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Scherbinsky K, Rasmussen BF, Li B, Kong D, Ball RO, Pencharz PB, Courtney-Martin G, Elango R. Total sulfur amino acid requirements are higher during late gestation compared with early gestation in healthy Canadian pregnancies in a repeated-measures trial. Am J Clin Nutr 2024; 120:973-983. [PMID: 39128498 DOI: 10.1016/j.ajcnut.2024.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/20/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Dietary Reference Intake (DRI) Recommendations for total sulfur amino acids (TSAAs; methionine + cysteine) during pregnancy are based on factorial calculations using data from adult males. To date, no data exist on TSAA requirements obtained directly during pregnancy. OBJECTIVES The objective of this study was to examine whether TSAA requirements during early (11-20 wk) and late (31-40 wk) gestation in healthy females with singleton pregnancies are different than current recommendations, and different between early and late gestation using the indicator amino acid oxidation (IAAO) technique. METHODS Twenty-five females 20-40 y with a healthy singleton pregnancy were studied using the IAAO technique in a repeated measures design for a total of 70, 8-h d. On each study day a methionine test intake (range: 0-40 mg⋅kg-1⋅d-1) was provided in 8 hourly, isonitrogenous and isocaloric meals with cysteine excluded from the diet. Breath samples were collected at baseline and isotopic steady state of orally provided L-1-13C-Phenylalanine for measurement of phenylalanine oxidation. The requirement was determined using biphasic linear regression crossover analysis to identify a breakpoint in 13CO2 production, representing the estimated average requirement (EAR). RESULTS The TSAA requirement in healthy pregnant participants in early gestation was 11.1 mg⋅kg-1⋅d-1 {R2m = 0.79, R2c = 0.79; 95% confidence interval [CI] (8.9, 13.3 mg⋅kg-1⋅d-1)} and 15.0 mg⋅kg-1⋅d-1 (R2m = 0.72, R2c = 0.79; 95% CI [13.0, 17.0 mg⋅kg-1⋅d-1]) in late gestation. The difference between confidence intervals of the 2 breakpoints was = -3.9 ± 3.0, and statistically different. CONCLUSIONS We directly measured TSAA requirements in healthy pregnant mothers, and our findings suggest that requirements are lower than current DRI recommendations of 20 and 25 mg⋅kg-1⋅d-1, as the EAR, and Recommended Dietary Allowance, respectively. Late gestation TSAA needs are significantly different and increased 35% compared with early gestation. Recommendations for TSAA intake need to be tailored for gestational stage. This clinical trial was registered at clinicaltrials.gov as NCT04326322.
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Affiliation(s)
- Kerri Scherbinsky
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Betina F Rasmussen
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bingqing Li
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Dehan Kong
- Department of Statistical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ronald O Ball
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Paul B Pencharz
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Glenda Courtney-Martin
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada; Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rajavel Elango
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
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Santos-Calderón LA, Rojas-Gómez A, Ramos-Rodríguez C, Murphy MM. Indicators of Cobalamin Status During Pregnancy, Pregnancy Outcome and Long-Term Effects on Offspring Health. Food Nutr Bull 2024; 45:S10-S15. [PMID: 38987881 DOI: 10.1177/03795721241229502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
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.
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Affiliation(s)
- Luis Adolfo Santos-Calderón
- Unit of Preventive Medicine and Public Health, Faculty of Medicine and Health Sciences, Reus, IISPV, Universitat Rovira i Virgili, Spain
| | - Alejandra Rojas-Gómez
- Unit of Preventive Medicine and Public Health, Faculty of Medicine and Health Sciences, Reus, IISPV, Universitat Rovira i Virgili, Spain
| | - Carla Ramos-Rodríguez
- Unit of Preventive Medicine and Public Health, Faculty of Medicine and Health Sciences, Reus, IISPV, Universitat Rovira i Virgili, Spain
| | - Michelle M Murphy
- Unit of Preventive Medicine and Public Health, Faculty of Medicine and Health Sciences, Reus, IISPV, Universitat Rovira i Virgili, Spain
- CIBERObn (Instituto de Salud Carlos III), Spain
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Venkata Surekha M, Shravanthi G, Shalini T, Uday Kumar P. Vitamin B12 status in term pregnant women and the cord blood samples of their newborns: A cross-sectional study. Nutr Health 2023:2601060231151720. [PMID: 36803291 DOI: 10.1177/02601060231151720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Background and aim: In India, total vitamin B12 (Vit B12) and its active form (active B12) have not been studied in mother's blood and cord blood. We hypothesized that total and active B12 levels are sufficiently maintained in cord blood despite low levels in mothers. Methods: Two hundred term pregnant mother's blood and cord blood was collected and analyzed for total Vit B12 (radioimmunoassay method) and active B12 levels (enzyme-linked immunosorbent assay). Mean values of constant or continuous variables (hemoglobin (Hb), packed cell volume (PCV), mean corpuscular volume (MCV), white blood cells (WBC), and Vit B12) were compared in mother's blood and newborn cord blood using Student's t-test and multiple comparisons within the groups were carried out with ANOVA. Spearman's correlation (Vit B12) and multivariable backward regression analyses (height, weight, education, body mass index (BMI) and Hb, PCV, MCV, WBC, and Vit B12 levels) were also performed. Results: Total Vit 12 deficiency was highly prevalent at 89% and active B12 deficiency was 36.7% in mothers. Cord blood showed total Vit B12 deficiency prevalence of 53% and active B12 deficiency being 9.3%. Total Vit B12 (p<0.001) and active B12 (p<0.001) levels were significantly higher in cord blood when compared to mother's blood. In multivariate analysis, higher total and active B12 levels in mother's blood predicted higher levels of total and active B12 levels in cord blood. Conclusion: Our study showed higher prevalence of total and active Vit B12 deficiency in mothers compared to cord blood thus indicating their transfer to fetus irrespective of mother's status. Maternal Vit B12 levels affected cord blood Vit B12 levels.
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Affiliation(s)
- Mullapudi Venkata Surekha
- Pathology and Microbiology Division, Indian Council of Medical Research (ICMR) - National Institute of Nutrition, Hyderabad, India
| | | | - Tattari Shalini
- Biochemistry Division, 28603ICMR - National Institute of Nutrition, Hyderabad, India
| | - Putcha Uday Kumar
- Pathology and Microbiology Division, Indian Council of Medical Research (ICMR) - National Institute of Nutrition, Hyderabad, India
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Chen X, Du Y, Xia S, Li Z, Liu J. Vitamin B 12 and gestational diabetes mellitus: a systematic review and meta-analysis. Br J Nutr 2022; 129:1-8. [PMID: 35915058 DOI: 10.1017/s000711452200246x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The relationship between vitamin B12 and gestational diabetes mellitus (GDM) remains controversial. To comprehensively evaluate the relationship between vitamin B12 and GDM, and to provide more information on GDM prevention, this study provides a systematic review and meta-analysis of vitamin B12 and GDM. As of September 22, 2021, 304 articles were searched in PubMed, Web of Science, EMBASE, and Cochrane databases, of which 15 studies met the inclusion criteria. Results presented there was no association between maternal vitamin B12 concentration during the first trimester with GDM, however, low vitamin B12 concentration in the second or third trimester of pregnancy was related to an increased risk of GDM. Compared with the non-GDM group, the vitamin B12 concentration in the GDM group was remarkably decreased (MD: -10·79; 95%CI: -21·37, -0·21), and vitamin B12 deficiency increased the risk for GDM (OR: 1·59; 95%CI: 1·10, 2·29). These effects were more significant among Asians. In addition, an increased ratio of high folate to low vitamin B12 in serum also increased the risk of GDM (OR: 1·87; 95% CI: 1·46, 2·41). These results suggest that more vitamin B12 may need to be provided during pregnancy.
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Affiliation(s)
- Xue Chen
- School of Public Health, Bengbu Medical College, Bengbu, Anhui Province, 233030, People's Republic of China
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yushan Du
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Shuangbo Xia
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Zhiwen Li
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Jufen Liu
- Institute of Reproductive and Child Health, Key Laboratory of Reproductive Health, National Health Commission of People's Republic of China, Beijing, People's Republic of China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
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Evidence based recommendations for an optimal prenatal supplement for women in the US: vitamins and related nutrients. Matern Health Neonatol Perinatol 2022; 8:4. [PMID: 35818085 PMCID: PMC9275129 DOI: 10.1186/s40748-022-00139-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/13/2022] [Indexed: 01/21/2023] Open
Abstract
The blood levels of most vitamins decrease during pregnancy if un-supplemented, including vitamins A, C, D, K, B1, B3, B5, B6, folate, biotin, and B12. Sub-optimal intake of vitamins from preconception through pregnancy increases the risk of many pregnancy complications and infant health problems. In the U.S., dietary intake of vitamins is often below recommended intakes, especially for vitamin D, choline and DHA. Many studies suggest that insufficient vitamin intake is associated with a wide range of pregnancy complications (anemia, Cesarean section, depression, gestational diabetes, hypertension, infertility, preeclampsia, and premature rupture of membranes) and infant health problems (asthma/wheeze, autism, low birth weight, congenital heart defects, intellectual development, intrauterine growth restriction, miscarriage, neural tube defects, orofacial defects, and preterm birth). The primary goal of this paper is to review the research literature and propose evidence-based recommendations for the optimal level of prenatal supplementation for each vitamin for most women in the United States. A secondary goal was to compare these new recommendations with the levels of vitamins in over 180 commercial prenatal supplements. The analysis found that prenatal supplements vary widely in content, often contained only a subset of essential vitamins, and the levels were often below our recommendations. This suggests that increasing prenatal vitamin supplementation to the levels recommended here may reduce the incidence of many pregnancy complications and infant health problems which currently occur.
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Sobowale OI, Khan MR, Roy AK, Raqib R, Ahmed F. Prevalence and Risk Factors of Vitamin B 12 Deficiency among Pregnant Women in Rural Bangladesh. Nutrients 2022; 14:1993. [PMID: 35631134 PMCID: PMC9144522 DOI: 10.3390/nu14101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
Vitamin B12 deficiency is associated with an increased risk of pregnancy complications and adverse birth outcomes. However, data on vitamin B12 deficiency in pregnant Bangladeshi women are limited. This study examines vitamin B12 deficiency and marginal deficiency in rural Bangladeshi women during early and late pregnancies. Some 522 women whose gestational age was <20 weeks were recruited. Serum vitamin B12 concentrations were measured at baseline and after 14 weeks of iron-folate supplementation. Logistic regression analysis examined the association of various socio-demographic, dietary, and pregnancy-related factors with vitamin B12 deficiency and marginal deficiency. Overall, 19% of the women during early pregnancy had vitamin B12 deficiency (serum vitamin B12 concentration < 203 pg/mL) and nearly 40% had marginal deficiency (serum vitamin B12 concentration 203 to <300 pg/mL). Vitamin B12 deficiency doubled to 38% during late pregnancy, while marginal deficiency slightly increased to 41.7%. The pregnant women with a gestational age of ≥27 weeks had a higher risk of developing vitamin B12 deficiency (OR = 2.61; 95% CI = 1.096−6.214) than those of a gestational age of <27 weeks. Vitamin B12 deficiency was significantly higher in pregnant women in rented accommodation (OR = 13.32; 95% CI = 1.55−114.25) than in those living in their own house. Vitamin B12 deficiency was significantly higher among women who consumed red or organ meat <3 times a week than in those who consumed it more often (OR = 2.327, 95% CI = 1.194−4.536). None of these factors were significantly associated with marginal vitamin B12 deficiency. In conclusion, vitamin B12 deficiency and marginal deficiency among pregnant rural Bangladeshi women increased as their pregnancies progressed. Increasing gestational age, living in a rented house, and the consumption of red or organ meat <3 times a week were identified as the independent risk factors of vitamin B12 deficiency in this population. Further research with more in-depth assessments of dietary vitamin B12 intakes is needed to develop an intervention program preventing vitamin B12 deficiency in this population.
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Affiliation(s)
| | - Moududur Rahman Khan
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh;
| | - Anjan Kumar Roy
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka 1212, Bangladesh; (A.K.R.); (R.R.)
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka 1212, Bangladesh; (A.K.R.); (R.R.)
| | - Faruk Ahmed
- Public Health, School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD 4220, Australia
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Dib MJ, Gumban-Marasigan M, Yoxall R, Andrew T, Harrington DJ, Sobczyńska-Malefora A, Ahmadi KR. Evaluating the Diagnostic Value of a Combined Indicator of Vitamin B12 Status (cB12) Throughout Pregnancy. Front Nutr 2022; 8:789357. [PMID: 35155515 PMCID: PMC8825834 DOI: 10.3389/fnut.2021.789357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background Inadequate provision of vitamin B12 during pregnancy is associated with a number of adverse maternal and fetal outcomes. We set out to (1) suggest pregnancy-specific reference ranges for a range of biomarkers of vitamin B12; (2) assess the temporal behaviors of these markers over the course of pregnancy; and (3) test whether any biomarkers, including the genetic marker HIBCH rs291466 strongly associated with MMA measured early in pregnancy could reliably and significantly predict future B12 status within a healthy UK population of pregnant women. Materials and Methods We used existing biobank samples from the placebo arm of the UK Selenium in PRegnancy Intervention (SPRINT) study, to generate biochemical data for serum folate, B12, holotranscobalamin (HoloTC), total homocysteine (tHcy), and MMA, calculate cB12, and genotyped the polymorphism rs291466 in gene HIBCH on a total of n=114 women across trimesters 1–3 of their pregnancy. We performed a series of exploratory cross-sectional and longitudinal analyses to investigate levels at each trimester, suggest references ranges, evaluate changes and correlations between the B12 biomarkers, and assess the predictive capabilities of each biomarker from 12-weeks to 35-weeks of gestation. Results Significant changes in all vitamin B12 biomarker values were observed over the three trimesters (P < 0.05). Our study shows that cB12 values were largely constant and stable throughout trimester 1 (T1) and T2 (i.e., up to week 20), but declined significantly in T3 (−66% | P < 0.001). Yet, cB12 generally remained within the normal boundaries. We identified pregnancy and trimester-specific reference ranges for each biomarker at each trimester, notably for total serum B12. This marker fell below the recommended cut-offs in 1/3 of the cohort at the third trimester, contrasting other markers (mostly normal). Our multivariate analyses indicated that none of the biomarkers could reliably and accurately predict any other biomarkers than themselves later in pregnancy. Yet, HoloTC seems to be a promising predictor within the limitations of our cohort, constituted of B12-replete individuals. Most notably, cB12 did not significantly predict itself between trimesters. Finally, we show that the HIBCH variant has little predictive power for MMA or cB12 as it does not explain the significant increase in MMA concentrations nor the decline of cB12 throughout pregnancy. Conclusion Trimester-specific reference ranges for biomarkers of vitamin B12 in normal pregnancy are suggested. However, these biomarkers have limited predictive value in identifying mothers at elevated risk of vitamin B12 insufficiency/deficiency during pregnancy.
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Affiliation(s)
- Marie-Joe Dib
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College, London, United Kingdom
- *Correspondence: Marie-Joe Dib
| | | | - Rozzie Yoxall
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Toby Andrew
- Department of Genomics of Common Disease, Imperial College, London, United Kingdom
| | - Dominic J. Harrington
- The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, United Kingdom
- Division of Women's Health, School of Medicine, King's College London, London, United Kingdom
| | - Agata Sobczyńska-Malefora
- The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, United Kingdom
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Kourosh R. Ahmadi
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
- Kourosh R. Ahmadi
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Sobczyńska-Malefora A, Yajnik CS, Harrington DJ, Hitman GA, Finer S. Vitamin B12 and Folate Markers Are Associated with Insulin Resistance During the Third Trimester of Pregnancy in South Asian Women, Living in the United Kingdom, with Gestational Diabetes and Normal Glucose Tolerance. J Nutr 2021; 152:163-170. [PMID: 34601603 PMCID: PMC8754569 DOI: 10.1093/jn/nxab352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/21/2021] [Accepted: 09/24/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) can adversely affect the health of the developing fetus. Women of South Asian origin are particularly at risk of developing GDM. Insulin resistance (IR) contributes to the etiology of GDM, and although studies have shown associations of vitamin B12 (B12) and folate status with GDM and IR, only a limited number of B12 and folate markers have been used. OBJECTIVE We used a comprehensive panel of B12 and folate markers to examine their association with IR in pregnant women with diet-controlled GDM and normal glucose tolerance (NGT). METHODS In this cross-sectional study, 59 British-Bangladeshi women (24 GDM and 35 NGT) with a mean age of 29 y, BMI (in kg/m2) 26.7 and gestational age 33 wk were recruited. Serum total B12, holotranscobalamin, folate, methylmalonic acid, plasma homocysteine, 5-methyltetrahydrofolate, and red cell folate (RCF) were measured along with other parameters. The independent sample t-test and chi-squared test were used to assess differences in markers between GDM and NGT women. Spearman's test was used to look for correlations. A simple multiple regression analysis was used to investigate if markers of B12 and folate status predicted IR, using the HOMA-IR and adjusting for age, GDM status, and BMI. RESULTS There were no differences in concentrations of B12 and folate markers between GDM and NGT women. In Spearman's analysis HOMA-IR correlated negatively with total serum B12 (P < 0.001) and holotranscobalamin (P < 0.05), and positively with BMI (P < 0.001), blood pressure (P < 0.05) and triglycerides (P < 0.05) in all women. MMA did not correlate with any of the B12 markers. In regression analysis, total B12 (β = -0.622, P = 0.004), RCF (β = 0.387, P = 0.018), and BMI (β = 0.024, P < 0.001) were the significant predictors of HOMA-IR variance. CONCLUSIONS Significant associations between markers of B12 and folate status with HOMA-IR were found during the third trimester in British-Bangladeshi women. B12 markers correlated poorly with each other.
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Affiliation(s)
| | | | - Dominic J Harrington
- Nutristasis Unit, Viapath, St. Thomas’ Hospital, London, United Kingdom,Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Graham A Hitman
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Sarah Finer
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom,Barts Health NHS Trust, London, United Kingdom
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BEYOĞLU MM, KÖSTÜ B. Gebe Popülasyonunda Vitamin B12 Düzeyinin Değerlendirilmesi ve Beslenme Yetersizliği ile İlişkisi. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.971131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Gebe popülasyonunda vitamin B12 düzeyini incelemek, yetersizlik ve eksiklik durumlarında beslenme bozukluğu ile ilişkisini araştırmak, erken teşhisle takviyesini başlamak.
Gereç-Yöntemler: Üçüncü basamak bir üniversite hastanesi tıp fakültesi kadın doğum ve hastalıkları anabilim dalına başvuran gebelik tanılı hastaların ultrasonografi verileri, rutin kan değerleri ve vitamin B12 verileri kaydedildi. Verilerin değerlendirilmesinde SPSS 22.0 istatistik programı kullanıldı. P
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Sobczyńska-Malefora A, Delvin E, McCaddon A, Ahmadi KR, Harrington DJ. Vitamin B 12 status in health and disease: a critical review. Diagnosis of deficiency and insufficiency - clinical and laboratory pitfalls. Crit Rev Clin Lab Sci 2021; 58:399-429. [PMID: 33881359 DOI: 10.1080/10408363.2021.1885339] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vitamin B12 (cobalamin) is an essential cofactor for two metabolic pathways. It is obtained principally from food of animal origin. Cobalamin becomes bioavailable through a series of steps pertaining to its release from dietary protein, intrinsic factor-mediated absorption, haptocorrin or transcobalamin-mediated transport, cellular uptake, and two enzymatic conversions (via methionine synthase and methylmalonyl-CoA-mutase) into cofactor forms: methylcobalamin and adenosylcobalamin. Vitamin B12 deficiency can masquerade as a multitude of illnesses, presenting different perspectives from the point of view of the hematologist, neurologist, gastroenterologist, general physician, or dietician. Increased physician vigilance and heightened patient awareness often account for its early presentation, and testing sometimes occurs during a phase of vitamin B12 insufficiency before the main onset of the disease. The chosen test often depends on its availability rather than on the diagnostic performance and sensitivity to irrelevant factors interfering with vitamin B12 markers. Although serum B12 is still the most commonly used and widely available test, diagnostics by holotranscobalamin, serum methylmalonic acid, and plasma homocysteine measurements have grown in the last several years in routine practice. The lack of a robust absorption test, coupled with compromised sensitivity and specificity of other tests (intrinsic factor and gastric parietal cell antibodies), hinders determination of the cause for depleted B12 status. This can lead to incorrect supplementation regimes and uncertainty regarding later treatment. This review discusses currently available knowledge on vitamin B12, informs the reader about the pitfalls of tests for assessing its deficiency, reviews B12 status in various populations at different disease stages, and provides recommendations for interpretation, treatment, and associated risks. Future directions for diagnostics of B12 status and health interventions are also discussed.
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Affiliation(s)
- Agata Sobczyńska-Malefora
- The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Edgard Delvin
- Sainte-Justine UHC Research Centre, Montreal, Canada.,Department of Biochemistry and Molecular Medicine, University of Montreal, Montreal, Canada
| | | | - Kourosh R Ahmadi
- Department of Nutrition & Metabolism, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Dominic J Harrington
- The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK.,Faculty of Life Sciences and Medicine, King's College London, London, UK
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Maternal vitamin B 12 status in early pregnancy and its association with birth outcomes in Canadian mother-newborn Dyads. Br J Nutr 2021; 126:1823-1831. [PMID: 33602347 DOI: 10.1017/s0007114521000581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Vitamin B12 (B12) is a co-enzyme essential for fetal growth and development. Lower maternal B12 status has been associated with preterm birth (<37 gestational weeks) and low birth weight (<2500 g), which are linked to morbidity and mortality across the lifespan. In Canada, 17-25 % of women in early pregnancy had a serum total B12 concentration <148 pmol/l and maternal total B12 concentration decreased throughout pregnancy. This study aimed to determine the association between maternal B12 status and birth outcomes in Canadian mother-newborn dyads. A secondary analysis of 709 mother-newborn dyads in British Columbia (BC), Canada, was conducted. Bio-banked first- (n 656) and second-trimester (n 709) maternal serum samples of apparently healthy South Asian (50 %) and European (50 %) women from the BC Prenatal Genetic Screening Program were quantified for B12 biomarkers (total B12, holotranscobalamin (holoTC), methylmalonic acid (MMA) and total homocysteine (tHcy)). Obstetric history and birth outcome data were obtained from the BC Perinatal Data Registry. All associations were determined using multiple linear regression. Maternal serum total B12, holoTC, MMA and tHcy had a mean weekly decrease of 3·64 pmol/l, 1·04 pmol/l, 1·44 nmol/l and 0·104 μmol/l, respectively (P < 0·001). Despite a total B12 concentration <148 pmol/l among 20-25 % of the women, maternal B12 biomarker concentrations were not associated with birth weight z-score, head circumference z-score and gestational age at birth (P > 0·05). Additional research in women at high risk of adverse birth outcomes and the association between maternal B12 status and functional, for example, cognitive, outcomes is needed.
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12
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Schroder TH, Tan A, Mattman A, Sinclair G, Barr SI, Vallance HD, Lamers Y. Reference intervals for serum total vitamin B12 and holotranscobalamin concentrations and their change points with methylmalonic acid concentration to assess vitamin B12 status during early and mid-pregnancy. Clin Chem Lab Med 2020; 57:1790-1798. [PMID: 31085739 DOI: 10.1515/cclm-2018-1337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/05/2019] [Indexed: 11/15/2022]
Abstract
Background Maternal vitamin B12 (B-12) adequacy is important for maternal health and optimal fetal growth. However, pregnancy-specific cut-offs for B-12 biomarkers are lacking. Methods Reference intervals for serum total B-12, holotranscobalamin (holoTC) and methylmalonic acid (MMA) concentrations were calculated following CLSI EP28-A3c guidelines in 723 pregnant women of European (50%) and South Asian (50%) ethnicity, residing in British Columbia, Canada, at median (range) 11.4 (8.3-13.9) and 16.1 (14.9-20.9) weeks of gestation. Change point analyses described relationships between log serum MMA concentration with serum total B-12 and holoTC concentrations, assuming linear-linear relationships. Results The central 95% reference interval limits indicated that serum total B-12 <89.9 and <84.0 pmol/L, holoTC <29.5 and <26.0 pmol/L and MMA >371 and >374 nmol/L, in the first and second trimesters, respectively, may indicate B-12 deficiency in pregnant women. The lower limits of total B-12 and holoTC and the upper limits of MMA significantly differed by ethnicity in both trimesters. According to the change point analysis, total B-12 <186 and <180 pmol/L and holoTC <62.2 and <67.5 pmol/L in the first and second trimesters, respectively, suggested an increased probability of impaired intracellular B-12 status, with no difference between ethnicities. Conclusions We present novel reference limits and change points for B-12 biomarkers, which may be employed to identify possible B-12 deficiency in women during early and mid-pregnancy. Future research is needed to validate these cut-offs and determine the predictors and functional outcomes associated with impaired B-12 status in ethnically diverse populations.
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Affiliation(s)
- Theresa H Schroder
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Amy Tan
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Andre Mattman
- Department of Clinical Chemistry and Laboratory Medicine, St Paul's Hospital, Vancouver, BC, Canada
| | - Graham Sinclair
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital and BC Women's Health Centre, Vancouver, BC, Canada
| | - Susan I Barr
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, BC, Canada
| | - Hilary D Vallance
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital and BC Women's Health Centre, Vancouver, BC, Canada
| | - Yvonne Lamers
- British Columbia Children's Hospital Research Institute, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada.,Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, FNH 245, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada
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13
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Torreggiani M, Fois A, D’Alessandro C, Colucci M, Orozco Guillén AO, Cupisti A, Piccoli GB. Of Mice and Men: The Effect of Maternal Protein Restriction on Offspring's Kidney Health. Are Studies on Rodents Applicable to Chronic Kidney Disease Patients? A Narrative Review. Nutrients 2020; 12:E1614. [PMID: 32486266 PMCID: PMC7352514 DOI: 10.3390/nu12061614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
In the almost 30 years that have passed since the postulation of the "Developmental Origins of Health and Disease" theory, it has been clearly demonstrated that a mother's dietary habits during pregnancy have potential consequences for her offspring that go far beyond in utero development. Protein malnutrition during pregnancy, for instance, can cause severe alterations ranging from intrauterine growth retardation to organ damage and increased susceptibility to hypertension, diabetes mellitus, cardiovascular diseases and chronic kidney disease (CKD) later in life both in experimental animals and humans. Conversely, a balanced mild protein restriction in patients affected by CKD has been shown to mitigate the biochemical derangements associated with kidney disease and even slow its progression. The first reports on the management of pregnant CKD women with a moderately protein-restricted plant-based diet appeared in the literature a few years ago. Today, this approach is still being debated, as is the optimal source of protein during gestation in CKD. The aim of this report is to critically review the available literature on the topic, focusing on the similarities and differences between animal and clinical studies.
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Affiliation(s)
- Massimo Torreggiani
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Antioco Fois
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
| | - Claudia D’Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Marco Colucci
- Unit of Nephrology and Dialysis, ICS Maugeri S.p.A. SB, Via S. Maugeri 10, 27100 Pavia, Italy;
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (C.D.); (A.C.)
| | - Giorgina Barbara Piccoli
- Nephrology and Dialysis, Centre Hospitalier Le Mans, Avenue Roubillard 194, 72000 Le Mans, France; (A.F.); (G.B.P.)
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, 10100 Torino, Italy
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14
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Ciangura C, Coupaye M, Deruelle P, Gascoin G, Calabrese D, Cosson E, Ducarme G, Gaborit B, Lelièvre B, Mandelbrot L, Petrucciani N, Quilliot D, Ritz P, Robin G, Sallé A, Gugenheim J, Nizard J. Clinical Practice Guidelines for Childbearing Female Candidates for Bariatric Surgery, Pregnancy, and Post-partum Management After Bariatric Surgery. Obes Surg 2020; 29:3722-3734. [PMID: 31493139 DOI: 10.1007/s11695-019-04093-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Emerging evidence suggests that bariatric surgery improves pregnancy outcomes of women with obesity by reducing the rates of gestational diabetes, pregnancy-induced hypertension, and macrosomia. However, it is associated with an increased risk of a small-for-gestational-age fetus and prematurity. Based on the work of a multidisciplinary task force, we propose clinical practice recommendations for pregnancy management following bariatric surgery. They are derived from a comprehensive review of the literature, existing guidelines, and expert opinion covering the preferred type of surgery for women of childbearing age, timing between surgery and pregnancy, contraception, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns.
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Affiliation(s)
- Cécile Ciangura
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Departments of Nutrition and Diabetology, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Explorations Fonctionnelles, Colombes, University Paris Diderot, Paris, France.,Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France
| | - Philippe Deruelle
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, Strasbourg, France.,Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France
| | - Géraldine Gascoin
- Department of Neonatal Medicine, Angers University Hospital, Angers, France.,Société Française de Néonatologie et Société Française de Pédiatrie, Paris, France
| | - Daniela Calabrese
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Digestive Surgery, Colombes, University Paris Diderot, Paris, France
| | - Emmanuel Cosson
- Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Bondy, 10 UMR U557 INSERM/U11125 INRA/CNAM, University Paris13, Bobigny, France.,Société Francophone du Diabète (SFD), Paris, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Departemental Hospital, La Roche-sur-Yon, France
| | - Bénédicte Gaborit
- Association Française d'Etude et de Recherche sur l'Obésité (AFERO), Paris, France.,Assistance Publique-Hôpitaux de Marseille, Department of Endocrinology, Metabolic Diseases and Nutrition, Marseille, INSERM, INRA, C2VN, Aix Marseille University, Marseille, France
| | - Bénédicte Lelièvre
- Laboratory of Pharmacology and Toxicology, Angers University Hospital, Angers, France
| | - Laurent Mandelbrot
- Assistance Publique-Hôpitaux de Paris, Louis Mourier Hospital, Department of Gynecology and Obstetrics, Colombes, University Paris Diderot, Paris, France
| | - Niccolo Petrucciani
- Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Division of Digestive Surgery and Liver Transplantation, UPEC University, Créteil, France
| | - Didier Quilliot
- Department of Diabetology-Endocrinology-Nutrition, CHRU Nancy, INSERM 954, University of Lorraine, Nancy, France.,Société Francophone Nutrition Clinique et Métabolisme (SFNCM), Paris, France
| | - Patrick Ritz
- Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital, UMR1027, Paul Sabatier University, Toulouse, France
| | - Geoffroy Robin
- Collège National des Gynécologues et Obstétriciens Français (CNGOF), Paris, France.,Department of Medical Gynecology, and Sexology and Department of Assisted Reproductive Technologies and Fertility Preservation, Jeanne de Flandre Hospital, Lille, EA4308 "gametogenesis and gamete quality", Lille University, Lille, France
| | - Agnès Sallé
- Department of Diabetology-Endocrinology-Nutrition, Angers University Hospital, Angers, France
| | - Jean Gugenheim
- Division of Digestive Surgery and Liver Transplantation, Nice University Hospital, University of Nice, Nice, France.,Société Française et Francophone de Chirurgie de l'Obésité et des Maladies Métaboliques (SOFFCOMM), Porte des Pierres Dorées, France
| | - Jacky Nizard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Department of Gynecology and Obstetrics, Sorbonne University, Paris, France
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15
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Diagnostic Accuracy of Holotranscobalamin, Vitamin B12, Methylmalonic Acid, and Homocysteine in Detecting B12 Deficiency in a Large, Mixed Patient Population. DISEASE MARKERS 2020; 2020:7468506. [PMID: 32089757 PMCID: PMC7017578 DOI: 10.1155/2020/7468506] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/26/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]
Abstract
Four biomarkers are commonly employed to diagnose B12 deficiency: vitamin B12 (B12), holotranscobalamin (HoloTC), methylmalonic acid (MMA), and homocysteine (Hcy). 4cB12, a combined index of the B12 status, has been suggested to improve the recognition of B12 deficiency. We aimed to evaluate the four different markers for detecting B12 deficiency, as determined by 4cB12. Within a large, mixed patient population, 11,833 samples had concurrent measurements of B12, HoloTC, MMA, and Hcy. 4cB12 was calculated according to the methods described by Fedosov. Diagnostic cutoffs as well as diagnostic accuracy for the detection of B12 deficiency were assessed with receiver operating characteristic (ROC) analysis. The median age was 56 years, and women accounted for 58.8% of the samples. Overall, the area under the curve (AUC) for the detection of subclinical B12 deficiency was highest for HoloTC (0.92), followed by MMA (0.91), B12 (0.9) and Hcy (0.78). The difference between HoloTC and B12 was driven by a significantly higher AUC for HoloTC (0.93) than for B12 (0.89), MMA (0.91), and Hcy in women 50 years and older (0.79; p < 0.05 for all). In the detection of subclinical B12 deficiency, there were no significant differences in the AUCs of HoloTC, B12, and MMA among men and women <50 years. In conclusion, in women < 50 years and in men, HoloTC, MMA, or Hcy do not appear superior to B12 for the detection of B12 deficiency. For women 50 years and older, HoloTC seems to be the preferred first-line marker for the detection of subclinical B12 deficiency.
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16
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The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients 2019; 11:nu11030557. [PMID: 30845641 PMCID: PMC6470702 DOI: 10.3390/nu11030557] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 11/17/2022] Open
Abstract
Vegetarian and vegan diets have increased worldwide in the last decades, according to the knowledge that they might prevent coronary heart disease, cancer, and type 2 diabetes. Althought plant-based diets are at risk of nutritional deficiencies such as proteins, iron, vitamin D, calcium, iodine, omega-3, and vitamin B12, the available evidence shows that well planned vegetarian and vegan diets may be considered safe during pregnancy and lactation, but they require a strong awareness for a balanced intake of key nutrients. A review of the scientific literature in this field was performed, focusing specifically on observational studies in humans, in order to investigate protective effects elicited by maternal diets enriched in plant-derived foods and possible unfavorable outcomes related to micronutrients deficiencies and their impact on fetal development. A design of pregestational nutrition intervention is required in order to avoid maternal undernutrition and consequent impaired fetal growth.
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17
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Abstract
Optimising micronutrient status globally is a major health priority. Nutritional biomarkers are critical for the identification of nutrient inadequacies in light of the limitations of dietary assessment methods. Early diagnosis and prevention of nutrient inadequacies require sensitive, validated and harmonised methods to determine and monitor micronutrient status in individual healthcare and population-based surveys. Important criteria in the identification, validation and implementation of nutritional biomarkers include the testing of biomarker specificity and sensitivity, and their response to dietary as well as physiologic changes, e.g. age or pregnancy. Nutritional status can be categorised into deficient, suboptimal, adequate and excess status, where appropriate, and provided cut-offs are available. Cut-offs are quantitative measures to reflect health outcomes and are important in validating nutritional surveys, interventions and monitoring of populations. For many biomarkers, available cut-offs have limited interpretability and are most commonly derived in adult populations only. For the comparison of studies from across the globe, the harmonisation of analytical methods is essential and can be realised with the use of internationally available reference material and interlaboratory comparison studies. This narrative review describes current efforts on identifying and validating existing and new biomarkers, the derivation of biomarker cut-offs, and international efforts on harmonisation of laboratory methods for biomarker quantitation and their interpretation, in the example of B-vitamins. Establishing sensitive, reliable and cost-efficient biomarkers and related cut-offs for use in populations across the globe are critical to facilitating the early diagnosis of micronutrient inadequacies on the clinical and community-based level for timely intervention and disease prevention.
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18
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Denissen KFM, Heil SG, Eussen SJPM, Heeskens JPJ, Thijs C, Mommers M, Smits LJM, van Dongen MCJM, Dagnelie PC. Intakes of Vitamin B-12 from Dairy Food, Meat, and Fish and Shellfish Are Independently and Positively Associated with Vitamin B-12 Biomarker Status in Pregnant Dutch Women. J Nutr 2019; 149:131-138. [PMID: 30544236 DOI: 10.1093/jn/nxy233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background The effect of vitamin B-12 from different animal foods on vitamin B-12 biomarker status has not previously been evaluated in pregnant women. Objective We examined the association of vitamin B-12 intake from dairy, meat, fish (including shellfish), and eggs with circulating concentrations of vitamin B-12 biomarkers and with the presence of vitamin B-12 deficiency in 1266 pregnant women participating in the KOALA Birth Cohort Study. Methods Blood samples were collected in weeks 34-36 of pregnancy, and vitamin B-12 intake from foods and supplements was estimated with a semiquantitative food-frequency questionnaire (FFQ). Total vitamin B-12, holotranscobalamin (holoTC), and methylmalonic acid (MMA) were determined in plasma. Vitamin B-12 deficiency was defined as holoTC <35 pmol/L and MMA >0.45 μmol/L. Associations were evaluated with linear and logistic regression analyses, adjusting for potential confounders. Results Significant dose-response relations were observed between vitamin B-12 intake from dairy, meat, and fish and plasma vitamin B-12, holoTC, and MMA [P-trend for (shell)fish with MMA = 0.002; P-trend for dairy, meat, and fish with all other markers < 0.001]. The OR (95% CI) of vitamin B-12 deficiency in the third compared with the first tertile of dairy-derived vitamin B-12 was 0.13 (0.04, 0.49), and the ORs for vitamin B-12 from meat and fish were 0.33 (0.11, 0.97) and 0.25 (0.08, 0.82), respectively. Egg-derived vitamin B-12 was only associated with holoTC. Additional analyses showed that self-defined vegetarians and FFQ-defined lacto-ovo-vegetarians had lower median total dietary vitamin B-12 intake and considerably worse vitamin B-12 biomarker status than omnivores and pescatarians. Conclusions In pregnant Dutch women, higher intakes of vitamin B-12 from dairy, meat, and fish were positively associated with vitamin B-12 status, suggesting that dairy, meat, and fish are good sources of bioactive vitamin B-12 in pregnancy. Nevertheless, for (lacto-)vegetarians, vitamin B-12 supplementation is recommended.
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Affiliation(s)
- Karlijn F M Denissen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Sandra G Heil
- Department of Clinical Chemistry, Erasmus MC University Medical Center, PO Box 2040, 3015 CN Rotterdam, Netherlands
| | - Simone J P M Eussen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Jim P J Heeskens
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Carel Thijs
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Monique Mommers
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Luc J M Smits
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Martien C J M van Dongen
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CAPHRI Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht The, Netherlands
| | - Pieter C Dagnelie
- Departments of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,DepartmentInternal Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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19
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Laine JE, Ilievski V, Richardson DB, Herring AH, Stýblo M, Rubio-Andrade M, Garcia-Vargas G, Gamble MV, Fry RC. Maternal one carbon metabolism and arsenic methylation in a pregnancy cohort in Mexico. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2018; 28:505-514. [PMID: 30068932 PMCID: PMC6531675 DOI: 10.1038/s41370-018-0041-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/18/2017] [Accepted: 09/06/2017] [Indexed: 05/04/2023]
Abstract
The prenatal period represents a critical window of susceptibility to inorganic arsenic (iAs) exposure from contaminated drinking water. Ingested iAs undergoes hepatic methylation generating mono and di-methyl arsenicals (MMAs and DMAs, respectively), a process that facilitates urinary arsenic (As) elimination. Differences in pregnant women's metabolism of As as indicated by greater proportions of MMAs and smaller proportions of DMAs in urine are a risk factor for adverse birth outcomes. One carbon metabolism (OCM), the nutritionally-regulated pathway essential for supplying methyl groups, plays a role in As metabolism and is understudied during the prenatal period. In this cross-sectional study from the Biomarkers of Exposure to ARsenic (BEAR) pregnancy cohort in Gómez Palacio, Mexico, we assessed the relationships among OCM indicators (e.g. maternal serum B12, folate, and homocysteine (Hcys)), and levels of iAs and its metabolites in maternal urine and in neonatal cord serum. The prevalence of folate sufficiency (folate levels > 9 nmol/L) in the cohort was high 99%, and hyperhomocysteinemia (Hcys levels > 10.4 μmol/L) was low (8%). However, 74% of the women displayed a deficiency in B12 (serum levels < 148 pmol/L). Association analyses identified that infants born to mothers in the lowest tertile of serum folate had significantly higher mean levels of %MMA in cord serum relative to folate replete women. In addition, elevated maternal Hcys was associated with total As in maternal urine and cord serum as well as cord serum %MMAs. The results from this study indicate that maternal OCM status may influence the distribution of As metabolites in cord serum.
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Affiliation(s)
- Jessica E Laine
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
| | - Vesna Ilievski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David B Richardson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy H Herring
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Miroslav Stýblo
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marisela Rubio-Andrade
- Facultad de Medicina, Universidad Juarez del Estado de Durango, Gómez Palacio, Durango, Mexico
| | - Gonzalo Garcia-Vargas
- Facultad de Medicina, Universidad Juarez del Estado de Durango, Gómez Palacio, Durango, Mexico
| | - Mary V Gamble
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rebecca C Fry
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Association between Maternal and Infantile Markers of Cobalamin Status During the First Month Post-Delivery. Indian J Pediatr 2018; 85:517-522. [PMID: 29306994 DOI: 10.1007/s12098-017-2598-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Exclusively breast-fed infants born to vitamin B12 (cobalamin, cbl)-deficient mothers can develop symptoms within a few months following delivery. The authors aimed to assess the relationship between maternal and infantile markers of cbl status. METHODS In 240 full-term infants (age, 2-30 d) admitted to Samsun Maternity and Child Health Hospital and their mothers, complete blood count testing and serum cbl, folate and plasma total homocysteine (tHcy) measurements were performed. In the mothers, serum ferritin and holotranscobalamin (holoTC) levels were measured additionally. RESULTS Among the infants, 146 (60.8%) had cbl deficiency (serum cbl <259 pg/mL), whereas 184 (76.7%) mothers had a low cbl level (serum cbl <300 pg/mL). When cbl deficiency was defined as a serum holoTC level < 40 pmol/L, 152 (63.3%) mothers were found as deficient. In addition, 147 (61.3%) infants had an elevated tHcy level (>10 μmol/L), in 35 (23.8%) of these 147 infants tHcy level being markedly elevated (>20 μmol/L). None of the infants had folate deficiency. In the correlational analysis between maternal and infantile markers associated with cbl status, the strongest correlation was observed between maternal holoTC and infantile tHcy (r = -0.49, p < 0.001), followed by the correlation between maternal tHcy and infantile tHcy (r = 0.47, p < 0.001). The weakest correlations were found between maternal cbl and infantile cbl (r = 0.28, p < 0.001), and between maternal cbl and infantile tHcy (r = -0.25, p < 0.001). CONCLUSIONS Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.
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21
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Varsi K, Ueland PM, Torsvik IK, Bjørke-Monsen AL. Maternal Serum Cobalamin at 18 Weeks of Pregnancy Predicts Infant Cobalamin Status at 6 Months-A Prospective, Observational Study. J Nutr 2018; 148:738-745. [PMID: 29947806 DOI: 10.1093/jn/nxy028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/30/2018] [Indexed: 02/05/2023] Open
Abstract
Background An adequate maternal cobalamin status is crucial for fetal and infant neurodevelopment. Pregnancy-induced physiologic changes make evaluation of maternal cobalamin status in pregnancy difficult. Objective We have investigated maternal cobalamin status during pregnancy in order to establish a maternal cobalamin concentration which secures an optimal infant cobalamin status during the first 6 mo of life. Methods In an observational, prospective study, markers of cobalamin status including serum cobalamin, plasma total homocysteine (tHcy), and plasma methylmalonic acid (MMA) were assessed in healthy pregnant women (n = 114) from week 18 of pregnancy through 6 mo postpartum and related to infant cobalamin status at 6 mo. Healthy, never-pregnant women aged 18-40 y (n = 123) were included as controls. Results Compared to controls, all markers of cobalamin status were lower in pregnant women. Median serum cobalamin concentration progressively decreased from week 18 to week 36 of pregnancy (356 to 302 pmol/L, P < 0.001) and increased by >40% by 6 wk postpartum (518 pmol/L). The metabolic markers increased from week 18 of pregnancy to 6 wk postpartum: median plasma tHcy 3.9 to 7.7 μmol/L (P < 0.001), and MMA 0.13 to 0.17 μmol/L (P < 0.001). The serum cobalamin concentration of infants at age 6 mo correlated with maternal serum cobalamin concentration during pregnancy and postpartum (rho = 0.36-0.55, P < 0.001). A maternal serum cobalamin concentration <394 pmol/L during week 18 of pregnancy was associated with an increased risk (OR: 4.2; 95% CI: 1.5, 11.5) of infant biochemical cobalamin deficiency at 6 mo (defined as tHcy ≥6.5 μmol/L). Conclusions The maternal serum cobalamin concentration in early pregnancy is a strong predictor for later maternal and infant cobalamin status. To secure an optimal infant cobalamin status during the first 6 mo of life, we recommend a maternal serum cobalamin concentration >394 pmol/L at week 18 of pregnancy. This should be confirmed in an intervention study. This trial was registered at clinicaltrials.gov as NCT03272022.
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Affiliation(s)
- Kristin Varsi
- Laboratory of Clinical Biochemistry, and Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Per M Ueland
- Laboratory of Clinical Biochemistry, and Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ingrid K Torsvik
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Anne-Lise Bjørke-Monsen
- Laboratory of Clinical Biochemistry, and Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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22
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Solé-Navais P, Salat-Batlle J, Cavallé-Busquets P, Fernandez-Ballart J, Ueland PM, Ballesteros M, Ornosa-Martín G, Inglès-Puig M, Colomina JM, Murphy MM. Early pregnancy folate-cobalamin interactions and their effects on cobalamin status and hematologic variables throughout pregnancy. Am J Clin Nutr 2018; 107:173-182. [PMID: 29529156 DOI: 10.1093/ajcn/nqx041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 11/20/2017] [Indexed: 12/21/2022] Open
Abstract
Background Periconception folic acid supplementation is widespread, but how it interacts with cobalamin status is rarely considered. Objective The aim of this study was to investigate whether first-trimester folate-cobalamin interactions affect pregnancy cobalamin status, hematologic variables, and pregnancy outcomes. Design In the longitudinal Reus-Tarragona Birth Cohort study from <12 gestational weeks throughout pregnancy, fasting plasma and red blood cell (RBC) folate, plasma cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), total homocysteine (tHcy), hemoglobin, mean cell volume (MCV), postglucose-load serum glucose, gestational hypertension, gestational age at birth, and birth weight were recorded in 563 participants. Results The highest plasma folate concentrations occurred in the first trimester when folic acid supplement use was extensive. Supplementation beyond the first trimester interacted with time of pregnancy on plasma folate, RBC folate, and tHcy throughout pregnancy (P-interaction <0.001). Plasma folate and RBC folate were higher and tHcy was lower in continued supplement users than in nonusers. Elevated plasma folate (≥30 nmol/L) occurred in 78.9% of women who exceeded the recommended 400 µg folic acid/d. First-trimester folate-cobalamin status interactions were associated with MMA (P-interaction <0.001) throughout pregnancy. When plasma cobalamin was suboptimal (≤221 pmol/L; n = 36), participants with elevated plasma folate (n = 11) had higher MMA concentrations than did those with nonelevated plasma folate (n = 23). First-trimester folate-MMA status interactions were associated with MCV throughout pregnancy (P-interaction <0.01) and with cord plasma holoTC (P-interaction <0.05). The mean difference (95% CI) in MCV (fL) between women with elevated and nonelevated plasma folate status was -2.12 (-3.71, -0.52) for top-quartile plasma MMA (≥0.139 µmol/L) and 0.60 (-0.39, 1.60) for plasma MMA <0.139 µmol/L. Cord plasma holoTC was higher in women with elevated compared with nonelevated plasma folate status only for MMA <0.139 µmol/L. Folate-cobalamin interactions were not associated with the other investigated outcomes. Conclusion First-trimester folate-cobalamin status interactions were associated with plasma MMA and MCV throughout pregnancy. This trial was registered at www.clinicaltrials.gov as NCT01778205.
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Affiliation(s)
- Pol Solé-Navais
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain
| | - Judith Salat-Batlle
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain
| | - Pere Cavallé-Busquets
- Units of Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain.,Units of Obstetrics and Gynecology, University Hospitals Sant Joan, Reus and Joan XXIII, Tarragona, Spain.,Biomedical Research Networking Center for the Pathophysiology of Obesity, Carlos III Institute of Health, Madrid, Spain
| | - Joan Fernandez-Ballart
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain.,Biomedical Research Networking Center for the Pathophysiology of Obesity, Carlos III Institute of Health, Madrid, Spain
| | - Per M Ueland
- Section of Pharmacology, Department of Internal Medicine, University of Bergen, Bergen, Norway
| | - Mónica Ballesteros
- Units of Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain.,Units of Joan XXIII, Tarragona, Spain
| | - Gemma Ornosa-Martín
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain
| | - Montserrat Inglès-Puig
- Units of Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain.,Units of Obstetrics and Gynecology, University Hospitals Sant Joan, Reus and Joan XXIII, Tarragona, Spain
| | - Jose M Colomina
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain
| | - Michelle M Murphy
- Units of Preventive Medicine and Public Health, Department of Basic Medical Sciences and Obstetrics and Gynecology, Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Pere Virgili Institute of Health Research, Rovira i Virgili University, Reus, Spain.,Biomedical Research Networking Center for the Pathophysiology of Obesity, Carlos III Institute of Health, Madrid, Spain
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23
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Pregnant women of South Asian ethnicity in Canada have substantially lower vitamin B12 status compared with pregnant women of European ethnicity. Br J Nutr 2017; 118:454-462. [PMID: 28920568 DOI: 10.1017/s0007114517002331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Maternal vitamin B12 (B12) status has been inversely associated with adverse pregnancy outcomes and positively with fetal growth and infant development. South Asians, Canada's largest ethnic minority, are prone to B12 deficiency. Yet, data are lacking on B12 status in South Asian pregnant women in North America. We sought to determine B12 status, using multiple biomarkers, in 1st and 2nd trimester pregnant women of South Asian and, for comparison, European ethnicity living in Vancouver, Canada. In this retrospective cohort study, total B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine concentrations were quantified in two routinely collected (mean gestational week: 11·5 (range 8·3-13·9) and 16·5 (range 14·9-20·9)), banked serum samples of 748 healthy pregnant South Asian (n 371) and European (n 377) women. South Asian pregnant women had significantly lower B12 status than European pregnant women at both time points, as indicated by lower serum total B12 and holoTC concentrations, and higher MMA concentrations (all P≤0·001). The largest difference, which was substantial (Cohen's d≥0·5), was observed in mean serum total B12 concentrations (1st trimester: 189 (95 % CI 180, 199) v. 246 (95 % CI 236, 257) pmol/l; 2nd trimester: 176 (95 % CI 168, 185) v. 226 (95 % CI 216, 236) pmol/l). Further, South Asian ethnicity was a significant negative predictor of B12 status during pregnancy. South Asian women living in Vancouver have substantially lower B12 status during early pregnancy. Future research identifying predictors and health consequences of this observed difference is needed to allow for targeted interventions.
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24
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van der Woude DAA, Pijnenborg JMA, de Vries J, van Wijk EM. The distribution of total vitamin B12, holotranscobalamin, and the active vitamin B12 fraction in the first 5 weeks postpartum. Int J Lab Hematol 2017; 40:72-76. [PMID: 28868811 DOI: 10.1111/ijlh.12730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Total vitamin B12 levels decrease significantly during pregnancy and recover to normal values within 8-week postpartum. Holotranscobalamin (holoTC) reflects the active part of vitamin B12 and has been shown to remain constant during pregnancy and postpartum. A mechanism of redistribution of vitamin B12 is suggested, with a shift toward holoTC if there is insufficient total vitamin B12 available. Our objective was to examine vitamin B12 deficiency and the active vitamin B12 fraction in postpartum women. METHODS Total vitamin B12 and holoTC were measured in 171 women within 48 hours (T0) and at 5 weeks (T5) postpartum. Vitamin B12 deficiency was defined as total vitamin B12 < 180 pmol/L or holoTC <32 pmol/L. The active vitamin B12 fraction was defined as holoTC/total vitamin B12. RESULTS Without intervention, vitamin B12 deficiency based on both serum total vitamin B12 and holoTC changed from 75% and 60%, to respectively 10% and 6% at T5. The fraction of active vitamin B12 was significant higher in vitamin B12 deficient women at both time points and across time (P < .0001 and P = .002). A high fraction of active vitamin B12 was only present in women with total vitamin B12 deficiency at T0. At T5, no high vitamin B12 fraction was found. CONCLUSION The changes in total vitamin B12 levels seem to be based on a physiological changes rather than vitamin B12 deficiency. The results of this study confirm the hypothesis that a shift toward the metabolic active vitamin B12 (holoTC) occurs in women with insufficient available total vitamin B12.
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Affiliation(s)
- D A A van der Woude
- CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,Department of Gynecology and Obstetrics, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - J M A Pijnenborg
- Department of Gynecology and Obstetrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J de Vries
- CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - E M van Wijk
- Laboratory of Clinical Chemistry and Hematology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
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25
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South Asian Ethnicity Is Related to the Highest Risk of Vitamin B12 Deficiency in Pregnant Canadian Women. Nutrients 2017; 9:nu9040317. [PMID: 28333089 PMCID: PMC5409656 DOI: 10.3390/nu9040317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 03/12/2017] [Accepted: 03/20/2017] [Indexed: 01/08/2023] Open
Abstract
Vitamin B12 (B12) adequacy during pregnancy is crucial for maternal health and optimal fetal development; however, suboptimal B12 status has been reported in pregnant Canadian women. Methylmalonic acid (MMA) is a sensitive indicator of B12 status. Since few studies have measured MMA during pregnancy in Canadian women, the objective of this study was to evaluate B12 status in pregnant women living in Metro Vancouver, using both plasma total B12 and MMA. We recruited a convenience sample of 320 pregnant women between 20 and 35 gestational weeks from local healthcare facilities. Plasma total B12 concentrations indicative of deficiency (<148 pmol/L) and suboptimal B12 status (148–220 pmol/L) were found in 18% and 33% of the women, respectively. Normal plasma MMA concentration (<210 nmol/L) was observed in 82% of all women. Gestational age was a strong predictor of plasma total B12 and MMA concentration, and South Asian ethnicity of B-12 deficiency and MMA concentrations. Overall, there was a high discrepancy between the prevalence of B12 inadequacy depending on the biomarker used. Independently, however, South Asian women were at particular risk for B12 deficiency, likely due to lower animal source food intake. Further study of this vulnerable group and performance testing of B12 biomarkers is warranted.
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26
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Sukumar N, Venkataraman H, Wilson S, Goljan I, Selvamoni S, Patel V, Saravanan P. Vitamin B12 Status among Pregnant Women in the UK and Its Association with Obesity and Gestational Diabetes. Nutrients 2016; 8:nu8120768. [PMID: 27916927 PMCID: PMC5188423 DOI: 10.3390/nu8120768] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/16/2016] [Accepted: 11/22/2016] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate vitamin B12 and folate status in pregnancy and their relationship with maternal obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Methods: A retrospective case-control study of 344 women (143 GDM, 201 no-GDM) attending a district general hospital and that had B12 and folate levels measured in the early 3rd trimester was performed. Maternal history including early pregnancy body mass index (BMI) and neonatal data (birthweight, sex, and gestational age) was recorded for all subjects. Results: 26% of the cohort had B12 levels <150 pmol/L (32% vs. 22% in the two groups respectively, p < 0.05) while 1.5% were folate deficient. After adjusting for confounders, 1st trimester BMI was negatively associated with 3rd trimester B12 levels. Women with B12 insufficiency had higher odds of obesity and GDM (aOR (95% CI) 2.40 (1.31, 4.40), p = 0.004, and 2.59 (1.35, 4.98), p = 0.004, respectively), although the latter was partly mediated by BMI. In women without GDM, the lowest quartile of B12 and highest quartile of folate had significantly higher adjusted risk of fetal macrosomia (RR 5.3 (1.26, 21.91), p = 0.02 and 4.99 (1.15, 21.62), p = 0.03 respectively). Conclusion: This is the first study from the UK to show that maternal B12 levels are associated with BMI, risk of GDM, and additionally may have an independent effect on macrosomia. Due to the increasing burden of maternal obesity and GDM, longitudinal studies with B12 measurements in early pregnancy are needed to explore this link.
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Affiliation(s)
- Nithya Sukumar
- Warwick Medical School, University of Warwick, Coventry CV2 2DX, UK.
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK.
| | - Hema Venkataraman
- Warwick Medical School, University of Warwick, Coventry CV2 2DX, UK.
| | - Sean Wilson
- Hull York Medical School, Hertford Building, University of Hull, Hull HU6 7RX, UK.
| | - Ilona Goljan
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK.
| | - Selvin Selvamoni
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK.
| | - Vinod Patel
- Warwick Medical School, University of Warwick, Coventry CV2 2DX, UK.
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK.
| | - Ponnusamy Saravanan
- Warwick Medical School, University of Warwick, Coventry CV2 2DX, UK.
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton CV10 7DJ, UK.
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27
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Abuyaman O, Torring N, Obeid R, Nexo E. First trimester serum levels of the soluble transcobalamin receptor, holo-transcobalamin, and total transcobalamin in relation to preeclampsia risk. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:641-644. [PMID: 27700208 DOI: 10.1080/00365513.2016.1230885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Human placenta expresses CD320, a receptor that ensures the uptake of holo-transcobalamin (holoTC). Soluble CD320 (sCD320) is present in the circulation and its concentration increases during pregnancy. AIMS To investigate a possible association of sCD320, holoTC and total transcobalamin (TC) with the risk of subsequent preeclampsia using serum samples from asymptomatic first trimester pregnant women. Moreover, we aimed to establish reference intervals of the aforementioned biomarkers for first trimester pregnant women who remained healthy throughout pregnancy. STUDY DESIGN This study was a retrospective case-control study that we performed on biobank serum samples. Cases (n = 50) and controls (n = 198) (matched for gestational age and date of sample collection) were asymptomatic women in early pregnancy [median (range) gestational age = 10 (8-12) weeks]. Cases developed preeclampsia while the controls remained normotensive throughout pregnancy. We measured the serum concentration of sCD320, holoTC, and total TC by using in-house ELISA methods. RESULTS First trimester median concentrations of sCD320, holoTC and total TC were not significantly different between cases and controls. The odd ratio for developing preeclampsia based on exposure to low or high levels of sCD320, holoTC or total TC at first trimester was not significant. The reference intervals (2.5-97.5% percentiles (median)) derived from the controls were 50-170 (90) pmol\L for sCD320, 20-140 (70) pmol\L for holoTC and 560-1300 (810) pmol\L for total TC. CONCLUSIONS The risk of preeclampsia is not predicted by first trimester serum concentrations of sCD320, holoTC or total TC. The first trimester reference intervals for the three parameters is reported.
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Affiliation(s)
- Omar Abuyaman
- a Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Niels Torring
- a Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
| | - Rima Obeid
- b Aarhus Institute for Advanced Studies, Aarhus University , Aarhus , Denmark
| | - Ebba Nexo
- a Department of Clinical Biochemistry , Aarhus University Hospital , Aarhus , Denmark
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28
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Sukumar N, Rafnsson SB, Kandala NB, Bhopal R, Yajnik CS, Saravanan P. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis. Am J Clin Nutr 2016; 103:1232-51. [PMID: 27076577 DOI: 10.3945/ajcn.115.123083] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/24/2016] [Indexed: 11/14/2022] Open
Abstract
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 ÷ 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.
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Affiliation(s)
- Nithya Sukumar
- Division of Health Sciences, Populations, Evidence, and Technologies Group, Warwick Medical School, The University of Warwick, Coventry, United Kingdom
| | - Snorri B Rafnsson
- Department of Epidemiology and Public Health, University College London, London, United Kingdom; Edinburgh Migration, Ethnicity, and Health Research Group, Centre for Population Health Sciences, Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Ngianga-Bakwin Kandala
- Department of Mathematics and Information Sciences, Faculty of Engineering and Environment, Northumbria University, Newcastle upon Tyne, United Kingdom; Health Economics and Evidence Synthesis Unit, Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Raj Bhopal
- Edinburgh Migration, Ethnicity, and Health Research Group, Centre for Population Health Sciences, Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Rasta Peth, Pune, Maharashtra, India; and
| | - Ponnusamy Saravanan
- Division of Health Sciences, Populations, Evidence, and Technologies Group, Warwick Medical School, The University of Warwick, Coventry, United Kingdom; Academic Department of Diabetes & Endocrinology, George Eliot Hospital, Nuneaton, United Kingdom
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29
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Lundqvist A, Sandström H, Stenlund H, Johansson I, Hultdin J. Vitamin D Status during Pregnancy: A Longitudinal Study in Swedish Women from Early Pregnancy to Seven Months Postpartum. PLoS One 2016; 11:e0150385. [PMID: 26938997 PMCID: PMC4777524 DOI: 10.1371/journal.pone.0150385] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/12/2016] [Indexed: 11/18/2022] Open
Abstract
Low vitamin D levels during pregnancy may have negative consequences for the health of both the mother and child. Cross-sectional studies in childbearing women suggest that vitamin D levels are low during pregnancy, but few studies have followed the same women during pregnancy and postpartum. The aims of this study were to longitudinally assess vitamin D status during pregnancy and postpartum and identify the factors associated with vitamin D status in pregnant women in northern Sweden. Between September 2006 and March 2009, 184 women were consecutively recruited at five antenatal primary care clinics. Blood was sampled, and dietary intake was estimated using a food frequency questionnaire with 66 food items/food aggregates and questions on the intake of vitamin supplements at gestational weeks 12, 21, and 35, as well as at 12 and 29 weeks after birth. Plasma 25(OH) vitamin D levels were analyzed using liquid chromatography tandem-mass spectrometry. At least one-third of the women had 25(OH) vitamin D levels <50 nmol/L on at least one sampling occasion. Plasma levels increased slightly over the gestation period and peaked in late pregnancy. The levels reverted to the baseline levels after birth. Multivariate analysis showed that gestational and postpartum week, season, dietary intake of vitamin D, and vitamin supplementation were significantly related to plasma levels. There was also an influence of season on the longitudinal concentration patterns. In conclusion, more than one-third of the women studied had low 25(OH) vitamin D levels, and gestational and postpartum week was related to 25(OH) vitamin D levels after adjustment for season and vitamin D intake.
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Affiliation(s)
- Anette Lundqvist
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Herbert Sandström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Johan Hultdin
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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30
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Bae S, West AA, Yan J, Jiang X, Perry CA, Malysheva O, Stabler SP, Allen RH, Caudill MA. Vitamin B-12 Status Differs among Pregnant, Lactating, and Control Women with Equivalent Nutrient Intakes. J Nutr 2015; 145:1507-14. [PMID: 25995278 DOI: 10.3945/jn.115.210757] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/21/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Limited data are available from controlled studies on biomarkers of maternal vitamin B-12 status. OBJECTIVE We sought to quantify the effects of pregnancy and lactation on the vitamin B-12 status response to a known and highly controlled vitamin B-12 intake. METHODS As part of a 10-12 wk feeding trial, pregnant (26-29 wk gestation; n = 26), lactating (5 wk postpartum; n = 28), and control (nonpregnant, nonlactating; n = 21) women consumed vitamin B-12 amounts of ∼8.6 μg/d [mixed diet (∼6 μg/d) plus a prenatal multivitamin supplement (2.6 μg/d)]. Serum vitamin B-12, holotranscobalamin (bioactive form of vitamin B-12), methylmalonic acid (MMA), and homocysteine were measured at baseline and study-end. RESULTS All participants achieved adequate vitamin B-12 status in response to the study dose. Compared with control women, pregnant women had lower serum vitamin B-12 (-21%; P = 0.02) at study-end, whereas lactating women had higher (P = 0.04) serum vitamin B-12 throughout the study (+26% at study-end). Consumption of the study vitamin B-12 dose increased serum holotranscobalamin in all reproductive groups (+16-42%; P ≤ 0.009). At study-end, pregnant (vs. control) women had a higher holotranscobalamin-to-vitamin B-12 ratio (P = 0.04) with ∼30% (vs. 20%) of total vitamin B-12 in the bioactive form. Serum MMA increased during pregnancy (+50%; P < 0.001) but did not differ by reproductive state at study-end. Serum homocysteine increased in pregnant women (+15%; P = 0.009) but decreased in control and lactating women (-16-17%; P < 0.001). Despite these changes, pregnant women had ∼20% lower serum homocysteine than the other 2 groups at study-end (P ≤ 0.02). CONCLUSION Pregnancy and lactation alter vitamin B-12 status in a manner consistent with enhanced vitamin B-12 supply to the child. Consumption of the study vitamin B-12 dose (∼3 times the RDA) increased the bioactive form of vitamin B-12, suggesting that women in these reproductive states may benefit from vitamin B-12 intakes exceeding current recommendations. This trial was registered at clinicaltrials.gov as NCT01127022.
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Affiliation(s)
- Sajin Bae
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Allyson A West
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Jian Yan
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Xinyin Jiang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Cydne A Perry
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Olga Malysheva
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
| | - Sally P Stabler
- Department of Medicine and Division of Hematology, University of Colorado Health Sciences Center, Denver, CO
| | - Robert H Allen
- Department of Medicine and Division of Hematology, University of Colorado Health Sciences Center, Denver, CO
| | - Marie A Caudill
- Division of Nutritional Sciences, Cornell University, Ithaca, NY; and
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Fayyaz F, Wang F, Jacobs RL, O’Connor DL, Bell RC, Field CJ. Folate, vitamin B12, and vitamin B6status of a group of high socioeconomic status women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. Appl Physiol Nutr Metab 2014; 39:1402-8. [DOI: 10.1139/apnm-2014-0181] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Folic acid supplementation and food fortification policies have improved folate status in North American women of child bearing age. Recent studies have reported the possible inadequacy of vitamin B12and B6in the etiology of neural tube defects in folate-fortified populations. The aims of this study were to describe folate status and its relationship to supplementation and to assess vitamin B12and B6status in a cohort of pregnant women. Supplement intake data were collected in each trimester from the first cohort (n = 599) of the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Red blood cell folate (RBCF) and plasma folate, holotranscobalamin, and pyridoxal 5-phosphate were measured. Overt folate deficiency was rare (3%) but 24% of women in their first trimester had suboptimal RBCF concentration (<906 nmol·L−1). The proportion of the cohort in this category declined substantially in second (9%) and third (7%) trimesters. High RBCF (>1360 nmol·L−1) was observed in approximately half of the women during each pregnancy trimester. Vitamin B12and B6deficiencies were rare (<1% of the cohort). Women consuming folic acid supplements above the upper level had significantly higher RBCF and plasma folate concentrations. In conclusion, the prevalence of vitamin B12and B6deficiency was very low. A quarter of the women had suboptimal folate status in the first trimester of pregnancy and over half the women had abnormally high RBCF, suggesting that supplementation during pregnancy is not appropriate in a cohort of women considered to be healthy and a low risk for nutritional deficiencies.
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Affiliation(s)
- Faiqa Fayyaz
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Flora Wang
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - René L. Jacobs
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Deborah L. O’Connor
- Department of Nutritional Sciences, University of Toronto and the Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Rhonda C. Bell
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
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Devalia V, Hamilton MS, Molloy AM. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br J Haematol 2014; 166:496-513. [PMID: 24942828 DOI: 10.1111/bjh.12959] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The clinical picture is the most important factor in assessing the significance of test results assessing cobalamin status because there is no 'gold standard' test to define deficiency. Serum cobalamin currently remains the first-line test, with additional second-line plasma methylmalonic acid to help clarify uncertainties of underlying biochemical/functional deficiencies. Serum holotranscobalamin has the potential as a first-line test, but an indeterminate 'grey area' may still exist. Plasma homocysteine may be helpful as a second-line test, but is less specific than methylmalonic acid. The availability of these second-line tests is currently limited. Definitive cut-off points to define clinical and subclinical deficiency states are not possible, given the variety of methodologies used and technical issues, and local reference ranges should be established. In the presence of discordance between the test result and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment. Treatment of cobalamin deficiency is recommended in line with the British National Formulary. Oral therapy may be suitable and acceptable provided appropriate doses are taken and compliance is not an issue. Serum folate offers equivalent diagnostic capability to red cell folate and is the first-line test of choice to assess folate status.
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Balcı YI, Ergin A, Karabulut A, Polat A, Doğan M, Küçüktaşcı K. Serum vitamin B12 and folate concentrations and the effect of the Mediterranean diet on vulnerable populations. Pediatr Hematol Oncol 2014; 31:62-7. [PMID: 24088029 DOI: 10.3109/08880018.2013.829894] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Low vitamin B12 and folate levels in expectant mothers may lead to low stores in babies. The aim of this study was to determine the frequencies of vitamin B12 and folate deficiencies in pregnant women and neonates, and to assess the effect of maternal vitamin status on babies' vitamin levels in the Aegean region of Turkey, where the Mediterranean diet (mainly fresh fruits and vegetables) is adopted. We studied 72 pregnant women and their singleton-term babies. Venous blood samples of expectant mothers were collected 1 h before delivery and cord blood of babies were obtained at birth. The mean vitamin B12 in maternal and cord blood serum was 163.1 ± 72.0 pg/mL and 146.2 ± 102.5 pg/mL, and the mean folate, 9.8 ± 4.8 ng/mL and 15.8 ± 3.8 ng/mL, respectively. There were statistically significant correlation between maternal and cord blood serum vitamin B12 (r = 0.61, P = .04) and folate levels (r = 0.65, P < .001). 70.8% of the mothers and 83.9% of the babies were vitamin B12 deficient (<200 pg/mL). Neither group showed folate deficiency. The mean level of vitamin B12 in mothers significantly varied by the type of diet (241.6 (72.1) pg/mL versus 155.9 (68.2) pg/mL; P = .012). Vitamin B12 deficiency in pregnant women and neonates may be a public health problem in our community. The Mediterranean diet in these vulnerable groups may be an aggravating factor for vitamin B12 deficiency. Prenatal screening of all expectant mothers, prenatal supplementation of vitamin B12, and an increase in animal-source food intake may improve expectant mother's vitamin B12 level.
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Affiliation(s)
- Yasemin Işık Balcı
- Department of Pediatric Hematology, Medical Faculty, Pamukkale University , Denizli , Turkey
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Wu BT, Innis SM, Mulder KA, Dyer RA, King DJ. Low plasma vitamin B-12 is associated with a lower pregnancy-associated rise in plasma free choline in Canadian pregnant women and lower postnatal growth rates in their male infants. Am J Clin Nutr 2013; 98:1209-17. [PMID: 24004892 DOI: 10.3945/ajcn.113.060269] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Choline needs are increased in pregnancy. Choline can be used as a source of methyl for homocysteine remethylation to methionine, but choline synthesis requires methyls from methionine. Vitamin B-12 deficiency increases choline use for homocysteine methylation. OBJECTIVES We investigated whether poor vitamin B-12 status occurs and contributes to low plasma choline and altered biomarkers of choline synthesis in pregnant women. With the use of a post hoc analysis, we addressed the association of maternal plasma vitamin B-12 status with postnatal growth rates in term infants. DESIGN Blood was analyzed for a prospective study of 264 and 220 pregnant women at 16 and 36 wk of gestation, respectively, and 88 nonpregnant women as a reference. RESULTS The proportion of women with a plasma total vitamin B-12 concentration <148 pmol/L (deficient) or 148-220 pmol/L (marginal) increased with pregnancy and pregnancy duration, which affected 3% and 9% of nonpregnant women, 10% and 21% of women at 16 wk of gestation, and 23% and 35% of women at 36 wk of gestation, respectively. Plasma free choline, betaine, and dimethylglycine were lower in women at 36 wk of gestation with a deficient or marginal compared with sufficient plasma total vitamin B-12 concentration (>220 pmol/L). Plasma total vitamin B-12 was positively associated with the increase in plasma free choline from midgestation to late gestation (P < 0.001). The postnatal growth rate to 9 mo was lower in infant boys of women classified as total vitamin B-12 deficient compared with sufficient. CONCLUSION This study shows that maternal vitamin B-12 status is related to choline status in late gestation in a folate-replete population and may be a determinant of infant growth even in the absence of undernutrition.
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Affiliation(s)
- Brian Tf Wu
- Nutrition and Metabolism Research Program, Child and Family Research Institute, Department of Paediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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The soluble receptor for vitamin B12 uptake (sCD320) increases during pregnancy and occurs in higher concentration in urine than in serum. PLoS One 2013; 8:e73110. [PMID: 24015289 PMCID: PMC3754917 DOI: 10.1371/journal.pone.0073110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/18/2013] [Indexed: 11/25/2022] Open
Abstract
Background Cellular uptake of vitamin B12 (B12) demands binding of the vitamin to transcobalamin (TC) and recognition of TC-B12 (holoTC) by the receptor CD320, a receptor expressed in high quantities on human placenta. We have identified a soluble form of CD320 (sCD320) in serum and here we present data on the occurrence of this soluble receptor in both serum and urine during pregnancy. Methods We examined serum from twenty-seven pregnant women (cohort 1) at gestational weeks 13, 24 and 36 and serum and urine samples from forty pregnant women (cohort 2) tested up to 8 times during gestational weeks 17-41. sCD320, holoTC, total TC and complex formation between holoTC and sCD320 were measured by in-house ELISA methods, while creatinine was measured on the automatic platform Cobas 6000. Size exclusion chromatography was performed on a Superdex 200 column. Results Median (range) of serum sCD320 increased from 125 (87-839) pmol/L (week 15) to reach a peak value of 199 (72-672) pmol/L (week 35) then dropped back to its baseline level just before birth (week 40). Around one third of sCD320 was precipitated with holoTC at all-time points studied. The urinary concentration of sCD320 was around two fold higher than in serum. Urinary sCD320/creatinine ratio correlated with serum sCD320 and reached a peak median level of 53 (30–101) pmol/mmol creatinine (week 35). sCD320 present in serum and urine showed the same elution pattern upon size exclusion chromatography. Conclusion We report for the first time that sCD320 is present in urine and in a higher concentration than in serum and that serum and urine sCD320 increase during pregnancy. The high urinary concentration and the strong correlation between urinary and serum sCD320 suggests that sCD320 is filtered in the kidney.
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Gatford KL, Houda CM, Lu ZX, Coat S, Baghurst PA, Owens JA, Sikaris K, Rowan JA, Hague WM. Vitamin B12 and homocysteine status during pregnancy in the metformin in gestational diabetes trial: responses to maternal metformin compared with insulin treatment. Diabetes Obes Metab 2013; 15:660-7. [PMID: 23402546 DOI: 10.1111/dom.12080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/15/2013] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
Abstract
AIM The aim of the study is to compare the effects of metformin and insulin treatment for gestational diabetes mellitus (GDM) on vitamin B12 and homocysteine (Hcy) status. METHODS Women with GDM, who met criteria for insulin treatment, were randomly assigned to metformin (n = 89) or insulin (n = 91) in the Adelaide cohort of the metformin in gestational diabetes (MiG) trial. Fasting serum total vitamin B12 (TB12), holotranscobalamin (HoloTC), a marker of functional B12 status and plasma Hcy concentrations were measured at 20-34 weeks (at randomization) and 36 weeks gestation, then at 6-8 weeks postpartum. RESULTS Circulating TB12, HoloTC and Hcy were similar in both treatment groups at each time point. Women who were taking dietary folate supplements at randomization had higher serum TB12 and HoloTC at randomization than those not taking folate. Overall, serum TB12 fell more between randomization and 36 weeks gestation in the metformin group than in the insulin group (metformin: -19.7 ± 4.7 pmol/l, insulin: -6.4 ± 3.6 pmol/l, p = 0.004). The decrease in serum TB12 during treatment was greater with increasing treatment duration in metformin-treated (p < 0.001), but not in insulin-treated women. CONCLUSIONS Total, but not bioavailable, vitamin B12 stores were depleted during pregnancy to a greater extent in metformin-treated than in insulin-treated women with GDM, but neither analyte differed between groups at any stage. This adds further evidence supporting metformin as a safe alternative treatment to insulin in GDM. Further investigation is needed to evaluate whether women treated with metformin for longer periods in pregnancy require additional B12 or other supplementation.
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Affiliation(s)
- K L Gatford
- Robinson Institute and Discipline of Obstetrics and Gynaecology, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
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Abraham A, Mathews JE, Sebastian A, Chacko KP, Sam D. A nested case-control study to evaluate the association between fetal growth restriction and vitamin B12 deficiency. Aust N Z J Obstet Gynaecol 2013; 53:399-402. [PMID: 23432069 DOI: 10.1111/ajo.12057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/22/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To study the association between maternal vitamin B12 levels and fetal growth restriction. METHODS In this nested case-control study, a cohort of low-risk women attending the antenatal clinic had their blood samples taken and stored at 28-31 weeks gestation. They were followed until delivery. Fifty-eight women delivering babies less than 2500 g were taken as cases and an equal number of controls delivering babies more than 2500 g were taken from the same cohort. Their B12 levels were assayed and studied for statistical significance. RESULTS The baseline characteristics of both groups were similar. The number of women with serum B12 levels less than 200 pg/mL were similar in both groups: 33% versus 29% (P = 0.84). Type of kitchen fuel used was taken as a surrogate marker for socioeconomic status. More women in the cases used non-LPG (liquid petroleum gas) kitchen fuels such as kerosene and wood than in controls, 35% versus 19% (P = 0.06). CONCLUSIONS No association between maternal vitamin B12 levels and fetal growth restriction was found in this study. Low birth weight babies were more common in women of low socioeconomic status.
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Affiliation(s)
- Anuja Abraham
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India
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Severe Anaemia during Late Pregnancy. Case Rep Obstet Gynecol 2012; 2012:485452. [PMID: 22988533 PMCID: PMC3439950 DOI: 10.1155/2012/485452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/09/2012] [Indexed: 11/17/2022] Open
Abstract
Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10-28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb) levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient's haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.
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Association between vitamin B12intake and EURRECA's prioritized biomarkers of vitamin B12in young populations: a systematic review. Public Health Nutr 2012; 16:1843-60. [DOI: 10.1017/s1368980012003953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractObjectiveTo review evidence on the associations between vitamin B12intake and its biomarkers, vitamin B12intake and its functional health outcomes, and vitamin B12biomarkers and functional health outcomes.DesignA systematic review was conducted by searching electronic databases, until January 2012, using a standardized strategy developed in the EURRECA network. Relevant articles were screened and sorted based on title and abstract, then based on full text, and finally included if they met inclusion criteria. A total of sixteen articles were included in the review.SettingArticles covered four continents: America (n4), Europe (n8), Africa (n1) and Asia (n3).SubjectsPopulation groups included healthy infants, children and adolescents, and pregnant and lactating women.ResultsFrom the total number of 5815 papers retrieved from the initial search, only sixteen were eligible according to the inclusion criteria: five for infants, five for children and adolescents, and six for pregnant and lactating women.ConclusionsOnly one main conclusion could be extracted from this scarce number of references: a positive association between vitamin B12intake and serum vitamin B12in the infant group. Other associations were not reported in the eligible papers or the results were not provided in a consistent manner. The low number of papers that could be included in our systematic review is probably due to the attention that is currently given to research on vitamin B12in elderly people. Our observations in the current systematic review justify the idea of performing well-designed studies on vitamin B12in young populations.
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Abstract
The water-soluble vitamins B6, B12 and C play important roles in maternal health as well as fetal development and physiology during gestation. This systematic review evaluates the risks and benefits of interventions with vitamins B6, B12 and C during pregnancy on maternal, neonatal and child health and nutrition outcomes. Relevant publications were identified by searching PubMed, Popline and Web of Science databases. Meta-analyses were conducted for outcomes where results from at least three controlled trials were available. Potential benefits of vitamin B6 supplementation were reduction in nausea and vomiting, improvement in dental health, and treatment of some cases of anaemia. In meta-analysis based on three small studies, vitamin B6 supplementation had a significant positive effect on birthweight (d = 217 g [95% confidence interval (CI) 130, 304]). Interventions with vitamin C alone or combined with vitamin E did not systematically reduce the incidence of pre-eclampsia, premature rupture of membranes, or other adverse pregnancy outcomes. In meta-analyses, vitamins C and E increased the risk of pregnancy-related hypertension (relative risk 1.10 [95% CI 1.02, 1.19]). Effects of vitamin B6 or C intervention on other neonatal outcomes, including preterm birth, low birthweight, and perinatal morbidity and mortality, were not significant. Data on child health outcomes were lacking. Despite the prevalence of vitamin B12 deficiency amongst populations with limited intake of animal source foods, no intervention trials have evaluated vitamin B12 supplementation before or during pregnancy. In conclusion, existing evidence does not justify vitamin C supplementation during pregnancy. Additional studies are needed to confirm positive effects of vitamin B6 supplementation on infant birthweight and other outcomes. While vitamin B12 supplementation may reduce the incidence of neural tube defects in the offspring based on theoretical considerations, research is needed to support this hypothesis.
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Affiliation(s)
- Daphna K Dror
- Allen Laboratory, USDA, ARS Western Human Nutrition Research Center, 430 W. Health Sciences Dr., Davis, CA 95616, USA.
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Halicioglu O, Sutcuoglu S, Koc F, Ozturk C, Albudak E, Colak A, Sahin E, Asik Akman S. Vitamin B12 and folate statuses are associated with diet in pregnant women, but not with anthropometric measurements in term newborns. J Matern Fetal Neonatal Med 2012; 25:1618-21. [PMID: 22185230 DOI: 10.3109/14767058.2011.648244] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants. METHODS A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B(12) and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B(12) deficient mothers were evaluated after birth. RESULTS The rate of vitamin B(12) deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B(12) levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B(12) and folate concentrations. CONCLUSION The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.
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Affiliation(s)
- Oya Halicioglu
- Department of Pediatrics, The Ministry of Health Tepecik Teaching and Research Hospital, Izmir, Turkey.
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Wilson SMC, Bivins BN, Russell KA, Bailey LB. Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutr Rev 2011; 69:572-83. [DOI: 10.1111/j.1753-4887.2011.00419.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Greibe E, Andreasen BH, Lildballe DL, Morkbak AL, Hvas AM, Nexo E. Uptake of cobalamin and markers of cobalamin status: a longitudinal study of healthy pregnant women. Clin Chem Lab Med 2011; 49:1877-82. [PMID: 21875397 DOI: 10.1515/cclm.2011.682] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Currently, it is unknown whether the decline in plasma cobalamin observed during pregnancy is caused by malabsorption of the vitamin. This study examined cobalamin absorption and markers of cobalamin status during normal pregnancy. METHODS Twenty-seven pregnant Danish women were examined at gestation weeks 13, 24 and 36. The absorption test CobaSorb was performed in all women implying measurement of holotranscobalamin or cyanocobalamin bound to transcobalamin before and after 2 days intake of 3 × 9 μg cobalamin. Serum cobalamin and the two cobalamin binding proteins transcobalamin and haptocorrin, including haptocorrin saturated with cobalamin or analogues, were measured, and so was plasma methylmalonic acid and homocysteine. RESULTS No change in the uptake of cobalamin was observed throughout pregnancy. Serum cobalamin displayed a gradual decline during pregnancy (p<0.0001), while holotranscobalamin remained unchanged, despite an increase in total transcobalamin (p<0.0001). In accord with these results, total haptocorrin showed a decline from the 1st to 3rd trimester (p=0.007) and cobalamin bound to haptocorrin declined (p<0.0001). Interestingly, the amount of cobalamin analogues attached to haptocorrin remained unchanged. Methylmalonic acid (p=0.002) and homocysteine (p<0.0001) increased during pregnancy. CONCLUSIONS Cobalamin absorption remains unchanged during normal pregnancy, as judged by the CobaSorb test. No change was observed in the biological active holotranscobalamin during pregnancy. Thus, the pregnancy-related decline in cobalamin is caused by alternations in haptocorrin-bound cobalamin. Surprisingly, no pregnancy-related change was observed in the amount of analogues attached to haptocorrin.
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Affiliation(s)
- Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
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Vanderjagt DJ, Ujah IAO, Ikeh EI, Bryant J, Pam V, Hilgart A, Crossey MJ, Glew RH. Assessment of the vitamin B12 status of pregnant women in Nigeria using plasma holotranscobalamin. ISRN OBSTETRICS AND GYNECOLOGY 2011; 2011:365894. [PMID: 21789284 PMCID: PMC3140786 DOI: 10.5402/2011/365894] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 05/18/2011] [Indexed: 11/23/2022]
Abstract
Maternal vitamin B12 deficiency during pregnancy is an independent risk factor for neural tube defects and other neurological problems in infants. We determined the vitamin B12 status of 143 pregnant women in Nigeria representing all trimesters who presented to an antenatal clinic in Jos, Nigeria, using holotranscobalamin II levels (holoTCII), which is a measure of the vitamin B12 that is available for uptake into tissues. The holoTCII concentration ranged from 13 to 128 pmol/L. Using a cutoff of 40 pmol/L, 36% of the women were classified as vitamin B12-deficient. HoloTCII concentrations correlated negatively with plasma homocysteine levels (r = −0.24, P = 0.003) and positively with red blood cell folate concentrations (r = 0.28, P < 0.001). These data underscore the importance of supplementing pregnant women in Nigeria with vitamin B12 in order to ensure adequate vitamin B12 status and decrease the risk for neural tube defects.
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Affiliation(s)
- Dorothy J Vanderjagt
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, MSC08 4670, Albuquerque, NM 87131-0001, USA
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Shields RC, Caric V, Hair M, Jones O, Wark L, McColl MD, Ramsay JE. Pregnancy-specific reference ranges for haematological variables in a Scottish population. J OBSTET GYNAECOL 2011; 31:286-9. [DOI: 10.3109/01443615.2010.545900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Goedhart G, van der Wal MF, van Eijsden M, Bonsel GJ. Maternal vitamin B-12 and folate status during pregnancy and excessive infant crying. Early Hum Dev 2011; 87:309-14. [PMID: 21324613 DOI: 10.1016/j.earlhumdev.2011.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 12/09/2010] [Accepted: 01/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND The etiology of excessive infant crying is largely unknown. We hypothesize that excessive infant crying may have an early nutritional origin during fetal development. AIMS This study is the first to explore whether (1) maternal vitamin B-12 and folate status during pregnancy are associated with excessive infant crying, and (2) whether and how maternal psychological well-being during pregnancy affects these associations. STUDY DESIGN Women were approached around the 12th pregnancy week to complete a questionnaire (n=8266) and to donate a blood sample (n=4389); vitamin B-12 and folate concentrations were determined in serum. Infant crying behavior was measured through a postpartum questionnaire (±3 months; n=5218). SUBJECTS Pregnant women living in Amsterdam and their newborn child. OUTCOME MEASURES Excessive infant crying, defined as crying ≥3 h/day on average in the past week. RESULTS Multiple logistic regression analysis was performed for 2921 (vitamin B-12) and 2622 (folate) women.Vitamin B-12 concentration (categorized into quintiles) was associated with excessive infant crying after adjustment for maternal age, parity, ethnicity, education, maternal smoking and psychological problems (OR[95%CI]: Q1=3.31[1.48-7.41]; Q2=2.50[1.08-5.77]; Q3=2.59[1.12-6.00]; Q4=2.77[1.20-6.40]; Q5=reference). Stratified analysis suggested a stronger association among women with high levels of psychological problems during pregnancy. Folate concentration was not associated with excessive infant crying. CONCLUSIONS First evidence is provided for an early nutritional origin in excessive infant crying. A low maternal vitamin B-12 status during pregnancy could, in theory, affect infant crying behavior through two potential mechanisms: the methionine-homocysteine metabolism and/or the maturation of the sleep-wake rhythm.
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Affiliation(s)
- Geertje Goedhart
- Public Health Service, Department of Epidemiology, Documentation and Health Promotion, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands.
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Hay G, Clausen T, Whitelaw A, Trygg K, Johnston C, Henriksen T, Refsum H. Maternal folate and cobalamin status predicts vitamin status in newborns and 6-month-old infants. J Nutr 2010; 140:557-64. [PMID: 20071650 DOI: 10.3945/jn.109.117424] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our aim in this longitudinal study was to determine predictors of folate and cobalamin status in infancy. Data were collected from 364 mother-infant pairs with blood measurements from pregnancy ( approximately 18 wk; n = 149), newborns (cord serum; n = 361), and 6-mo-old partially or exclusively breast-fed children (n = 221). Serum/plasma folate, cobalamin, holotranscobalamin (holoTC), holohaptocorrin (holoHC), methylmalonic acid (MMA) and total homocysteine (tHcy) at birth and 6 mo were related to maternal vitamin status, parity, lifestyle variables, and anthropometry. In multivariate analyses, the strongest predictors of folate at birth and 6 mo were maternal folate and cord folate, respectively (P < 0.01). Maternal holoTC best predicted cobalamin status at birth (positively associated with cord cobalamin, holoTC, and holoHC; inversely with MMA and tHcy; P < or = 0.001), whereas maternal and cord holoHC were the strongest predictors of cobalamin status at 6 mo (positively associated with cobalamin, holoTC, holoHC; inversely with tHcy; P < 0.05). The association between cobalamin status and parity was negative at birth but positive at 6 mo. Birth weight, female sex, and smoking were associated with low cobalamin or high tHcy at birth but showed no or opposite associations at 6 mo. In conclusion, maternal folate and cobalamin status exerts a long-term positive effect on infant vitamin status. The effect of smoking, parity and female sex on cobalamin status did not persist beyond the newborn period. Maternal holoTC was the superior predictor of newborn cobalamin status, while holoHC could be a valuable marker for predicting cobalamin status later in infancy.
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Affiliation(s)
- Gry Hay
- Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, 0316 Oslo, Norway.
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Vanderjagt DJ, Ujah IAO, Patel A, Kellywood J, Crossey MJ, Allen RH, Stabler SP, Obande OS, Glew RH. Subclinical vitamin B12 deficiency in pregnant women attending an antenatal clinic in Nigeria. J OBSTET GYNAECOL 2010; 29:288-95. [PMID: 19835494 DOI: 10.1080/01443610902812709] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
SUMMARY Inadequate vitamin B12 status in a pregnant woman increases the risk for adverse maternal and fetal outcomes. The use of serum vitamin B12 concentration alone to assess vitamin B12 status in pregnant women is unreliable because of the decrease in serum vitamin B12 levels in normal pregnancy. The combination of serum vitamin B12 and methylmalonic acid (MMA) concentrations may provide a better estimate of vitamin B12 status. We obtained blood samples from 98 pregnant women in the third trimester at an antenatal clinic in Jos, Nigeria. All subjects were taking iron and folate supplements. Twelve of the subjects had a serum vitamin B12 concentration <148 pmol/l and 18 subjects had a serum MMA level >271 nmol/l. Using a combination of low serum vitamin B12 and elevated MMA concentrations, eight subjects were classified as having subclinical vitamin B12 deficiency. Because of the potential harmful consequences of vitamin B12 deficiency in pregnant women, it would be advisable to add vitamin B12 supplements to the existing regimen of folate and iron supplements currently provided to pregnant women in Nigeria.
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Affiliation(s)
- D J Vanderjagt
- Department of Biochemistry and Molecular Biology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131-001, USA
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Carmel R, Parker J, Kelman Z. Genomic mutations associated with mild and severe deficiencies of transcobalamin I (haptocorrin) that cause mildly and severely low serum cobalamin levels. Br J Haematol 2009; 147:386-91. [PMID: 19686235 DOI: 10.1111/j.1365-2141.2009.07855.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transcobalamin (TC) I deficiency, like the function of TC I itself, is incompletely understood. It produces low serum cobalamin levels indistinguishable from those of true cobalamin deficiency. Diagnosis is especially elusive when TC I deficiency is mild. To provide new, more substantive definition, the TCN1 gene was examined in two well-characterised families that included members with both severe and mild TC I deficiencies. A severely deficient proposita with undetectable TC I levels displayed compound heterozygosity for two mutations, each causing a premature stop codon. Relatives in both families who had mildly low or low-normal plasma levels of TC I and cobalamin were heterozygous for one or the other of these mutations. An unrelated patient with mild TC I deficiency and unknown familial TC I and cobalamin status was then tested and found to be similarly heterozygous for one of the mutations. The two nonprivate mutations identify a genetic basis for TC I deficiency for the first time. They also add new approaches to studying mild and severe TC I deficiency and to reducing confusion of its low cobalamin levels with those of cobalamin deficiency and its often dramatically different prognosis and management.
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Affiliation(s)
- Ralph Carmel
- Department of Medicine, New York Methodist Hospital, Brooklyn, NY 11215, USA.
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