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Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal.

Abstract

Questions have been raised about potentially negative effects of antenatal folic acid use in populations with a high prevalence of vitamin B-12 deficiency. Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and/or vitamin B-12 status. Pregnant women were cluster randomized to receive daily supplements containing vitamin A alone or with folic acid, folic acid+iron, folic acid+iron+zinc, or a multiple micronutrient. In a subsample (n = 1132), micronutrient status biomarkers were analyzed at baseline and late pregnancy. Children born to the women who participated in the trial were visited at 6-8 y of age. Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment (HOMA-IR). Children whose mothers were deficient in vitamin B-12 (<148 pmol/L, 27%) during early pregnancy had a 26.7% increase in HOMA-IR (P = 0.02), but there was no association with maternal folate status. Among children born to women who were vitamin B-12 deficient at baseline, the percent difference in HOMA-IR compared to the control group was 15.1% (95% CI: -35.9, 106.4), 4.9% (-41.6, 88.5), 3.3% (-38.4, 73.5), and 18.1% (-29.0, 96.7) in the folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrient supplementation groups, respectively, none of which were significant. Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance, but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring.

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  • Authors+Show Affiliations

    ,

    Program in International and Community Nutrition, University of California, Davis, CA, USA. pchristi@jhsph.edu

    , , , , ,

    Source

    The Journal of nutrition 141:10 2011 Oct pg 1912-7

    MeSH

    Anemia, Iron-Deficiency
    Child
    Cohort Studies
    Dietary Supplements
    Female
    Folic Acid
    Folic Acid Deficiency
    Humans
    Insulin Resistance
    Iron, Dietary
    Male
    Maternal Nutritional Physiological Phenomena
    Nepal
    Pregnancy
    Pregnancy Complications
    Prenatal Exposure Delayed Effects
    Prevalence
    Rural Health
    Vitamin B 12 Deficiency
    Zinc

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21865563

    Citation

    Stewart, Christine P., et al. "Low Maternal Vitamin B-12 Status Is Associated With Offspring Insulin Resistance Regardless of Antenatal Micronutrient Supplementation in Rural Nepal." The Journal of Nutrition, vol. 141, no. 10, 2011, pp. 1912-7.
    Stewart CP, Christian P, Schulze KJ, et al. Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal. J Nutr. 2011;141(10):1912-7.
    Stewart, C. P., Christian, P., Schulze, K. J., Arguello, M., LeClerq, S. C., Khatry, S. K., & West, K. P. (2011). Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal. The Journal of Nutrition, 141(10), pp. 1912-7. doi:10.3945/jn.111.144717.
    Stewart CP, et al. Low Maternal Vitamin B-12 Status Is Associated With Offspring Insulin Resistance Regardless of Antenatal Micronutrient Supplementation in Rural Nepal. J Nutr. 2011;141(10):1912-7. PubMed PMID: 21865563.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low maternal vitamin B-12 status is associated with offspring insulin resistance regardless of antenatal micronutrient supplementation in rural Nepal. AU - Stewart,Christine P, AU - Christian,Parul, AU - Schulze,Kerry J, AU - Arguello,Margia, AU - LeClerq,Steven C, AU - Khatry,Subarna K, AU - West,Keith P,Jr Y1 - 2011/08/24/ PY - 2011/8/26/entrez PY - 2011/8/26/pubmed PY - 2011/12/13/medline SP - 1912 EP - 7 JF - The Journal of nutrition JO - J. Nutr. VL - 141 IS - 10 N2 - Questions have been raised about potentially negative effects of antenatal folic acid use in populations with a high prevalence of vitamin B-12 deficiency. Our objective was to examine the association between maternal folate and vitamin B-12 status in pregnancy on offspring insulin resistance and examine whether the effects of maternal micronutrient supplementation varied by baseline maternal folate and/or vitamin B-12 status. Pregnant women were cluster randomized to receive daily supplements containing vitamin A alone or with folic acid, folic acid+iron, folic acid+iron+zinc, or a multiple micronutrient. In a subsample (n = 1132), micronutrient status biomarkers were analyzed at baseline and late pregnancy. Children born to the women who participated in the trial were visited at 6-8 y of age. Fasting plasma glucose and insulin were used to estimate insulin resistance using the homeostasis model assessment (HOMA-IR). Children whose mothers were deficient in vitamin B-12 (<148 pmol/L, 27%) during early pregnancy had a 26.7% increase in HOMA-IR (P = 0.02), but there was no association with maternal folate status. Among children born to women who were vitamin B-12 deficient at baseline, the percent difference in HOMA-IR compared to the control group was 15.1% (95% CI: -35.9, 106.4), 4.9% (-41.6, 88.5), 3.3% (-38.4, 73.5), and 18.1% (-29.0, 96.7) in the folic acid, folic acid-iron, folic acid-iron-zinc, and multiple micronutrient supplementation groups, respectively, none of which were significant. Maternal vitamin B-12 deficiency is associated with an elevated risk of insulin resistance, but supplementation with folic acid or other micronutrients led to no significant change in insulin resistance in school-aged offspring. SN - 1541-6100 UR - https://www.unboundmedicine.com/medline/citation/21865563/Low_maternal_vitamin_B_12_status_is_associated_with_offspring_insulin_resistance_regardless_of_antenatal_micronutrient_supplementation_in_rural_Nepal_ L2 - https://academic.oup.com/jn/article-lookup/doi/10.3945/jn.111.144717 DB - PRIME DP - Unbound Medicine ER -