Maternal Vitamin B12 Status During Pregnancy and Its Association With Outcomes of Pregnancy and Health of the Offspring: A Systematic Review and Implications for Policy in India
| Autor: | Chittaranjan S. Yajnik, Anagha S. Deshmukh, Mohan D Gupte, Suhas Otiv, Rishikesh V. Behere |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Vitamin medicine.medical_specialty Offspring pregnancy outcomes Endocrinology Diabetes and Metabolism Birth weight India folate lcsh:Diseases of the endocrine glands. Clinical endocrinology 03 medical and health sciences chemistry.chemical_compound Folic Acid Endocrinology 0302 clinical medicine Pregnancy medicine Humans 030212 general & internal medicine Vitamin B12 public health policy offspring health lcsh:RC648-665 030109 nutrition & dietetics Obstetrics business.industry Pregnancy Outcome vitamin B12 medicine.disease Gestational diabetes Vitamin B 12 Low birth weight Systematic review chemistry Female Systematic Review medicine.symptom business |
| Zdroj: | Frontiers in Endocrinology Frontiers in Endocrinology, Vol 12 (2021) |
| ISSN: | 1664-2392 |
| DOI: | 10.3389/fendo.2021.619176 |
| Popis: | BackgroundVitamins B12 and folate participate in the one-carbon metabolism cycle and hence regulate fetal growth. Though vitamin B12 deficiency is widely prevalent, the current public health policy in India is to supplement only iron and folic acid for the prevention of anaemia. Prompted by our research findings of the importance of maternal vitamin B12 status for a healthy pregnancy, birth and offspring health outcomes, we evaluated available literature evidence using a systematic review approach, to inform policy.MethodsA systematic search was performed for relevant Indian studies in the MEDLINE/PubMed and IndMed databases. We selected studies reporting maternal vitamin B12 status (dietary intake or blood concentrations), and/or metabolic markers of vitamin B12 deficiency (homocysteine, methylmalonic acid) or haematological indices during pregnancy and their associations with outcomes of pregnancy, infancy or in later life. Intervention trials of vitamin B12 during pregnancy were also included. Quality of evidence was assessed on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsOf the 635 articles identified, 46 studies met the inclusion criteria (cohort studies-26, case-control studies-13, RCT’s -7). There is a high prevalence of vitamin B12 deficiency in Indian women during pregnancy (40-70%) (3 studies). Observational studies support associations (adjusted for potential sociodemographic confounders, maternal body size, postnatal factors) of lower maternal B12, higher homocysteine or an imbalance between vitamin B12-folate status with a higher risk of NTDs (6 studies), pregnancy complications (recurrent pregnancy losses, gestational diabetes, pre-eclampsia) (9 studies), lower birth weight (10 studies) and adverse longer-term health outcomes in the offspring (cognitive functions, adiposity, insulin resistance) (11 studies). Vitamin B12 supplementation (7 RCT’s) in pregnancy showed a beneficial effect on offspring neurocognitive development and an effect on birth weight was inconclusive. There is a high quality evidence to support the role of low maternal vitamin B12 in higher risk for NTD and low birth weight and moderate-quality evidence for higher risk of gestational diabetes and later life adverse health outcomes (cognitive functions, risk for diabetes) in offspring.ConclusionIn the Indian population low maternal vitaminB12 status, is associated with adverse maternal and child health outcomes. The level of evidence supports adding vitamin B12 to existing nutritional programs in India for extended benefits on outcomes in pregnancy and offspring health besides control of anaemia.Systematic Review Registration[website], identifier [registration number] |
| Databáze: | OpenAIRE |
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