An important problem in developing countries: maternal and neonatal vitamin B12 deficiency Original Article

Abstract

Summary Aim: A significant increase has been noted in the number of infants admitted to our hospital due to neurologic findings and diagnosed as vitamin B12 deficiency within the first 6 months of life Therefore the aim of the present study was to determine the presence of maternal and neonatal vitamin B12 deficiency in infants born in our hospital Material and Method: The study population consisted of 250 women giving birth in our hospital and term newborns completing 48 hours after birth Serum vitamin B12 levels were measured in mothers and vitamin B12 and homocysteine levels were measured in their newborns The differential diagnosis between vitamin B12 deficiency and impaired cobalamin synthesis was made in infants with hyperhomocysteinemia The diagnostic threshold for vitamin B12 deficiency was 300 pg mL in mothers and 200 pg mL in newborns Results: Vitamin B12 deficiency was found in 81 6 of the mothers and 42 of the infants The mean homocysteine level in infants with vitamin B12 deficiency was significantly higher compared to those with normal vitamin B12 levels Impaired cobalamin synthesis was not observed in any cases Conclusions: Inadequate consumption of animal proteins during pregnancy due to low socioeconomic status appears to be a significant risk factor for vitamin B12 deficiency both in the mother and the infant The present study draws attention to the need for parenteral vitamin B12 replacement during pregnancy in developing countries such as Turkey Turk Arch Ped 2010; 45: 242 5 Key words: Developing countries maternal vitamin B12 deficiency neonatal vitamin B12 deficiency

Keywords

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Gelişmekte olan ülkelerde önemli bir sorun: annede ve yenidoğanda B12 vitamini eksikliği Özgün Araştırma

Öz

Özet Amaç: Son yıllarda yaşamın ilk altı aylık dönemi içinde nörolojik bulgular ile hastanemize başvuran ve B12 eksikliği tanısı alan olgularda ciddi bir artış dikkat çekmiştir Bundan dolayı hastanemizde doğan bebeklerde annede ve bebekte B12 eksikliğinin araştırılması gereği duyulmuştur Gereç ve Yöntem: Çalışma grubu hastanemizde doğum yapan 250 anne ve doğum sonrası 48 saatini doldurmuş term bebeklerden oluşturuldu Annede B12 bebekte B12 ve homosistein düzeyi ölçüldü Hiperhomosisteinemisi bulunan olgularda B12 yetersizliği ile kobalamin sentez bozukluğu ayırıcı tanısı yapıldı B12 eksikliği tanısının konulmasında annede B12 eşik değeri 300 pg ml bebekte 200 pg ml olarak alındı Bulgular: Annelerin 81 6 rsquo;sında bebeklerin 42 rsquo;sinde B12 yetersizliği saptandı B12 eksikliği bulunan olguların ortalama homosistein düzeyi B12 düzeyi normal olan olgulara göre anlamlı olarak yüksek bulundu Kobalamin sentez bozukluğu hiçbir olguda saptanmadı Çıkarımlar: Sosyoekonomik seviyenin düşük olması nedeni ile hayvansal proteinlerin anneler tarafından yeterince tüketilememesi hem anne hem de bebek için B12 vitamin eksikliği açısından önemli bir neden olarak gözükmektedir Bu çalışma bizim gibi gelişmekte olan ülkelerde gebelik döneminde B12 desteğinin kas içine uygulanarak karşılanması gerekliliğini tartışmaya açmaktadır Türk Ped Arş 2010; 45: 242 5 Anahtar sözcükler: Annede vitamin B12 eksikliği bebekte vitamin B12 eksikliği gelişmekte olan ülkeler

Anahtar Kelimeler

• Annede vitamin B12 eksikliği, bebekte vitamin B12 eksikliği, gelişmekte olan ülkeler

Kaynakça

1. Mittal VS, Agarwal KN. Observations on nutritional megaloblastic anemias in early childhood. Indian J Med Res 1969; 57: 730-8. (Abstract)
2. Allen LH. Vitamin B12 metabolism and status during pregnan- cy, lactation and infancy. In: Allen L H, King J, Lonnerdal B (eds). Nutrient regulation during pregnancy, lactation and infant growth. New York: Plenum Pres, 1994: 173-86.
3. Refsum H, Grindflek AW, Ueland PM, et al. Screening for serum total homocysteine in newborn children. Clin Chem 2004; 50: 1769-84. (Abstract) / (Full Text) / (PDF)
4. Neki NS. Hyperhomocysteinemia-an independent risk factor for cardiovascular diseases. JIACM 2003; 4: 55-60.
5. Whiteheat VM, Rosenblatt DS, Cooper BA. Megaloblastic ane- mia. In: Nathan DG, Orkin SH (eds). Nathan and Oski’s Hematology of Infancy and Chilhood. 15th ed. Philadelphia: WB Saunders Co, 1998: 385-415.
6. Adkins Y, Lönnerdal B. Mechanisms of vitamin B12 absorption in breast-fed infants. J Pediatr Gastroenterol Nutr 2002; 35: 192-8. (Full Text)
7. Rosenblatt DS, Whitehead VM. Cobalamin and folate deficien- cy: acquired and hereditary disorders in children. Semin Hematol 1999; 36: 19-34. (Abstract)
8. Michaud JL, Lemieux B, Ogier H, Lambert MA. Nutritional vita- min B12 deficiency: two cases detected by routine newborn urinary screening. Eur J Pediatr 1992; 151: 218-20. (Abstract)

9. Guerra-Shinohar EM, Paiva AA, Rondo PH, Yamasaki K, Terzi CA, D'Almeida V. Relationship between total homocysteine and folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12. BJOG 2002; 109: 784-91. (Abstract) / (Full Text) / (PDF)
10. Bjorke-Monsen AL, Ueland PM, Vollset SE, et al. Determinants of cobalamin status in newborns. Pediatrics 2001; 108: 624-30. (Abstract) / (PDF)
11. Minet JC, Bisse E, Aebischer CP, Beil A, Wieland H, Lütschg J. Assessment of vitamin B-12, folate, and vitamin B-6 status and relation to sulfur amino acid metabolism in neonates. Am J Clin Nutr 2000; 72: 751-7. (Abstract) / (Full Text) / (PDF)
12. Molloy AM, Mills JL, McPartlin J, Kirke PN, Scott JM, Daly S.Maternal and fetal plasma homocysteine concentrations at birth: the influence of folate, vitamin B12, and the 5, 10-meth- ylenetetrahydrofolate reductase 677C→T variant. Am J Obstet Gynecol 2002; 186: 499-503. (Abstract) / (Full Text) / (PDF)
13. Lindenbaum J, Healton EB, Savage DG, et al. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988; 318: 1720-8.
14. Stabler SP, Marcell PD, Podell ER, Allen RH, Savage DG, Lindenbaum J. Elevation of total homocysteine in the serum of patients with cobalamin or folate deficiency detected by capil- lary gas chromatography-mass spectrometry. J Clin Invest 1988; 81: 466-74. (Abstract) / (Full Text) / (PDF)
15. Hvas AM, Nexo E. Diagnosis and treatment of vitamin B12 defi- ciency-an update. Haematologica 2006; 91: 1506-12. (Abstract) / (PDF)
16. Fenech M. The role of folic acid and vitamin B12 in genomic stability of human cells. Mutat Res 2001; 475: 57-67. (Abstract) / (PDF)
17. Karademir F, Suleymanoglu S, Ersen A, et al. Vitamin B12, folate, homocysteine and urinary methylmalonic acid levels in infants. J Int Med Res 2007; 35: 384-8. (Abstract) / (PDF)
18. Ackurt F, Wetherilt H, Loker M, Hacibekiroğlu M. Biochemical assessment of nutritional status in pre and post-natal Turkish women and outcome of pregnancy. Eur J Clin Nutr 1995; 49: 613-22. (Abstract)
19. Koc A, Kocyigit A, Soran M, et al. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vita- min B12 deficiency in Şanlıurfa province of Turkey. Eur J Nutr 2006; 45: 291-7. (Abstract) / (PDF)
20. Specker BL, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in veg- etarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr 1990; 52: 1073-6. (Abstract) / (PDF)
21. Casterlina JE, Allen LH, Ruel MT. Vitamin B-12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum. J Nutr 1997; 127: 1966-72. (Abstract) / (Full Text) / (PDF)