Skip to main content
SpringerLink
Log in

Association between Maternal and Infantile Markers of Cobalamin Status During the First Month Post-Delivery

  • Original Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objective

Exclusively breast-fed infants born to vitamin B12 (cobalamin, cbl)-deficient mothers can develop symptoms within a few months following delivery. The authors aimed to assess the relationship between maternal and infantile markers of cbl status.

Methods

In 240 full-term infants (age, 2–30 d) admitted to Samsun Maternity and Child Health Hospital and their mothers, complete blood count testing and serum cbl, folate and plasma total homocysteine (tHcy) measurements were performed. In the mothers, serum ferritin and holotranscobalamin (holoTC) levels were measured additionally.

Results

Among the infants, 146 (60.8%) had cbl deficiency (serum cbl <259 pg/mL), whereas 184 (76.7%) mothers had a low cbl level (serum cbl <300 pg/mL). When cbl deficiency was defined as a serum holoTC level < 40 pmol/L, 152 (63.3%) mothers were found as deficient. In addition, 147 (61.3%) infants had an elevated tHcy level (>10 μmol/L), in 35 (23.8%) of these 147 infants tHcy level being markedly elevated (>20 μmol/L). None of the infants had folate deficiency. In the correlational analysis between maternal and infantile markers associated with cbl status, the strongest correlation was observed between maternal holoTC and infantile tHcy (r = −0.49, p < 0.001), followed by the correlation between maternal tHcy and infantile tHcy (r = 0.47, p < 0.001). The weakest correlations were found between maternal cbl and infantile cbl (r = 0.28, p < 0.001), and between maternal cbl and infantile tHcy (r = −0.25, p < 0.001).

Conclusions

Maternal cbl status is an important determinant of infantile cbl status. Both maternal holoTC and tHcy may assist in predicting infantile cbl status. The finding of high prevalence of maternal and infantile cbl deficiency in this study points towards the need for effective strategies to prevent cbl deficiency in women prior to getting pregnant.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149–60.

    Article  PubMed  CAS  Google Scholar 

  2. Specker BL, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr. 1990;52:1073–6.

    Article  PubMed  CAS  Google Scholar 

  3. Zengin E, Sarper N, Caki Kilic S. Clinical manifestations of infants with nutritional vitamin B deficiency due to maternal dietary deficiency. Acta Paediatr. 2009;98:98–102.

    Article  PubMed  CAS  Google Scholar 

  4. Akcaboy M, Malbora B, Zorlu P, Altınel E, Oguz MM, Senel S. Vitamin B12 deficiency in infants. Indian J Pediatr. 2015;82:619–24.

    Article  PubMed  Google Scholar 

  5. Yenicesu I. Pancytopenia due to vitamin B12 deficiency in a breast-fed infant. Pediatr Hematol Oncol. 2008;25:365–7.

    Article  PubMed  Google Scholar 

  6. Cetinkaya F, Yildirmak Y, Kutluk G, Erdem E. Nutritional vitamin B12 deficiency in hospitalized young children. Pediatr Hematol Oncol. 2007;24:15–21.

    Article  PubMed  CAS  Google Scholar 

  7. Koc A, Kocyigit A, Soran M, et al. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vitamin B12 deficiency in Sanliurfa province of Turkey. Eur J Nutr. 2006;45:291–7.

    Article  PubMed  CAS  Google Scholar 

  8. Sezgin Evim M, Erdöl Ş, Özdemir Ö, Baytan B, Güneş AM. Long-term outcome in children with nutritional vitamin B12 deficiency. Turk J Haematol. 2011;28:286–93.

    Article  PubMed  CAS  Google Scholar 

  9. Seetharam B, Yammani RR. Cobalamin transport proteins and their cell-surface receptors. Expert Rev Mol Med. 2003;13:1–18.

    Google Scholar 

  10. Thompson MD, Cole DE, Ray JG. Vitamin B-12 and neural tube defects: the Canadian experience. Am J Clin Nutr. 2009;89:697S–701S.

    Article  PubMed  CAS  Google Scholar 

  11. Koebnick C, Heins UA, Dagnelie PC, et al. Longitudinal concentrations of vitamin B(12) and vitamin B(12)-binding proteins during uncomplicated pregnancy. Clin Chem. 2002;48:928–33.

    PubMed  CAS  Google Scholar 

  12. Milman N, Byg KE, Bergholt T, Eriksen L, Hvas AM. Cobalamin status during normal pregnancy and postpartum: a longitudinal study comprising 406 Danish women. Eur J Haematol. 2006;76:521–5.

    Article  PubMed  CAS  Google Scholar 

  13. Morkbak AL, Hvas AM, Milman N, Nexo E. Holotranscobalamin remains unchanged during pregnancy. Longitudinal changes of cobalamins and their binding proteins during pregnancy and postpartum. Haematologica. 2007;92:1711–2.

    Article  PubMed  CAS  Google Scholar 

  14. Kalay Z, Islek A, Parlak M, et al. Reliable and powerful laboratory markers of cobalamin deficiency in the newborn: plasma and urinary methylmalonic acid. J Matern Fetal Neonatal Med. 2016;29:60–3.

    Article  PubMed  CAS  Google Scholar 

  15. Hay G, Clausen T, Whitelaw A, et al. Maternal folate and cobalamin status predicts vitamin status in newborns and 6-month-old infants. J Nutr. 2010;140:557–64.

    Article  PubMed  CAS  Google Scholar 

  16. Dayaldasani A, Ruiz-Escalera J, Rodríguez-Espinosa M, Rueda I, Pérez-Valero V, Yahyaoui R. Serum vitamin B12 levels during the first trimester of pregnancy correlate with newborn screening markers of vitamin B12 deficiency. Int J Vitam Nutr Res. 2014;84:92–7.

    Article  PubMed  CAS  Google Scholar 

  17. Casterline 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.

    Article  PubMed  CAS  Google Scholar 

  18. Greibe E, Lildballe DL, Streym S, et al. Cobalamin and haptocorrin in human milk and cobalamin-related variables in mother and child: a 9-mo longitudinal study. Am J Clin Nutr. 2013;98:389–95.

    Article  PubMed  CAS  Google Scholar 

  19. Solomon LR. Low cobalamin levels as predictors of cobalamin deficiency: ımportance of comorbidities associated with ıncreased oxidative stress. Am J Med. 2016;129:115.e9–16.

    Article  CAS  Google Scholar 

  20. Bailey D, Colantonio D, Kyriakopoulou L, et al. Marked biological variance in endocrine and biochemical markers in childhood: establishment of pediatric reference intervals using healthy community children from the CALIPER cohort. Clin Chem. 2013;59:1393–405.

    Article  PubMed  CAS  Google Scholar 

  21. Refsum H, Grindflek AW, Ueland PM, et al. Screening for serum total homocysteine in newborn children. Clin Chem. 2004;50:1769–84.

    Article  PubMed  CAS  Google Scholar 

  22. Jones KM, Ramirez-Zea M, Zuleta C, Allen LH. Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. J Nutr. 2007;137:1307–13.

    Article  PubMed  CAS  Google Scholar 

  23. Incecik F, Herguner MO, Altunbasak S, Leblebisatan G. Neurologic findings of nutritional B12 deficiency in children. Turk J Pediatr. 2010;52:17–21.

    PubMed  Google Scholar 

  24. Balci YI, Ergin A, Karabulut A, Polat A, Doğan M, Küçüktaşcı K. Serum vitamin B12 and folate concentrations and the effect of the Mediterranean diet on vulnerable populations. Pediatr Hematol Oncol. 2014;31:62–7.

    Article  PubMed  CAS  Google Scholar 

  25. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299–326.

    Article  PubMed  CAS  Google Scholar 

  26. Carmel R. Macrocytosis, mild anemia, and delay in the diagnosis of pernicious anemia. Arch Intern Med. 1979;139:47–50.

    Article  PubMed  CAS  Google Scholar 

  27. Obeid R, Morkbak AL, Munz W, Nexo E, Herrmann W. The cobalamin-binding proteins transcobalamin and haptocorrin in maternal and cord blood sera at birth. Clin Chem. 2006;52:263–9.

    Article  PubMed  CAS  Google Scholar 

  28. Quadros EV, Nakayama Y, Sequeira JM. The protein and the gene encoding the receptor for the cellular uptake of transcobalamin-bound cobalamin. Blood. 2009;113:186–92.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the physicians and nurses in Samsun Maternity and Child Health Hospital for their collaboration during the collection of blood samples and data.

Contributions

EYK and MI designed the study. SC collected and processed tha data. SC, EYK and MI wrote the manuscript, and EYK revised the manuscript. EYK will act as guarantor for this paper.

Author information

Authors and Affiliations

  1. Clinic of Pediatrics, Samsun Training and Research Hospital, Samsun, Turkey

    Sümeyra Çoban & Mahir İğde

  2. Department of Pediatric Hematology and Oncology, Süleyman Demirel University Medical School, Isparta, Turkey

    Ebru Yılmaz Keskin

Authors
  1. Sümeyra Çoban
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ebru Yılmaz Keskin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mahir İğde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ebru Yılmaz Keskin.

Ethics declarations

Conflict of Interest

None.

Source of Funding

Samsun Training and Research Hospital.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Çoban, S., Yılmaz Keskin, E. & İğde, M. Association between Maternal and Infantile Markers of Cobalamin Status During the First Month Post-Delivery. Indian J Pediatr 85, 517–522 (2018). https://doi.org/10.1007/s12098-017-2598-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-017-2598-4

Keywords

Search

Navigation