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      Vitamin B 12 Status in Pregnant Adolescents and Their Infants

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          Abstract

          Vitamin B 12 deficiency has been associated with increased risk of adverse pregnancy outcomes. Few prospective studies have investigated the burden or determinants of vitamin B 12 deficiency early in life, particularly among pregnant adolescents and their children. The objectives of this study were to determine the prevalence of vitamin B 12 deficiency and to examine associations between maternal and neonatal vitamin B 12 status in a cohort study of healthy pregnant adolescents. Serum vitamin B 12 and folate concentrations were measured in adolescents at mid-gestation ( n = 124; 26.4 ± 3.5 weeks) and delivery ( n = 131; 40.0 ± 1.3 weeks), and in neonates at birth using cord blood. Linear regression was used to examine associations between maternal and neonatal vitamin B 12 status. Although the prevalence of vitamin B 12 deficiency (<148.0 pmol/L; 1.6%) in adolescents was low during pregnancy, 22.6% of adolescents were vitamin B 12 insufficient (<221.0 pmol/L; 22.6%) at mid-gestation. Maternal vitamin B 12 concentrations significantly decreased from mid-gestation to delivery ( p < 0.0001), and 53.4% had insufficient vitamin B 12 status at delivery. Maternal vitamin B 12 concentrations ( p < 0.001) and vitamin B 12 deficiency ( p = 0.002) at delivery were significantly associated with infant vitamin B 12 concentrations in multivariate analyses, adjusting for gestational age, maternal age, parity, smoking status, relationship status, prenatal supplement use, pre-pregnancy body mass index, race, and intake of vitamin B 12 and folate. Maternal vitamin B 12 concentrations significantly decreased during pregnancy and predicted neonatal vitamin B 12 status in a cohort of healthy pregnant adolescents.

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          Most cited references 53

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          Effects of vitamin B12 and folate deficiency on brain development in children.

          Folate deficiency in the periconceptional period contributes to neural tube defects; deficits in vitamin B12 (cobalamin) have negative consequences on the developing brain during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood. This review examines two mechanisms linking folate and vitamin B12 deficiency to abnormal behavior and development in infants: disruptions to myelination and inflammatory processes. Future investigations should focus on the relationship between the timing of deficient and marginal vitamin B12 status and outcomes such as infant growth, cognition, social development, and depressive symptoms, along with prevention of folate and vitamin B12 deficiency.
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            Review of the magnitude of folate and vitamin B12 deficiencies worldwide.

            Human deficiencies of folate and vitamin B12 result in adverse effects which may be of public health significance, but the magnitude of these deficiencies is unknown. Therefore, we examine the prevalence data currently available, assess global coverage of surveys, determine the frequency with which vitamin status assessment methods are used, and identify patterns of status related to geographical distribution and human development. Surveys were identified through PubMed and the Vitamin and Mineral Nutrition Information System at the World Health Organization (WHO). Since different thresholds were frequently used to define deficiency, measures of central tendency were used to compare blood vitamin concentrations among countries. The percentage of countries with at least one survey is highest in the WHO Regions of South-East Asia and Europe. Folate and vitamin B12 status were most frequently assessed in women of reproductive age (34 countries), and in all adults (27 countries), respectively. Folate status assessment surveys assessed plasma or serum concentrations (55%), erythrocyte folate concentrations (21%), or both (23%). Homocysteine was assessed in one-third of the surveys of folate and vitamin B12 status (31% and 34% respectively), while methylmalonic acid was assessed in fewer surveys of vitamin B12 status (13%). No relationship between vitamin concentrations and geographical distribution, level of development, or population groups could be identified, but nationally representative data were few. More representative data and more consistent use of thresholds to define deficiency are needed in order to assess whether folate and vitamin B12 deficiencies are a public health problem.
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              Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification.

              Folic acid fortification has reduced neural tube defect prevalence by 50% to 70%. It is unlikely that fortification levels will be increased to reduce neural tube defect prevalence further. Therefore, it is important to identify other modifiable risk factors. Vitamin B(12) is metabolically related to folate; moreover, previous studies have found low B(12) status in mothers of children affected by neural tube defect. Our objective was to quantify the effect of low B(12) status on neural tube defect risk in a high-prevalence, unfortified population. We assessed pregnancy vitamin B(12) status concentrations in blood samples taken at an average of 15 weeks' gestation from 3 independent nested case-control groups of Irish women within population-based cohorts, at a time when vitamin supplementation or food fortification was rare. Group 1 blood samples were from 95 women during a neural tube defect-affected pregnancy and 265 control subjects. Group 2 included blood samples from 107 women who had a previous neural tube defect birth but whose current pregnancy was not affected and 414 control subjects. Group 3 samples were from 76 women during an affected pregnancy and 222 control subjects. Mothers of children affected by neural tube defect had significantly lower B(12) status. In all 3 groups those in the lowest B(12) quartiles, compared with the highest, had between two and threefold higher adjusted odds ratios for being the mother of a child affected by neural tube defect. Pregnancy blood B(12) concentrations of 300 ng/L (221 pmol/L) before becoming pregnant. Improving B(12) status beyond this level may afford a further reduction in risk, but this is uncertain.
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                13 February 2019
                February 2019
                : 11
                : 2
                Affiliations
                [1 ]Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA; af544@ 123456cornell.edu (A.F.); hg384@ 123456cornell.edu (H.M.G.); trk8@ 123456cornell.edu (T.R.K.); koo4@ 123456cornell.edu (K.O.O.)
                [2 ]University of Rochester Medical Center, Rochester, NY 14642, USA; ronnie_guillet@ 123456urmc.rochester.edu (R.G.); eva_Pressman@ 123456urmc.rochester.edu (E.K.P.)
                Author notes
                [* ]Correspondence: jfinkelstein@ 123456cornell.edu ; Tel.: +1-607-255-9180; Fax: +1-607-255-1033
                Article
                nutrients-11-00397
                10.3390/nu11020397
                6413223
                30781902
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Nutrition & Dietetics

                vitamin b12, micronutrients, pregnancy, adolescents, folate

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