Pre-conceptional Maternal Vitamin B12 Supplementation Improves Offspring Neurodevelopment at 2 Years of Age: PRIYA Trial

Background: The first thousand days window does not include the pre-conceptional period. Maternal pre-conceptional health has a profound influence on early embryonic development (implantation, gastrulation, placentation etc). Nutrition provided by B-complex vitamins is important for fetal growth, especially neural development. We report effects of a maternal pre-conceptional vitamin B12 and multi micronutrient (MMN) supplementation on offspring neurodevelopmental performance.Methods: In the Pune Rural Intervention in Young Adolescents trial (PRIYA), adolescents (N = 557, 226 females) were provided with vitamin B12 (2 μg/day) with or without multiple micronutrients, or a placebo, from preconception until delivery. All groups received mandatory iron and folic acid. We used the Bayley's Scale of Infant Development (BSID-III) at 24–42 months of age to investigate effects on offspring neurodevelopment.Results: Participants had similar baseline B12 levels. The levels improved in the B12 supplemented groups during pre-conception and pregnancy (28 weeks gestation), and were reflected in higher cord blood holotranscobalamin (holo-TC) levels compared to the placebo group. Neurodevelopmental outcomes in the B12 alone group (n = 21) were better than the placebo (n = 27) in cognition (p = 0.044) and language (p = 0.020) domains (adjusted for maternal baseline B12 levels). There was no difference in neurodevelopmental outcomes between the B12 + MMN (n = 26) and placebo group. Cord blood Brain Derived Neurotrophic Factor (BDNF) levels were highest in the B12 alone group, though not significant.Conclusion: Pre-conceptional vitamin B12 supplementation improved maternal B12 status and offspring neurodevelopment at 2 years of age. The usefulness of cord BDNF as a marker of brain development needs further investigation. Our results highlight the importance of intervening during pre-conception.

P-OGC11 Vitamin B12 supplementation post gastrectomy. A service audit in St. James’s hospital, Dublin

Background Vitamin B12 deficiency is a well described complication post gastrectomy. It is caused by the loss of parietal cell mass leading to megaloblastic anaemia and possible long term neurological symptoms. Treatment can be with standardised replacement regimens or to monitor B12 levels and replace as required. This study assesses patient understanding of and compliance with B12 supplementation guidelines post total and subtotal gastrectomy. Methods 125 patients who underwent gastrectomy between 2010-2020 were available for study (86 total gastrectomies, 39 subtotal gastrectomies). Patient data was collected by review of the hospital electronic records and individual phone calls. Patients were asked standardised questions to elicit knowledge of the importance of B12 supplementation and compliance with supplementation. Results 92% (79/86) of total gastrectomy patients reported compliance in regular parenteral B12 supplementation. Compliance was significantly lower for subtotal gastrectomies for checking and/or replacing their vitamin B12 at 53.8% (21/39) (p < 0.001). 62.6% of patients stated that they knew it was important to supplement B12 post gastrectomy. 37.8% of participants could explain why this was important and 14.8% had any knowledge of the complications of vitamin B12 deficiency. Patients who were compliant with B12 supplementation had an improved understanding of why supplementation was important compared to those who did not. Conclusions Regular monitoring and supplementation of vitamin B12 levels is important post gastrectomy. This study demonstrates good compliance in those undergoing total gastrectomy. Patient understanding correlates with compliance, suggesting that patient education and knowledge reinforcement may be key to compliance with vitamin B12 supplementation.

Pre-conceptional maternal vitamin B12 supplementation improves offspring neurodevelopment at 2 years of age: PRIYA trial

Background: Nutritional interventions during the first 1000 days of life improves lifelong health. Better pre-conceptional maternal nutrition improves the nutrition of the early embryo. Vitamins B12 and folate are important for fetal neural development. Vitamin B12 deficiency is common in India. Methods: In the Pune Rural Intervention in Young Adolescents (PRIYA) adolescents (N=557, 226 females) were provided with vitamin B12 (2μg/day) with or without multiple micronutrients, or a placebo, from preconception until delivery. All groups received mandatory iron and folic acid. We used the Bayleys Scale of Infant Development (BSID-III) at 24-42 months of age to investigate effects on offspring neurodevelopment. We examined cord blood concentrations of brain-derived neurotropic factor (BDNF). Results: Participants in the three groups had similar baseline B12 levels. These improved in the B12 supplemented groups at pre-conceptional and pregnancy (28 weeks gestation) measurements, reflected in higher cord holo-TC levels compared to the placebo. Neurodevelopmental outcomes are available for 74 children. Offspring in the B12 alone group (n=21) performed better than the placebo (n=27) on cognition (p=0.044) and language (p=0.020) domains (adjusted for maternal baseline B12 levels). There were no differences between the B12+MMN (n=26) and placebo group. Cord blood BDNF levels were highest in the B12 alone group (not statistically significant). Conclusion: Pre-conceptional vitamin B12 supplementation improved maternal B12 status and offspring neurodevelopment at 2 years of age. The usefulness of cord BDNF as a marker of brain development needs further investigation. Our results highlight the importance of intervening in the pre-conceptional period.

Pancytopenia in pregnant patients with COVID-19 infection and vitamin B12 deficiency: a case report study

Background: Folate and vitamin B 12 deficiency can lead to pancytopenia in pregnancy. Some cases of pancytopenia due to COVID-19 infection have also been reported. The two cases that we present are related to the coincidence of pregnancy and deficiency of folic acid and vitamin B12 with COVID-19 infection. Case presentation: A 26-year- woman G3P1L1A1 and 21-year-woman G2P1L1 presented with pancytopenia and mild COVID-19 infection. The antenatal period was uneventful, and both cases also had folate and vitamin B12 deficiency. They received blood products, folic acid, and vitamin B12 supplementation. COVID- 19 infection was managed well with analgesic and vital monitoring. Postpartum hemorrhage occurred in the second case, which was well managed with uterotonics. All laboratory parameters came out to be normal after three months of supplementation of folic acid and vitamin B12. Conclusion: Pancytopenia in pregnancy due to folate and vitamin B12 deficiency and COVID- 19 infection can be easily managed with timely intensive targeted therapy, but we should be extra vigilant while handling such complicated cases, keeping in mind all possible differential diagnoses for pancytopenia.

Un bambino che non mangia… e non sta seduto

The Authors describe the case of an 11-month-old infant with severe vitamin B12 deficiency consequent to a strict vegan diet followed by the mother during pregnancy and to a strictly vegan weaning. The child presented with food refusal, somatic growth arrest and seriously compromised maturational patterns. The encephalic MR showed a marked white matter atrophy. Symptoms improved after vitamin B12 supplementation.

Effects of Vitamin B12 Supplementation on Cognitive Function, Depressive Symptoms, and Fatigue: A Systematic Review, Meta-Analysis, and Meta-Regression

Vitamin B12 is often used to improve cognitive function, depressive symptoms, and fatigue. In most cases, such complaints are not associated with overt vitamin B12 deficiency or advanced neurological disorders and the effectiveness of vitamin B12 supplementation in such cases is uncertain. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) is to assess the effects of vitamin B12 alone (B12 alone), in addition to vitamin B12 and folic acid with or without vitamin B6 (B complex) on cognitive function, depressive symptoms, and idiopathic fatigue in patients without advanced neurological disorders or overt vitamin B12 deficiency. Medline, Embase, PsycInfo, Cochrane Library, and Scopus were searched. A total of 16 RCTs with 6276 participants were included. Regarding cognitive function outcomes, we found no evidence for an effect of B12 alone or B complex supplementation on any subdomain of cognitive function outcomes. Further, meta-regression showed no significant associations of treatment effects with any of the potential predictors. We also found no overall effect of vitamin supplementation on measures of depression. Further, only one study reported effects on idiopathic fatigue, and therefore, no analysis was possible. Vitamin B12 supplementation is likely ineffective for improving cognitive function and depressive symptoms in patients without advanced neurological disorders.

Effect of Vıtamın B12 on Acetic Acıd Induced Colıtıs

Background/Aims: Inflammatory bowel disease (IBD) is a chronic, relapsing, and remittent inflammatory disease of the gastrointestinal tract. Nutritional deficiency may be instrumental and contributable in this disease, among which vitamin B12 deficiency has been identified in IBD. Since the relationship between vitamin B12 and IBD remains controversial, in this study, we have examined the effect of vitamin B12 supplementation on acetic acid (AA)-induced colitis in rats. Methods Total of 28 rats were randomized into four groups of seven animals per group; Group 1 (Control saline) was the control group, group 2 (AA colitis control) was the disease control group, group 3 (VitB12) was the vitamin B12 alone treatment group, group 4 (VitB12 treatment in AA colitis) was the AA-induced colitis VitB12 treatment group. Weight change was measured. Macroscopic and microscopic scores were measured in each group. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, myeloperoxidase (MPO), malondialdehyde (MDA), glutathione reduced (GSH), and superoxide dismutase (SOD) were measured in each group. Results Macroscopic scores, as well as microscopic scores, were not different between the group. Also, the levels of TNF-α, IL-1β, MPO, MDA, and SOD did not differ between AA control and VitB12 treated AA colitic group. However, the levels of IL-6 and GSH were significantly different in rats with AA-induced colitis after vitamin B12 injection. Conclusion Nutritional deficiencies might contribute to the pathogenesis of IBD, but in this study, the efficacy of vitamin B12 supplementation has controversial effects on the intestinal mucosa.

Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy

Background: This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. Methods: The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. Results: Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). Conclusions: Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.