Prevalencia de déficit de vitamina B12 en sangre periférica de madres cursando el puerperio inmediato en el Centro Hospitalario Pereira Rossell

Helena Sobrero; Fabiola Castedo; Florencia Ceriani; Fiorella Cavalleri; Jennise De Los Santos; Claudio Sosa; Pedro Cladera; Maite Areosa; Gabriela Greising; Camila Jeldres; Catalina Vaz Ferreira; Mario Moraes

doi:10.29193/RMU.39.4.4

Authors

Helena Sobrero Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0000-0002-6142-0717
Fabiola Castedo Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0000-0002-0811-7145
Florencia Ceriani Universidad de la República, Escuela de Nutrición https://orcid.org/0000-0003-2105-8044
Fiorella Cavalleri Universidad de la República, Facultad de Medicina https://orcid.org/0000-0002-0028-3544
Jennise De Los Santos Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0000-0001-6600-2170
Claudio Sosa Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Servicio de Ginecología y Obstetricia, Clínica Ginecotocológica C https://orcid.org/0000-0002-2539-0848
Pedro Cladera Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Patología Clínica https://orcid.org/0000-0002-0131-8913
Maite Areosa Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0009-0003-1757-4617
Gabriela Greising Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0009-0001-8555-6096
Camila Jeldres Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0009-0005-6067-348X
Catalina Vaz Ferreira Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0000-0002-9724-7047
Mario Moraes Universidad de la República, Facultad de Medicina, Centro Hospitalario Pereira Rossell, Departamento de Neonatología https://orcid.org/0000-0002-5174-2405

DOI:

https://doi.org/10.29193/RMU.39.4.4

Keywords:

VITAMIN B12, VITAMIN B12 DEFICIENCY, PUERPERIUM

Abstract

Objective: To assess the prevalence of vitamin B12 deficiency in women during the immediate postpartum period.
Method: Descriptive observational study with prospective cohort recruitment, involving a sample of 133 women in their third trimester of pregnancy at the Maternity Department of the Pereira Rossell Hospital Center (CHPR) in Montevideo, Uruguay, between September 2021 and October 2022. Maternal blood samples were obtained during the immediate postpartum period through peripheral venous puncture. These samples were processed using electrochemiluminescence (ECL) immunoassay. Additionally, a nutritional interview was conducted to assess dietary habits.
Results: All patients reported following an omnivorous diet, except for one who reported following a vegan diet and received daily vitamin B12 supplementation. Seventy-five point nine percent (75.9%) of the study sample exhibited a low socioeconomic status as determined by the Socioeconomic Level Measurement Questionnaire of the INSE (Socioeconomic Level Index, 2018 – CEISMU, Uruguay). Resulting in a vitamin B12 deficiency prevalence of 39.10% (n: 52).
Conclusions: Despite the fact that this sample of pregnant women maintains an omnivorous diet, a high prevalence of vitamin B12 deficiency was detected. Given the significance of vitamin B12 for maternal, fetal, and neonatal health, public health policies for preventing deficiency should be considered for both pregnant women and lactating mothers.

References

Langan RC, Goodbred AJ. Vitamin B12 deficiency: recognition and management. Am Fam Physician 2017; 96(6):384-9.

Robertson JA, Gallagher ND. Increased intestinal uptake of cobalamin in pregnancy does not require synthesis of new receptors. Biochim Biophys Acta 1983; 757(2):145-50. doi: 10.1016/0304-4165(83)90101-0.

Hellegers A, Okuda K, Nesbitt Re, Smith DW, Chow Bf. Vitamin B12 absorption in pregnancy and in the newborn. Am J Clin Nutr 1957; 5(3):327–31. doi: 10.1093/ajcn/5.3.327.

Brown J, Robertson J, Gallagher N. Humoral regulation of vitamin B12 absorption by pregnant mouse small intestine. Gastroenterology 1977; 72(5 Pt 1):881-8.

Bartels PC, Helleman PW, Soons JB. 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 1989; 49(8):763-71. doi: 10.3109/00365518909091555.

Fernandez-Costa F, Metz J. Levels of transcobalamins I, II, and III during pregnancy and in cord blood. Am J Clin Nutr 1982; 35(1):87-94. doi: 10.1093/ajcn/35.1.87.

Giugliani ER, Jorge SM, Gonçalves AL. Serum vitamin B12 levels in parturients, in the intervillous space of the placenta and in full-term newborns and their interrelationships with folate levels. Am J Clin Nutr 1985; 41(2):330-5. doi: 10.1093/ajcn/41.2.330.

Fréry N, Huel G, Leroy M, Moreau T, Savard R, Blot P, et al. Vitamin B12 among parturients and their newborns and its relationship with birthweight. Eur J Obstet Gynecol Reprod Biol 1992; 45(3):155-63. doi: 10.1016/0028-2243(92)90076-b.

Economides DL, Ferguson J, Mackenzie IZ, Darley J, Ware II, Holmes‐Siedle M. Folate and vitamin B12 concentrations in maternal and fetal blood, and amniotic fluid in second trimester pregnancies complicated by neural tube defects. Br J Obstet Gynaecol 1992; 99(1):23-5. doi: 10.1111/j.1471-0528.1992.tb14386.x.

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(12):1711-2. doi: 10.3324/haematol.11636.

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(6):521-5. doi: 10.1111/j.0902-4441.2006.t01-1-EJH2550.x.

Obeid R, Murphy M, Solé-Navais P, Yajnik C. Cobalamin status from pregnancy to early childhood: lessons from global experience. Adv Nutr 2017; 8(6):971-9. doi: 10.3945/an.117.015628.

Batalha MA, Ferreira AL, Freitas-Costa NC, Figueiredo AC, Carrilho TR, Shahab-Ferdows S, et al. Factors associated with longitudinal changes in B-vitamin and choline concentrations of human milk. Am J Clin Nutr 2021; 114(4):1560-73. doi: 10.1093/ajcn/nqab191.

Sklar R. Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-diet mother. Clin Pediatr (Phila) 1986; 25(4):219-21. doi: 10.1177/000992288602500409.

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(6):1073-6. doi: 10.1093/ajcn/52.6.1073.

Dagnelie PC, van Staveren WA, Roos AH, Tuinstra LG, Burema J. Nutrients and contaminants in human milk from mothers on macrobiotic and omnivorous diets. Eur J Clin Nutr 1992; 46(5):355-66.

Davis JR, Goldenring J, Lubin BH. Nutritional vitamin B12 deficiency in infants. Am J Dis Child 1981; 135(6):566-7. doi: 10.1001/archpedi.1981.02130300064021.

Obeid R, Eussen SJ, Mommers M, Smits L, Thijs C. Imbalanced folate and vitamin b12 in the third trimester of pregnancy and its association with birthweight and child growth up to 2 years. Mol Nutr Food Res 2022; 66(2):e2100662. doi: 10.1002/mnfr.202100662.

Gu Q, Li Y, Cui ZL, Luo XP. Homocysteine, folate, vitamin B12 and B6 in mothers of children with neural tube defects in Xinjiang, China. Acta Paediatr 2012; 101(11): e486-90. doi: 10.1111/j.1651-2227.2012.02795.x.

Finkelstein JL, Layden AJ, Stover PJ. Vitamin B-12 and perinatal health. Adv Nutr 2015; 6(5):552-63. doi: 10.3945/an.115.008201.

Rashid S, Meier V, Patrick H. Review of vitamin B12 deficiency in pregnancy: a diagnosis not to miss as veganism and vegetarianism become more prevalent. Eur J Haematol 2021; 106(4):450-5. doi: 10.1111/ejh.13571.

de Benoist B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull 2008; 29(2 Suppl): S238-44. doi: 10.1177/15648265080292S129.

Ramírez-Vélez R, Correa-Bautista JE, Martínez-Torres J, Meneses-Echávez JF, Lobelo F. Vitamin B12 concentrations in pregnant Colombian women: analysis of nationwide data 2010. BMC Pregnancy Childbirth 2016; 16:26. doi: 10.1186/s12884-016-0820-4.

Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr 2009; 89(2):693S-396S. doi: 10.3945/ajcn.2008.26947A.

McLean E, de Benoist B, Allen LH. Review of the magnitude of folate and vitamin B12 deficiencies worldwide. Food Nutr Bull 2008; 29(2 Suppl):S38-S51. doi: 10.1177/15648265080292S107.

Allen LH, Rosenberg IH, Oakley GP, Omenn GS. Considering the case for vitamin B12 fortification of flour. Food Nutr Bull 2010; 31(1 Suppl):S36-S46. doi: 10.1177/15648265100311S104.

Allen LH. Folate and vitamin B12 status in the Americas. Nutr Rev 2004; 62(6 Pt 2):S29-33. doi: 10.1111/j.1753-4887.2004.tb00069.x.

Siekmann JH, Allen LH, Bwibo NO, Demment MW, Murphy SP, Neumann CG. Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. J Nutr 2003; 133(11 Suppl 2): 3972S-3980S. doi: 10.1093/jn/133.11.3972S.

McLean ED, Allen LH, Neumann CG, Peerson JM, Siekmann JH, Murphy SP, et al. Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods. J Nutr 2007; 137(3):676-82. doi: 10.1093/jn/137.3.676.

Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, et al. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr 2001; 74(2):233-41. doi: 10.1093/ajcn/74.2.233.

Taneja S, Bhandari N, Strand TA, Sommerfelt H, Refsum H, Ueland PM, et al. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. Am J Clin Nutr 2007; 86(5):1302-9. doi: 10.1093/ajcn/86.5.1302.

Department of Health. Obstetrics and Gynaecology. Clinical Practice Guidelines: Vitamin B12 deficiency: management during pregnancy. Canberra, 2021. Disponible en: https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Vitamin-B12-Deficiency-Management.pdf?thn=0 (Consulta: 24 setiembre 2022).