during pregnancy. This study aimed to assess utilization and associated factors of prenatal vitamins among pregnant women attending antenatal care at public hospitals in the south Gondar zone, 2024.

Methods

Multi center crossectional study design was conducted among 416 pregnant women from March 1 to May 30, 2024. Systematic sampling technique was used to select the study participants. Data was collected using Interviewer administered questionnaire. After data, SPSS version 26 software was used for analysis. Factors associated with utilization of prenatal vitamins were identified using bi-variable and multi variable logistic regression models. Statistical significance was declared at 95%CI and p-value < 0.05.

Result

In this study, we found that 87.5% (95% CI: 84.31, 90.34) of pregnant women did not use prenatal vitamins. Women not having formal education (AOR = 2.72, 95%CI: 1.44-5.15), being unplanned pregnancy (AOR = 2.58, 95%CI: 1.76-3.78), husband being decision maker in health care (AOR = 1.71, 95%CI:1.09-2.68), having poor knowledge (AOR = 3.27, 95%CI: 1.44-7.42) and unfavorable attitude (AOR = 3.63, 95%CI: 1.61-8.18) on prenatal vitamins were significantly associated with non-users of prenatal vitamins.

Conclusion

The proportion of non-users of prenatal vitamin were higher. Educational level of women, pregnancy plan, decision on health care, knowledge and attitude on prenatal vitamins had statistically significant with utilization of prenatal vitamins. Developing and implementing targeted educational programs to increase awareness about the importance and benefits of prenatal vitamins and encouraging women to take an active role in their healthcare decisions is recommended to improve the utilization of prenatal vitamins.

Vitamin B12 intake during pregnancy linked to child speech development and intelligence quotient

BACKGROUND

Nutrient deficiencies during pregnancy may affect offspring development. We aim to examine the association between prenatal vitamin B12 intake and children's cognitive development.

METHODS

A total of 5151 mother-child pairs from the Czech part of ELSPAC study were included in the analysis. Dietary information was obtained during pregnancy using food frequency questionnaire. Parents reported on their child's speech and language development at 18 months, 3, 5 and 7 years. Intelligence quotient (IQ) was measured at 8 years in subcohort of 854 children.

RESULTS

Children of mothers with higher vitamin B12 intake demonstrated higher scores in language (B = 0.20, 95% CI 0.06, 0.34) and talking and understanding (B = 2.39, 95% CI 0.97, 3.80) in a fully adjusted model at 18 months. Additionally, they were more likely to get maximum points in the intelligibility test at age 3 (OR = 1.05, 95% CI 1.01, 1.09) in unadjusted model, however, not in fully adjusted model. We found a positive effect of higher vitamin B12 intake on verbal IQ (B = 1.08, 95% CI 0.09, 2.08).

CONCLUSIONS

We identified consistent associations between prenatal vitamin B12 intake and children's cognitive development. The results suggest that inadequate vitamin B12 during pregnancy may negatively affect children's cognitive development, particularly in speech and language.

Indicators of Cobalamin Status During Pregnancy, Pregnancy Outcome and Long-Term Effects on Offspring Health

BACKGROUND

Little attention has been given to prenatal cobalamin insufficiency in settings where dietary cobalamin intake is presumed adequate, such as populations with habitual intake of foods from animal sources.

RESULTS

However, low cobalamin status in women of fertile age has been reported in Europe, United States, and Canada. In India, where cobalamin deficiency is highly prevalent, it has been associated with an increased risk of miscarriage, intrauterine growth retardation, as well as insulin resistance and lower neurodevelopment scores in the offspring. Low cobalamin status in pregnancy has been associated with similar outcomes as those reported in the Indian studies although the evidence is scant and conflicting.

CONCLUSIONS

Consideration should be given to maternal cobalamin status in the context of prevention of adverse pregnancy outcomes as well as cobalamin insufficiency both in the mother and the offspring during lactation. Further attention is now justified with the increasing tendency toward plant-based diets. Reference intervals for cobalamin status during each trimester of pregnancy are needed and further investigation of the long-term conse-quences of low cobalamin status during pregnancy for health and development in the offspring is warranted.

Prenatal Vitamin B12 and Children's Brain Development and Cognitive, Language and Motor Outcomes: A Scoping Review

Adequate maternal nutrient intake of vitamin B12 is critical to fetal brain development and subsequent neurodevelopmental outcomes. We conducted a scoping review to map the current state of knowledge from human epidemiological studies on the associations between maternal vitamin B12 during pregnancy and children's brain, cognitive, language, and motor development to identify gaps in the literature and suggest directions for future research. PubMed and OVID MEDLINE were searched. Search terms were vitamin B12, prenatal or maternal, neurodevelopment or cognitive development or brain. Animal studies were excluded. In total, 148 publications were identified, of which 19 met our inclusion criteria: (1) maternal vitamin B12 assessed via a measure of status, dietary intake, supplementation, or deficiency; and (2) an outcome related to brain development or cognitive, language, or motor development in children less than 18 years of age was assessed. This scoping review suggests that evidence supporting a relationship between maternal vitamin B12 during pregnancy and children's neurodevelopmental outcomes is inconclusive. Further longitudinal research is needed to clarify the effects of maternal vitamin B12 supplementation, status, and intake on children's brain development and neurodevelopmental outcomes.

Associations of prenatal one-carbon metabolism nutrients and metals with epigenetic aging biomarkers at birth and in childhood in a US cohort

Epigenetic gestational age acceleration (EGAA) at birth and epigenetic age acceleration (EAA) in childhood may be biomarkers of the intrauterine environment. We investigated the extent to which first-trimester folate, B12, 5 essential, and 7 non-essential metals in maternal circulation are associated with EGAA and EAA in early life. Bohlin EGAA and Horvath pan-tissue and skin and blood EAA were calculated using DNA methylation measured in cord blood (N=351) and mid-childhood blood (N=326; median age = 7.7 years) in the Project Viva pre-birth cohort. A one standard deviation increase in individual essential metals (copper, manganese, and zinc) was associated with 0.94-1.2 weeks lower Horvath EAA at birth, and patterns of exposures identified by exploratory factor analysis suggested that a common source of essential metals was associated with Horvath EAA. We also observed evidence nonlinear associations of zinc with Bohlin EGAA, magnesium and lead with Horvath EAA, and cesium with skin and blood EAA at birth. Overall, associations at birth did not persist in mid-childhood; however, arsenic was associated with greater EAA at birth and in childhood. Prenatal metals, including essential metals and arsenic, are associated with epigenetic aging in early life, which might be associated with future health.

A review of the auditory-gut-brain axis

Hearing loss places a substantial burden on medical resources across the world and impacts quality of life for those affected. Further, it can occur peripherally and/or centrally. With many possible causes of hearing loss, there is scope for investigating the underlying mechanisms involved. Various signaling pathways connecting gut microbes and the brain (the gut-brain axis) have been identified and well established in a variety of diseases and disorders. However, the role of these pathways in providing links to other parts of the body has not been explored in much depth. Therefore, the aim of this review is to explore potential underlying mechanisms that connect the auditory system to the gut-brain axis. Using select keywords in PubMed, and additional hand-searching in google scholar, relevant studies were identified. In this review we summarize the key players in the auditory-gut-brain axis under four subheadings: anatomical, extracellular, immune and dietary. Firstly, we identify important anatomical structures in the auditory-gut-brain axis, particularly highlighting a direct connection provided by the vagus nerve. Leading on from this we discuss several extracellular signaling pathways which might connect the ear, gut and brain. A link is established between inflammatory responses in the ear and gut microbiome-altering interventions, highlighting a contribution of the immune system. Finally, we discuss the contribution of diet to the auditory-gut-brain axis. Based on the reviewed literature, we propose numerous possible key players connecting the auditory system to the gut-brain axis. In the future, a more thorough investigation of these key players in animal models and human research may provide insight and assist in developing effective interventions for treating hearing loss.

Comparative analysis of methyl-donor nutrient intakes and RCPM cognitive performance among school-aged children

BACKGROUND

Evidence shows a link between methyl-donor nutrient intakes and a child's cognitive ability. However, this is less known among Ghanaian children who might be at higher risk of methyl-donor nutrient deficiencies. This study showed comparative analysis of methyl-donor nutrient intakes and Raven's Coloured Progressive Matrices (RCPM) test performance among 2073 Ghanaian school children aged 9-13 years across four regions of Ghana.

METHODS

Data for the present study were obtained from the Child Nutrition, Fitness, and Cognition project; a cross-sectional survey conducted in four regions of Ghana. Dietary methyl-donor nutrient values were based on repeated 24 h recall data collected during the study periods. Cognitive tests were performed on the 2073 children using Raven's Coloured Progressive Matrices (RCPM) test.

RESULTS

We found dietary zinc (adjusted: β = 0.21, p = 0.003) and methionine (adjusted: β = 0.60, p = 0.044) intakes to be associated with RCPM scores in the linear regression model. School children living in Northern Region (adjusted OR = 0.6, p < 0.001, 95% CI = 0.4-0.7) and Volta Region (adjusted OR = 0.7, p = 0.006, 95% CI = 0.5-0.9) had lower odds of scoring above the 50th percentile on the RCPM test compared with those living in Greater Accra Region. Children who consumed below the RDA for dietary folate (unadjusted OR = 0.8, p = 0.055, 95% CI = 0.7-1.0) and zinc (unadjusted OR = 0.8, p = 0.049, 95%CI = 0.7-1.0) had lower odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the RDA for dietary folate and zinc respectively. Children who consumed below the EAR for dietary vitamin B₁₂ (unadjusted OR = 0.7, p = 0.004, 95% CI = 0.6-0.9) had reduced odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the EAR for dietary vitamin B₁₂.

CONCLUSIONS

Higher dietary methionine intake was strongly associated with higher RCPM scores. Regional differences, and children's dietary consumption below the EAR/RDA for dietary folate, vitamin B₁₂, and zinc were associated with poor RCPM test performance. School children's nutrient intake should be prioritized for improved cognition.

Acquired Vitamin B12 Deficiency in Newborns: Positive Impact on Newborn Health through Early Detection

The early diagnosis of and intervention in vitamin B12 deficiency in exclusively breastfed infants by mothers with low vitamin B12 is crucial in preventing possible irreversible neurologic damage, megaloblastic anemia, and failure to thrive. We assess the usefulness of the early detection of asymptomatic B12 deficiency related to acquired conditions and highlight the importance of monitoring serum vitamin B12 levels during pregnancy. We describe demographic, clinical, dietary, and biochemical data, including the evolution of a vitamin B12 deficiency’s functional biomarkers. We enrolled 12 newborns (5 males) with an age range of 1–2 months old that were exclusively breastfed and asymptomatic. These cases were referred to our metabolic unit due to alterations in expanded newborn screening: high levels of methylmalonic acid and/or total homocysteine (tHcy). All mothers were under a vegetarian diet except three who had abnormal B12 absorption, and all presented low or borderline serum B12 level and high plasma levels of tHcy. Supplementation with oral vitB12 re-established the metabolic homeostasis of the mothers. In infants, therapy with an intramuscular injection of 1.0 mg hydroxocobalamin led to the rapid normalization of the metabolic pattern, and a healthy outcome was observed. Acquired B12 deficiency should be ruled out before proceeding in a differential diagnosis of cobalamin metabolism deficits, methylmalonic acidemia, and homocystinuria.

Behavioral profile of vitamin B12 deficiency: A reflection of impaired brain development, neuronal stress and altered neuroplasticity

Our understanding of brain biology and function is one of the least characterized and therefore, there are no effective treatments for most of neurological disorders. The influence of vitamins, and particularly vitamin B₁₂, in neurodegenerative disease is demonstrated but largely unresolved. Behaviors are often quantified to attest brain dysfunction alone or in parallel with neuro-imaging to identify regions involved. Nevertheless, attention should be paid to extending observations made in animal models to humans, since, first, behavioral tests have to be adjusted in each model to address the initial question and second, because brain analysis should not be conducted for a whole organ but rather to specific sub-structures to better define function. Indeed, cognitive functions such as psychiatric disorders and learning and memory are often cited as the most impacted by a vitamin B₁₂ deficiency. In addition, differential dysfunctions and mechanisms could be defined according sub-populations and ages. Vitamin B₁₂ enters the cell bound to Transcobalamin, through the Transcobalamin Receptor and serves in two cell compartments, the lipid metabolism in the mitochondrion and the one-carbon metabolism involved in methylation reactions. Dysfunctions in these mechanisms can lead to two majors outcomes; axons demyelinisation and upregulation of cellular stress involving mislocalization of RNA binding proteins such as the ELAVL1/HuR or the dysregulation of pro- or anti-oxidant NUDT15, TXNRD1, VPO1 and ROC genes. Finally, it appears that apart from developmental problems that have to be identified and treated as early as possible, other therapeutic approaches for behavioral dysfunctions should investigate cellular methylation, oxidative and endoplasmic reticulum stress and mitochondrial function.

Lipid nutrition: "In silico" studies and undeveloped experiments

This review examines lipids and lipid-binding sites on proteins in relation to cardiovascular disease. Lipid nutrition involves food energy from ingested fatty acids plus fatty acids formed from excess ingested carbohydrate and protein. Non-esterified fatty acids (NEFA) and lipoproteins have many detailed attributes not evident in their names. Recognizing attributes of lipid-protein interactions decreases unexpected outcomes. Details of double bond position and configuration interacting with protein binding sites have unexpected consequences in acyltransferase and cell replication events. Highly unsaturated fatty acids (HUFA) have n-3 and n-6 motifs with documented differences in intensity of destabilizing positive feedback loops amplifying pathophysiology. However, actions of NEFA have been neglected relative to cholesterol, which is co-produced from excess food. Native low-density lipoproteins (LDL) bind to a high-affinity cell surface receptor which poorly recognizes biologically modified LDLs. NEFA increase negative charge of LDL and decrease its processing by "normal" receptors while increasing processing by "scavenger" receptors. A positive feedback loop in the recruitment of monocytes and macrophages amplifies chronic inflammatory pathophysiology. Computer tools combine multiple components in lipid nutrition and predict balance of energy and n-3:n-6 HUFA. The tools help design and execute precise clinical nutrition monitoring that either supports or disproves expectations.

Maternal One-Carbon Metabolism during the Periconceptional Period and Human Foetal Brain Growth: A Systematic Review

The maternal environment during the periconceptional period influences foetal growth and development, in part, via epigenetic mechanisms moderated by one-carbon metabolic pathways. During embryonic development, one-carbon metabolism is involved in brain development and neural programming. Derangements in one-carbon metabolism increase (i) the short-term risk of embryonic neural tube-related defects and (ii) long-term childhood behaviour, cognition, and autism spectrum disorders. Here we investigate the association between maternal one-carbon metabolism and foetal and neonatal brain growth and development. Database searching resulted in 26 articles eligible for inclusion. Maternal vitamin B6, vitamin B12, homocysteine, and choline were not associated with foetal and/or neonatal head growth. First-trimester maternal plasma folate within the normal range (>17 nmol/L) associated with increased foetal head size and head growth, and high erythrocyte folate (1538-1813 nmol/L) with increased cerebellar growth, whereas folate deficiency (<7 nmol/L) associated with a reduced foetal brain volume. Preconceptional folic acid supplement use and specific dietary patterns (associated with increased B vitamins and low homocysteine) increased foetal head size. Although early pregnancy maternal folate appears to be the most independent predictor of foetal brain growth, there is insufficient data to confirm the link between maternal folate and offspring risks for neurodevelopmental diseases.

Current Nanocarrier Strategies Improve Vitamin B12 Pharmacokinetics, Ameliorate Patients' Lives, and Reduce Costs

Vitamin B12 (VitB12) is a naturally occurring compound produced by microorganisms and an essential nutrient for humans. Several papers highlight the role of VitB12 deficiency in bone and heart health, depression, memory performance, fertility, embryo development, and cancer, while VitB12 treatment is crucial for survival in inborn errors of VitB12 metabolism. VitB12 is administrated through intramuscular injection, thus impacting the patients’ lifestyle, although it is known that oral administration may meet the specific requirement even in the case of malabsorption. Furthermore, the high-dose injection of VitB12 does not ensure a constant dosage, while the oral route allows only 1.2% of the vitamin to be absorbed in human beings. Nanocarriers are promising nanotechnology that can enable therapies to be improved, reducing side effects. Today, nanocarrier strategies applied at VitB12 delivery are at the initial phase and aim to simplify administration, reduce costs, improve pharmacokinetics, and ameliorate the quality of patients’ lives. The safety of nanotechnologies is still under investigation and few treatments involving nanocarriers have been approved, so far. Here, we highlight the role of VitB12 in human metabolism and diseases, and the issues linked to its molecule properties, and discuss how nanocarriers can improve the therapy and supplementation of the vitamin and reduce possible side effects and limits.