Advertisement

Vitamin B12 Metabolism and Status during Pregnancy, Lactation and Infancy

  • Lindsay H. Allen
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 352)

Abstract

It is generally assumed that vitamin B12 deficiency only occurs during pregnancy and lactation in women who have consumed no animal products for a substantial period of time. However, recently it has emerged that pregnant women who have been strict vegetarians for only a few years, and even omnivores who consume low amounts of animal products, are more likely to become vitamin B12 deficient during pregnancy and lactation, to give birth to an infant who develops clinical or biochemical signs of B12 deficiency, and/or to have low levels of this vitamin in their breast milk. Also, there is recent evidence that vitamin B12 deficiency may be more prevalent in women and infants in some developing countries than formerly appreciated. In view of the potential for vitamin B12 deficiency to cause permanent neurological damage, it is important to understand the relationships between maternal intake and metabolism of vitamin B12 during pregnancy and lactation, and their impact on the mother, fetus, neonate, and secretion of the vitamin in breast milk.

Keywords

Breast Milk Pernicious Anemia Megaloblastic Anemia Breastfed Infant Corrin Ring 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Allen, L. H., Backstrand, J. R., Chavez, A. and Pelto, G. H., 1992, “Functional Implications of Malnutrition. Mexico Project Final Report”, University of Connecticut, Storrs, CT.Google Scholar
  2. Baker, S. J., Jacob, E., Rajan, K. T., and Swaminathan, S. P., 1962, Vitamin B12 deficiency in pregnancy and the puerperium, Br. Med. J. 1:1658.PubMedCrossRefGoogle Scholar
  3. Bartels, P. C., Helleman, P. W., and Soons, J. B. J., 1989, Investigation of red cell size-distribution histograms related to folate, vitamin B12 and iron state in the course of pregnancy, Scand. J. Clin. Lab. Invest. 49:763.PubMedCrossRefGoogle Scholar
  4. Bloomfield, F. J., Scott, J. M., Somerville, J. J. F., and Weir, D. G., 1973, Levels in normal, pathological and foetal sera of the three transcobalamins, Irish J. Med. Sci. 142:51.PubMedCrossRefGoogle Scholar
  5. Brown, J., Robertson, J., and Gallagher, N., 1977, Humoral regulation of vitamin B12 absorption by pregnant mouse small intestine, Gastroenterology 72:881.PubMedGoogle Scholar
  6. Chanarin, I., 1979, “The Megaloblastic Anemias,” Second edition, Blackwell Scientific Publications, London.Google Scholar
  7. Close, G. C., 1983, Rastafarianism and the Vegans syndrome, Br. Med. J. 286:473.CrossRefGoogle Scholar
  8. Cordingley, F. T. and Crawford, G. P. M., 1986, Giardia infection causes vitamin B12 deficiency, Aust N Z. J Med. 16:78.PubMedCrossRefGoogle Scholar
  9. Craft, I. L., Matthews, D. M., and Linnell, J. C., 1971, Cobalamins in human pregnancy and lactation J. Clin Path. 24:449.PubMedCrossRefGoogle Scholar
  10. Dolphin, B., 1982, “B12. Vol 1, Chemistry; vol. 2, Biochemistry and Medicine,” John Wiley and Sons, New York.Google Scholar
  11. Donangelo, C. M., Trugo, N. M. F., Koury, J. C., Barreto Silva, M. L, Freitas, L. A., Feldheim, W., and Barth, C., 1989, Iron, zinc, folate and vitamin B12 nutritional status and milk composition of low-income Brazilian mothers, Eur. J. Clin. Nutr. 43:253.PubMedGoogle Scholar
  12. Dostálová, L., 1984, Vitamin status in the puerperium and lactation, Ann. Nutr. Metab. 28:385.PubMedCrossRefGoogle Scholar
  13. Economides, D. L., Ferguson, J., Mackenzie, I. Z., Darley, J., Ware, I.I., and Holmes-Siedle, M., 1992, Folate and vitamin B12 concentrations in maternal and fetal blood, and amniotic fluid in second trimester pregnancies complicated by neural tube defects, Brit. J. Obstet. Gynecol. 99:23.CrossRefGoogle Scholar
  14. Fernandes-Costa, F. and Metz, J., 1979, Transplacental transport in the rabbit of vitamin B12 bound to human transcobalamins I, II and III, Br. J. Haematol. 43:625.PubMedCrossRefGoogle Scholar
  15. Fernandes-Costa, F. and Metz, J., 1982, Levels of transcobalamins I, II, and III during pregnancy and in cord blood, Am. J. Clin. Nutr. 35:87.PubMedGoogle Scholar
  16. Food and Agriculture Organization, 1988, “Requirements of Vitamin A, Iron, Folate and Vitamin B12. Report of a Joint FAO/WHO Expert Consultation”, FAO, Rome.Google Scholar
  17. Ford, J. E., 1974, Some observations on the possible nutritional significance of vitamin B12-and folate-binding proteins in milk, Br. J. Nutr. 31:243.PubMedCrossRefGoogle Scholar
  18. Fréry, N., Huel, G., Leroy, M., Moreau, T., Savard, R., Blot, P., and Lellouch, J., 1992, Vitamin B12 among parturients and their newborns and its relationship with birthweight, Eur. J. Obstet. Gynecol. Repro. Biol. 45:155.CrossRefGoogle Scholar
  19. Friedman, P. A., Shia, M. A., and Wallace, J. K., 1977, A saturable high affinity binding site for transcobalamin II-vitamin B12 complexes in human placental membrane preparations, J. Clin. Invest. 59:51.PubMedCrossRefGoogle Scholar
  20. Garewal, G., Narang, A., and Das, K. C., 1988, Infantile tremor syndrome: a vitamin B12 deficiency syndrome in infants, J. Trop. Pediat. 34:174.CrossRefGoogle Scholar
  21. Gimsing, P. and Nexo, E., 1983, The forms of cobalamin in biological materials, in “The cobalamins”, C. A. Hall, ed., Churchill-Livingstone, New York.Google Scholar
  22. Giugliani, E. R. J., Jorge, S. M., and Goncalves, A. L., 1985, Serum vitamin B12 levels in parturients, in the inter-villous space of the placenta, and in full-term newborns and their interrelationships with folate levels, Am.J. Clin. Nutr. 41:330.PubMedGoogle Scholar
  23. Graber, S. E., Scheffel, U., Hodkinson, B., and Mclntyre, P. A., 1971, Placental transport of vitamin B12 in the pregnant rat, J. Clin. Invest. 50:1000.PubMedCrossRefGoogle Scholar
  24. Gregory, M. E. and Holdsworth, E. S., 1955, The occurrence of a cyanocobalamin-binding protein in milk and the isolation of a cyanocobalamin-protein complex from sow’s milk, Biochem. J. 59:329.PubMedGoogle Scholar
  25. Grossowitz, N., Jablonska, M., and Beyth, Y., 1983, Vitamin B12-binding proteins in human amniotic fluid: an index to fetal maturity, Am. J. Obstet. Gynecol. 146:331.Google Scholar
  26. Hall, C. A. and Begley, J. A., 1977, Congenital deficiency of human R-type binding proteins of cobalamin, Am. J. Human Genetics. 29:619.Google Scholar
  27. Heisel, M. A., Siegel, S. E., Falk, R. E., Siegel, M. M., Carmel, R., Lechago, J., Skaff, G., Roessel, T., Nielsen, P. G., and Cummings, P., 1984, Congenital pernicious anemia: Report of seven patients, with studies of the extended family, J. Pediatr. 105:564.PubMedCrossRefGoogle Scholar
  28. Hellegers, A., Okuda, K., Nesbitt, R. E. L., Smith, D. W., and Chow, B. F., 1957, Vitamin B12 absorption in pregnancy and in the newborn, Am. J. Clin. Nutr. 5:327.PubMedGoogle Scholar
  29. Herbert, V., Colman, N., Spivack, M. et al., 1975, Folic acid deficiency in the United States: folate assays in a prenatal clinic, Am. J. Obstet. Gynecol 123:175.PubMedGoogle Scholar
  30. Herbert, V., Manusselis, C., Drivas, G., and Colman, N., 1983, Low vitamin B12 content of heavily processed milks may explain vitamin B12 deficiency in young adults in Mexico, Clin. Res. 31:241 A.Google Scholar
  31. Herbert, V., 1987a, The 1986 Herman Award Lecture, Nutrition science as a continually unfolding story: the folate and vitamin B-12 paradigm, Am. J. Clin. Nutr. 46:387.PubMedGoogle Scholar
  32. Herbert, V., 1987b, Recommended dietary intakes (RDI) of vitamin B-12 in humans, Am. J. Clin. Nutr. 45:671.PubMedGoogle Scholar
  33. Herbert, V., 1990a, Vitamin B-12, in “Present Knowledge in Nutrition,” International Life Sciences Institute-Nutrition Foundation, Washington D. C.Google Scholar
  34. Herbert, V., Fong, W., Guile, V., and Stopler, T., 1990b, Low holotranscobalamin II is the earliest serum marker for subnormal vitamin B12 (cobalamin) absorption in patients with AIDS, Am. J. Hemat. 34:132.PubMedCrossRefGoogle Scholar
  35. Hitzig, W. H., Dohmann, V., Pluss, H. J., and Vischer, D., 1974, Hereditary transcobalamin II deficiency: clinical findings in a family, J. Pediatr. 85:622.PubMedCrossRefGoogle Scholar
  36. Hoey, H., Linnell, J. C., Oberholzer, V. G., and Laurance, B. M., 1982, Vitamin B12 deficiency in a breastfed infant with pernicious anemia, J. Roy. Soc. Med. 75:656.PubMedGoogle Scholar
  37. Immerman, A. M., 1981, Vitamin B12 status on a vegetarian diet, World. Rev. Nutr. Diet. 37:38.PubMedGoogle Scholar
  38. Institute of Medicine., 1990, “Nutrition During Pregnancy,” National Academy Press, Washington D. C.Google Scholar
  39. Institute of Medicine., 1991, “Nutrition During Lactation,” National Academy Press, Washington D. C.Google Scholar
  40. Jadhav, M., Webb, J. K. G., Vaishnava, S., and Baker, S. J., 1962, Vitamin B12 deficiency in Indian infants: a clinical syndrome, Lancet ii:903.CrossRefGoogle Scholar
  41. Johnson, P. R. and Roloff, J. S., 1982, Vitamin B12 deficiency in an infant strictly breast-fed by a mother with pernicious anemia, J. Pediatr. 100:917.PubMedCrossRefGoogle Scholar
  42. Kanazawa, S., Herbert, V., Herzlicj, B., Drivas, G., and Manusselis, C., 1983, Removal of cobalamin analogues in bile by enterohepatic circulation of vitamin B12, Lancet i:707.CrossRefGoogle Scholar
  43. Kaul, K. K., Prasan, N., and Chowdhury, R. M., 1963, Some clinical observations and impressions on a syndrome of tremors in infants from India, J. Pediat. 63:1158.PubMedCrossRefGoogle Scholar
  44. Kolhouse, J. F., Kondo, H., Allen, N. C., Pdell, E., and Allen, R. H., 1978, Cobalamin analogues are present in human plasma and can mask cobalamin deficiency because current radioisotope-dilution assays are not specific for true cobalamin, N. Engl. J. Med. 299:785.PubMedCrossRefGoogle Scholar
  45. Kumento, A., 1969, Studies on the serum binding of vitamin B12 in the newborn human infant, Acta Paediatr. Scand. 194:1.Google Scholar
  46. Lampkin, B. D., Shore, N. A., and Chadwick, D., 1966, Megaloblastic anemia of infancy secondary to maternal pernicious anemia, N. Engl. J. Med. 274, 1168.PubMedCrossRefGoogle Scholar
  47. Luhby, A. L., Cooperman, J. M., Donnfield, A. M. et al., 1958, Observations on the transfer of vitamin B-12 from mother to fetus and newborn, Am. J. Dis. Child 96:532.Google Scholar
  48. Luhby, A. L., Cooperman, J. M., Stone, M. L. et al., 1961, Physiology of vitamin B12 in pregnancy, the placenta, and the newborn, Am. J. Dis. Child 102:753.Google Scholar
  49. McPhee, A. J., Davidson, G. P., Leahy, M., and Beare, T., 1988, Vitamin B12 deficiency in a breast fed infant, Arch. Dis. Childh. 63:921.PubMedCrossRefGoogle Scholar
  50. National Research Council, 1989, Vitamin B12, in “Recommended Dietary Allowances”, 10th edition, National Academy Press, Washington D. C.Google Scholar
  51. Neumann, C., Bwibo, N. O., and Sigman, M., 1992, “Functional Implications of Malnutrition. Kenya Project Final Report,” University of California, Los Angeles, CA.Google Scholar
  52. Pathak, A., Godwin, H. A., and Prudent, L. M., 1972, Vitamin B12 and folic acid in premature infants, Pediatrics 50:584.PubMedGoogle Scholar
  53. Porck, H. J., Frater-Schroder, M., Frants, R. R., Kierat, L., and Eriksson, A. W., 1983, Genetic evidence for fetal origin of transcobalamin II in human cord blood, Blood 62:234.PubMedGoogle Scholar
  54. Ramasamy, M., Alpers, D. H., Tiruppathi, C., and Seetharam, B., 1989, Cobalamin release from intrinsic factor and transfer to transcobalamin II within the rat enterocyte, Am. J. Physiol. 257:G791.PubMedGoogle Scholar
  55. Rapazzo, M. E., Salmi, H. A., and Hall, C. A., 1970, The content of vitamin B12 in adult and foetal tissue: A comparative study, Br. J. Haematol. 18:425.CrossRefGoogle Scholar
  56. Roberts, P. D., James, H., Petrie, A., Morgan, J. O., and Hoffbrand, A. V., 1973, Vitamin B12 status in pregnancy among immigrants to Britain, Br. Med. J. 3:67.PubMedCrossRefGoogle Scholar
  57. Robertson, J. A. and Gallagher, N. D., 1983, Increased intestinal uptake of cobalamin in pregnancy does not require synthesis of new receptors, Biochim. Biophys. Acta. 757:145.PubMedCrossRefGoogle Scholar
  58. Rosenblatt, D. S. and Cooper, B. A., 1987, Inherited disorders of vitamin B12 metabolism, Blood Reviews, 1:177.PubMedCrossRefGoogle Scholar
  59. Sadowitz, P. D., Livingston, A., and Cavanaugh, R. M., 1986, Developmental regression as an early manifestation of vitamin B12 deficiency, Clin. Pediatr. 25:369.CrossRefGoogle Scholar
  60. Sandberg, D. P., Begely, J. A., and Hall, C. A., 1981, The content, binding, and forms of vitamin B12 in milk, Am.J. Clin. Nutr. 34:1717.PubMedGoogle Scholar
  61. Schwartz, M. and Weber, J., 1971, Gastric intrinsic factor in human foetus, Scand. J. Gastroent. 9:suppl. 29:57.Google Scholar
  62. Seligman, P. A. and Allen, R. H., 1978, Characterization of the receptor for transcobalamin II isolated from human placenta, J. Biol. Chem. 253:1766.PubMedGoogle Scholar
  63. Sneed, S. S., Zane, C., and Thomas, M. R., 1981, The effects of ascorbic acid, vitamin B6 vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women, Am. J. Clin. Nutr. 34:1338.PubMedGoogle Scholar
  64. Specker, B. L., Miller, D., Norman, E. J., Greene, H., and Hayes, K. C., 1988, Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12, Am. J. Clin. Nutr. 47:89.PubMedGoogle Scholar
  65. Specker, B. L., Black, A., Allen, L., and Morrow, F., 1990a, 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. 52:1073.PubMedGoogle Scholar
  66. Specker, B. L., Brazerol, W., Ho, M. L., and Norman, E. J., 1990b, Urinary methylmalonic acid excretion in infants fed formula or human milk, Am. J. Clin. Nutr. 51:209.PubMedGoogle Scholar
  67. Srikantia, S. G. and Reddy, V., 1967, Megaloblastic anemia of infancy and vitamin B12, Br. J. Haemat. 13:949.CrossRefGoogle Scholar
  68. Suter, P. M., Golner, B. B., Goldin, B. R., Morrow, F. D., and Russell, R. M., 1991, Reversal of protein-bound vitamin B12 malabsorption with antibiotics in atrophic gastritis, Gastroenterology 101:1039.PubMedGoogle Scholar
  69. Thomas, M. R., Sneed, S. M., Wei, C., Nail, P. A., Wilson, M., and Sprinkle, E. E., 1980, The effects of vitamin C., vitamin B6, vitamin B12, folic acid, riboflavin and thiamin on the breast milk and maternal status of well-nourished women at 6 months postpartum, Am. J. Clin. Nutr. 33:2151.PubMedGoogle Scholar
  70. Trugo, N. M. F., 1992, Vitamin Bj2 absorption in the neonatal period, in “Mechanisms Regulating Lactation and Infant Nutrient Utilization”. M. F. Picciano and B. Lonnerdal, eds. New York, Wiley-Liss.Google Scholar

Copyright information

© Springer Science+Business Media New York 1994

Authors and Affiliations

  • Lindsay H. Allen
    • 1
  1. 1.Department of Nutritional SciencesUniversity of ConnecticutStorrsUSA

Personalised recommendations