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Abstract
Vitamin B12 deficiency is a significant public health problem globally. Although it is a well-known cause of macrocytic anaemia and in advanced cases, pancytopenia, there remains a relative paucity of cases reported in pregnancy. It is associated with an increased risk of pregnancy complications and adverse birth outcomes such as neural tube defects, preterm birth, low birth weight, neurological sequelae and intrauterine death. It has a predilection for individuals aged >60 years. It has been implicated in a spectrum of neuropsychiatric disorders and it may also exert indirect cardiovascular effects. Severe vitamin B12 deficiency may present with haematological abnormalities that mimic thrombotic microangiopathy such as HELLP syndrome (haemolysis, elevated liver enzymes and low platelets) or it may present as pseudothrombotic microangiopathy (Moschcowitz syndrome) characterised by anaemia, thrombocytopenia and schistocytosis. It can also closely mimic thrombotic thrombocytopenia purpura, hence posing a diagnostic challenge to the unwary physician. Serological measurement of vitamin B12 levels confirms the diagnosis. Oral supplementation with vitamin B12 remains a safe and effective treatment. The authors describe the case of a multiparous woman in her late 20s presenting with a plethora of non-specific symptoms at 29+5 weeks' gestation. Her haemoglobin was 45 g/L, platelets 32×109/L, vitamin B12 <150 ng/L and serum folate <2 µg/L. She was not a vegetarian, but her diet lacked nutrition. Following parenteral B12 supplementation, her haematological parameters improved. The pregnancy was carried to term. Due to the plethora of non-specific symptoms, the diagnosis can be challenging to establish. Adverse maternal or fetal outcomes may occur. Folic acid supplementation may mask an occult vitamin B12 deficiency and further exacerbate or initiate neurological disease.
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Affiliation(s)
- Louise Dunphy
- Department of Obstetrics, Leighton Hospital, Cheshire, UK
| | - Ai-Wei Tang
- Department of Obstetrics, Liverpool Women's Hospital, Liverpool, UK
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Güitrón Leal CE, Palma Molina XE, Williams JL, Venkatramanan S, Finkelstein JL, Kuriyan R, Crider KS. Vitamin B 12
supplementation for growth, development, and cognition in children. Hippokratia 2022. [DOI: 10.1002/14651858.cd015264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Jennifer L Williams
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta GA USA
| | | | | | - Rebecca Kuriyan
- Division of Nutrition; St John's Research Institute; Bengaluru India
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities; Centers for Disease Control and Prevention; Atlanta GA USA
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3
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Guetterman HM, Huey SL, Knight R, Fox AM, Mehta S, Finkelstein JL. Vitamin B-12 and the Gastrointestinal Microbiome: A Systematic Review. Adv Nutr 2021; 13:S2161-8313(22)00075-8. [PMID: 34612492 PMCID: PMC8970816 DOI: 10.1093/advances/nmab123] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vitamin B-12 deficiency is a major public health problem affecting individuals across the lifespan, with known hematological, neurological, and obstetric consequences. Emerging evidence suggests that vitamin B-12 may have an important role in other aspects of human health, including the composition and function of the gastrointestinal (gut) microbiome. Vitamin B-12 is synthesized and utilized by bacteria in the human gut microbiome and is required for over a dozen enzymes in bacteria, compared to only two in humans. However, the impact of vitamin B-12 on the gut microbiome has not been established. This systematic review was conducted to examine the evidence that links vitamin B-12 and the gut microbiome. A structured search strategy was used to identify in vitro, animal, and human studies that assessed vitamin B-12 status, dietary intake, or supplementation, and the gut microbiome using culture-independent techniques. A total of 22 studies (3 in vitro, 8 animal, 11 human observational studies) were included. Nineteen studies reported vitamin B-12 intake, status, or supplementation was associated with gut microbiome outcomes, including beta-diversity, alpha-diversity, relative abundance of bacteria, functional capacity, or short chain fatty acid production. Evidence suggests vitamin B-12 may be associated with changes in bacterial abundance. While results from in vitro studies suggest vitamin B-12 may increase alpha-diversity and shift gut microbiome composition (beta-diversity), findings from animal studies and observational human studies were heterogeneous. Based on evidence from in vitro and animal studies, microbiome outcomes may differ by cobalamin form and co-intervention. To date, few prospective observational studies and no randomized trials have been conducted to examine the effects of vitamin B-12 on the human gut microbiome. The impact of vitamin B-12 on the gut microbiome needs to be elucidated to inform screening and public health interventions. Statement of significance: Vitamin B-12 is synthesized and utilized by bacteria in the human gut microbiome and is required by over a dozen enzymes in bacteria. However, to date, no systematic reviews have been conducted to evaluate the impact of vitamin B-12 on the gut microbiome, or its implications for human health.
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Affiliation(s)
| | - Samantha L Huey
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA,Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA, USA,Department of Bioengineering, University of California San Diego, La Jolla, CA, USA,Center for Microbiome Innovation, University of California San Diego, La Jolla, CA, USA
| | - Allison M Fox
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA,Division of Epidemiology, Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA,Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, NY, USA
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4
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Wilcox NS, Tapé C, Cordisco AJ, Than MT, Zuroff L, Dobkin J, Massa RC, Lytle AG, Bagg A, Min H, Glaser LJ, Kosseim LM. Anemia in a young Guinean male. Clin Case Rep 2021; 9:e04593. [PMID: 34401166 PMCID: PMC8346596 DOI: 10.1002/ccr3.4593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 11/12/2022] Open
Abstract
The etiology of anemia in adults is often multifactorial. This case highlights an uncommon combination of causes of anemia and the importance of a diagnostic workup guided by a patient's unique history, risk factors, and laboratory findings.
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Affiliation(s)
- Nicholas S. Wilcox
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Chantal Tapé
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Anthony J. Cordisco
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Minh T. Than
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Leah Zuroff
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jane Dobkin
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Ryan C. Massa
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Andrew G. Lytle
- Department of PathologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Adam Bagg
- Department of PathologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Htun Min
- Department of PathologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Laurel J. Glaser
- Department of PathologyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Laura M. Kosseim
- Department of MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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Darnton-Hill I. Public Health Aspects in the Prevention and Control of Vitamin Deficiencies. Curr Dev Nutr 2019; 3:nzz075. [PMID: 31598578 PMCID: PMC6775441 DOI: 10.1093/cdn/nzz075] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Abstract
Vitamin deficiencies remain major etiological factors in the global burden of disease, especially in low- and middle-income countries. The purpose of this state-of-the-art review was to update current information on deficiencies of vitamins and public health approaches to addressing them. Some stages of life present a higher risk of deficiency than others: risks are higher in pregnant women, children (from conception to young childhood), adolescents, the elderly, and all of the over 800 million people globally who are undernourished. At risk are approximately 125 million preschool children with vitamin A deficiency, as well as sub-populations at risk of deficiencies of folate, thiamin, vitamin B12, niacin, riboflavin, other B vitamins. and vitamin D. Addressing micronutrient deficiencies requires identifying those at risk and then working to prevent and manage that risk. Public health approaches include improved, diversified diets; supplementation; fortification and biofortification; and other supportive public health measures. Historically, as with pellagra and beriberi and, in the last 3 decades, with vitamin A and folic acid, there has been encouraging progress, but much remains to be done.
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Affiliation(s)
- Ian Darnton-Hill
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Charles Perkins Centre, Faculty of Medicine, University of Sydney, New South Wales 2006, Australia
- The Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA 021111, USA
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