Vitamin B12 and Folate Status in Pregnant Females and Their Infants in Norway: Secondary Analysis from the Mommy's Food Study.
Sol Maja G Bjørkevoll,
Carolien Konijnenberg,
Ingrid Kvestad,
Adrian McCann,
Per M Ueland
et al.
Other
The Journal of nutrition
2023
4 उद्धरण
PubMed
DOI
CC-BY
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Study Design
- अध्ययन प्रकार
- Cohort
- नमूना आकार
- 136
- अवधि
- 36 weeks
- हस्तक्षेप
- Vitamin B12 and Folate Status in Pregnant Females and Their Infants in Norway: Secondary Analysis from the Mommy's Food Study. None
- तुलनित्र
- Placebo
- प्रभाव की दिशा
- Positive
- पूर्वाग्रह का जोखिम
- Moderate
Abstract
BACKGROUND: Vitamin B12 and folate are essential micronutrients important for normal infant growth and development. OBJECTIVES: The aims were to describe vitamin B12 and folate status in pregnant females and their infants according to commonly used status cutoffs and examine the associations between maternal status, maternal supplement use, and breastfeeding and infant status. METHODS: Pregnant females were recruited at 18 wk gestation in Bergen, Norway. Maternal vitamin B12 and folate status were measured at gestational weeks 18 (n = 136) and 36 (n = 116), and infant status was measured at ages 3 (n = 73) and 6 (n = 74) mo. RESULTS: At gestational weeks 18 and 36, respectively, 4.4% and 2.6% of the mothers had plasma cobalamin concentrations <148 pmol/L, 0.7% and 6.9% had methylmalonic acid (MMA) concentrations >0.26 μmol/L, and 3.7% and 30% had folate concentrations <10 nmol/L. None of the females had total homocysteine (t-Hcy) concentrations >13 μmol/L or 3 combined indicator of vitamin B12 (cB12) < -0.5. At 3 and 6 mo, respectively, 4.1% and 5.4% of the infants had cobalamin concentrations <148 pmol/L, 63% and 74% had t-Hcy concentrations >6.5 μmol/L, 59% and 66% had MMA concentrations >0.26 μmol/L, and 47% and 60% had cB12 > -0.5. None of the infants had folate concentrations <10 nmol/L. Several of the vitamin B12 biomarkers in infants were associated with maternal vitamin B12 status during pregnancy. Breastfed infants had lower vitamin B12 status (as indicated by plasma cobalamin, t-Hcy, and cB12) than nonbreastfed infants at both 3 and 6 mo. Use of supplements during pregnancy was associated with better vitamin B12 status among infants at 3 and 6 mo, as indicated by infants' cobalamin and t-Hcy concentrations. CONCLUSIONS: Subclinical vitamin B12 deficiency among infants was common and associated with maternal vitamin B12 status during pregnancy and breastfeeding. Among the mothers, an increase in biochemical folate deficiency was discovered toward the end of gestation. Further studies are needed to investigate clinical consequences. This trial was registered at clinicaltrials.gov as NCT02610959.
Full Text
Figures
FIGURE 1
Study flow or recruitment diagram for the secondary analysis of vitamin B12 and folate status in pregnant females and their infants from Norway's Mommy's Food Study.
flowchart
FIGURE 2
Vitamin B12 and folate serum concentrations across pregnancy trimesters and in cord blood, revealing the prevalence of deficiency among Norwegian mothers and infants.
chart
FIGURE 3
Associations between maternal dietary intake or supplement use and vitamin B12 and folate biomarker levels during pregnancy and at delivery.
chartTables
TABLE 1
| Indicator | Cutoff | Definition |
|---|---|---|
| Vitamin B12 status | ||
| Cobalamin | <148 pmol/L | Low B12-status [ |
| t-Hcy | >13 μmol/L (mothers) | Elevated t-Hcy [ |
| >6.5 μmol/L (infants) | Subclinical B12 deficiency [ | |
| MMA | >0.26 | |
| cB12 | < −0.5 | Low B12 status [ |
| Folate status | ||
| Folate | <10 nmol/L | Folate deficiency [ |
| t-Hcy | >13 μmol/L (mothers) | Elevated t-Hcy [ |
TABLE 2
| Characteristics | mean (SD) or % | |
|---|---|---|
| Mothers | ||
| Age, y | 135 | 29.3 (3.8) |
| BMI before pregnancy | 132 | 23.1 (4.0) |
| BMI during pregnancy | 118 | 24.5 (4.0) |
| Education, y | ||
| | 19 | 14.3 |
| 14–17 | 33 | 24.8 |
| >17 | 81 | 60.9 |
| Household income, NOK | ||
| Low (<549,999) | 39 | 29.3 |
| Medium (550,000–1,249,999) | 77 | 57.9 |
| High (>1,250,000) | 17 | 12.8 |
| Marital status | ||
| Single or divorced | 2 | 1.5 |
| Cohabitant | 85 | 63.9 |
| Married | 43 | 32.3 |
| Other | 3 | 2.3 |
| Supplement users | ||
| GW18 | ||
| Users | 79 | 72.5 |
| Nonusers | 30 | 27.5 |
| GW36 | ||
| Users | 53 | 43.6 |
| Nonusers | 41 | 56.4 |
| 3 mo postpartum | ||
| Users | 39 | 48.2 |
| Nonusers | 42 | 51.9 |
| 6 mo postpartum | ||
| Users | 29 | 40.9 |
| Nonusers | 42 | 59.2 |
| Infants | ||
| Sex (female) | 58 | 50.4 |
| Birth weight, g | 93 | 3491 (536) |
| GA at time of delivery, wk | 122 | 40.2 (2.1) |
| Preterm delivery | 6 | 4.9 |
| Breastfeeding status, 3 mo | ||
| Not breastfed | 5 | 4.4 |
| Partially breastfed | 19 | 16.5 |
| Exclusively breastfed | 91 | 79.1 |
| Breastfeeding status, 6 mo | ||
| Not breastfed | 8 | 7.3 |
| Partially breastfed | 98 | 89.9 |
| Exclusively breastfed | 3 | 2.8 |
TABLE 3
| Mothers | Infants | |||||||
|---|---|---|---|---|---|---|---|---|
| GW18 ( | GW36 ( | 3 mo ( | 6 mo ( | |||||
| Median (IQR) | Def, | Median (IQR) | Def, | Median (IQR) | Def, | Median (IQR) | Def, | |
| Cob | 220.0 (184.5, 301.9) | 6 (4.4) | 224.4 (187.9, 291.1) | 3 (2.6) | 244.9 (199.0, 321.8) | 3 (4.1) | 221.6, (194.2, 324.8) | 4 (5.4) |
| t-Hcy | 4.7 (4.3, 5.3) | 0 (0.0) | 5.7 (4.9, 6.5) | 0 (0.0) | 7.3 (6.2, 8.8) | 46 (63.0) | 7.5 (6.5, 8.8) | 55 (74.3) |
| MMA | 0.1 (0.1, 0.2) | 1 (0.7) | 0.2 (0.1, 0.2) | 8 (6.9) | 0.4 (0.2, 0.9) | 43 (58.9) | 0.5 (0.2, 1.0) | 49 (66.2) |
| Folate | 26.4 (16.4, 34.9) | 5 (3.7) | 14.2 (9.4, 27.3) | 35 (30.2) | 42.0 (34.7, 58.7) | 0 (0.0) | 45.7 (34.2, 63.4) | 0 (0.0) |
| cB12 | 0.7 (0.5, 0.9) | 0 (0.0) | 0.4 (0.2, 0.7) | 0 (0.0) | −0.4 (−1.0, 0.2) | 34 (46.6) | −0.7 (−1.0, 0.0) | 44(59.5) |
TABLE 4
| Mothers GW18 ( | Mothers GW36 ( | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Cobalamin | t-Hcy | MMA | Folate | cB12 | Cobalamin | t-Hcy | MMA | Folate | cB12 | ||
| Infants 3 mo ( | Cobalamin | 0.36 (0.002) | −0.29 (0.013) | −0.15 (0.218) | 0.21 (0.075) | 0.37 (0.001) | 0.39 (0.001) | −0.25 (0.037) | −0.27 (0.022) | 0.25 (0.036) | 0.44 (<0.001) |
| t-Hcy | −0.28 (0.017) | 0.18 (0.124) | 0.21 (0.081) | −0.27 (0.023) | −0.33 (0.004) | −0.39 (0.001) | 0.40 (<0.001) | 0.34 (0.004) | −0.32 (0.006) | −0.54 (<0.001) | |
| MMA | −0.15 (0.196) | 0.06 (0.598) | 0.32 (0.006) | 0.04 (0.730) | −0.29 (0.013) | −0.22 (0.077) | −0.02 (0.884) | 0.31 (0.010) | 0.08 (0.521) | −0.26 (0.031) | |
| Folate | 0.14 (0.265) | 0.01 (0.909) | −0.01 (0.965) | −0.06 (0.627) | 0.03 (0.831) | 0.06 (0.655) | −0.10 (0.405) | −0.05 (0.685) | 0.01 (0.904) | 0.08 (0.534) | |
| cB12 | 0.26 (0.026) | −0.19 (0.113) | −0.34 (0.004) | 0.04 (0.735) | 0.41 (<0.001) | 0.33 (0.006) | −0.14 (0.243) | −0.38 (0.001) | 0.04 (0.732) | 0.43 (<0.001) | |
| Infants 6 mo ( | Cobalamin | 0.22 (0.060) | −0.15 (0.217) | −0.07 (0.578) | 0.24 (0.043) | 0.22 (0.059) | 0.29 (0.014) | −0.19 (0.119) | −0.17 (0.142) | 0.29 (0.016) | 0.31 (0.009) |
| t-Hcy | −0.13 (0.287) | 0.16 (0.184) | 0.25 (0.031) | −0.18 (0.126) | −0.24 (0.036) | −0.21 (0.076) | 0.27 (0.021) | 0.36 (0.002) | −0.13 (0.287) | −0.42 (<0.001) | |
| MMA | −0.17 (0.146) | 0.07 (0.528) | 0.43 (<0.001) | 0.05 (0.700) | −0.40 (<0.001) | −0.27 (0.025) | 0.19 (0.106) | 0.48 (<0.001) | 0.01 (0.923) | −0.49 (<0.001) | |
| Folate | 0.18 (0.130) | −0.04 (0.726) | −0.04 (0.737) | −0.06 (0.612) | 0.10 (0.397) | 0.07 (0.580) | 0.06 (0.618) | −0.09 (0.469) | −0.07 (0.575) | 0.04 (0.767) | |
| cB12 | 0.23 (0.053) | −0.09 (0.442) | −0.42 (<0.001) | 0.06 (0.612) | 0.43 (<0.001) | 0.36 (0.002) | −0.26 (0.031) | −0.52 (<0.001) | 0.11 (0.357) | 0.59 (<0.001) | |
TABLE 5
| Log cob | Log t-Hcy | Log MMA | Log folate | cB12 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Exp (95%CI) | Exp (95%CI) | Exp (95%CI) | Exp (95%CI) | Coef. (95%CI) | ||||||
| Infant status 3 mo | ||||||||||
| BF status 3 mo | 0.041 | |||||||||
| Non-BF ( | Ref | Ref | Ref | Ref | Ref | |||||
| BF ( | 0.64 (0.43, 0.94) | 0.023 | 1.44(1.04, 2.00) | 0.030 | 2.04(0.60, 6.94) | 0.251 | 0.63(0.38, 1.06) | 0.080 | −0.94(−1.83, −0.04) | 0.041 |
| Infant status 6 mo | ||||||||||
| BF status 6 mo | ||||||||||
| Non-BF ( | Ref | Ref | Ref | Ref | Ref | |||||
| BF ( | 0.50 (0.40, 0.64) | <0.001 | 1.55 (1.30, 1.85) | <0.001 | 3.15 (1.58, 6.29) | 0.001 | 0.70 (0.52, 0.93) | 0.015 | −1.40 (−1.89, −0.90) | <0.001 |
TABLE 6
| 3 mo | 6 mo | |||||||
|---|---|---|---|---|---|---|---|---|
| BF( | Non-BF ( | BF ( | Non-BF ( | |||||
| Median (IQR) | Def, | Median (IQR) | Def, | Median (IQR) | Def, | Median (IQR) | Def, | |
| Cob | 239.1 (194.9, 313.0) | 3 (4.3) | 390.8 (364,0, 446.8) | 0 (0.0) | 212.8 (188.2, 277.1) | 4 (6.1) | 461.0, 374,5, 562,4) | 0 (0.0) |
| t-Hcy | 7.5 (6.3, 9.0) | 46 (65.7) | 4.7 (4.7, 6.1) | 0 (0.0) | 7.8 (6.7, 9.0) | 54 (81.8) | 5.6 (4.3, 5.6) | 0 (0.0) |
| MMA | 0.4 (0.2, 1.0) | 42 (60.0) | 0.2 (0.2, 0.3) | 1 (33.3) | 0.6 (0.3, 1.1) | 49 (74.2) | 0.2 (0.2, 0.3) | 0 (0.0) |
| cB12 | −0.5 (−1.0, 1.4) | 34 (48.6) | 0.5 (0.3, 0.5) | 0 (0.0) | −0.8 (−1.1, −0.2) | 44 (66.7) | 0.6 (0.6, 1.1) | 0 (0.0) |
TABLE 7
| Log cob | Log t-Hcy | Log MMA | Log folate | cB12 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Exp (95%CI) | Exp (95%CI) | Exp (95%CI) | Exp (95%CI) | Coef. (95%CI) | ||||||
| Infants’ status 3 mo | ||||||||||
| Supplement use GW18, ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.33 (1.09, 1.63) | 0.005 | 0.89 (0.76, 1.05) | 0.165 | 0.95 (0.50, 1.79) | 0.863 | 1.07 (0.81, 1.41) | 0.641 | 0.28 (−0.20, 0.77) | 0.249 |
| Supplement use GW36 ( | ||||||||||
| No | ||||||||||
| Yes | 1.10 (0.91, 1.32) | 0.323 | 0.98 (0.84, 1.14) | 0.777 | 1.11 (0.64, 1.91) | 0.717 | 1.00 (0.80, 1.26) | 0.985 | 0.01 (−0.39, 0.42) | 0.954 |
| Supplement use 3 mo PP ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.09 (0.91, 1.32) | 0.351 | 0.86 (0.74, 1.00) | 0.056 | 1.00 (0.55, 1.81) | 0.995 | 1.08 (0.84, 1.38) | 0.553 | 0.15 (−0.30, 0.60) | 0.512 |
| Infants’ status 6 mo | ||||||||||
| Supplement use GW18 ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.21 (0.95, 1.52) | 0.118 | 0.85 (0.73, 0.99) | 0.042 | 0.74 (0.42, 1.28) | 0.276 | 0.88 (0.69, 1.12) | 0.295 | 0.41 (−0.05, 0.86) | 0.084 |
| Supplement use GW36 ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.20 (1.01, 1.44) | 0.043 | 0.89 (0.78, 1.02) | 0.104 | 0.91 (0.56, 1.49) | 0.707 | 0.87 (0.71, 1.06) | 0.161 | 0.24 (−0.15, 0.63) | 0.223 |
| Supplement use 3 mo PP ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.10 (0.91, 1.33) | 0.334 | 0.92 (0.81, 1.05) | 0.212 | 1.39 (0.85, 2.25) | 0.188 | 1.01 (0.83, 1.24) | 0.900 | −0.09 (−0.48, 0.29) | 0.641 |
| Supplement use 6 mo PP ( | ||||||||||
| No | Ref | Ref | Ref | Ref | Ref | |||||
| Yes | 1.02 (0.82, 1.27) | 0.875 | 0.88 (0.77, 1.02) | 0.089 | 1.26 (0.73, 2.18) | 0.398 | 0.95 (0.77, 1.18) | 0.670 | −0.06 (−0.48, 0.36) | 0.785 |
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