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High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study.
Am J Clin Nutr 2013; 98(6):1450-8AJ

Abstract

BACKGROUND

Folic acid supplementation in those with a low vitamin B-12 intake or status may have adverse effects. These effects are unknown with regard to birth outcome in pregnant Indian women who are routinely supplemented with high doses of folic acid.

OBJECTIVE

The objective was to examine the association of unbalanced vitamin B-12 and total folate (folic acid supplement + dietary folate) intakes during pregnancy with outcomes in small-for-gestational-age (SGA) infants.

DESIGN

This was a prospective observational cohort study of 1838 pregnant women in South India. Low intake of dietary vitamin B-12 in the presence of high total folate intake was examined as the ratio of vitamin B-12 intake to total folate intake.

RESULTS

The inadequacy of vitamin B-12 intake (<1.2 μg/d) assessed by a food-frequency questionnaire in the first, second, and third trimesters of pregnancy was 25%, 11%, and 10%, respectively. Multivariate log binomial regression showed that low vitamin B-12 and folate intakes in the first trimester were independently associated with a higher risk of SGA. In a subgroup of women with high supplemental folic acid intakes in the second trimester, those with the lowest tertile of vitamin B-12:folate ratio had a higher risk of SGA outcome than did those in the highest tertile (adjusted RR: 2.73; 95% CI: 1.17, 6.37). A similar trend was observed in the analysis of blood micronutrient status in a random subset (n = 316) of the sample.

CONCLUSIONS

These findings suggest that, in addition to vitamin B-12 and folate deficiencies alone, there may be adverse birth outcomes associated with unbalanced vitamin B-12 and folate intakes or status during pregnancy. These findings have important implications for the antenatal B vitamin supplementation policy in India. This trial was registered at the Clinical Trial Registry of India as 2013/07/005342.

Authors+Show Affiliations

Division of Nutrition (PD and AVK) and the Epidemiology and Biostatistics Unit (TT), St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India; Harvard College, Cambridge, MA (JRB); the Department of Obstetrics and Gynecology, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India (AT); and the Department of Pediatrics, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India (SB).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24108785

Citation

Dwarkanath, Pratibha, et al. "High Folate and Low Vitamin B-12 Intakes During Pregnancy Are Associated With Small-for-gestational Age Infants in South Indian Women: a Prospective Observational Cohort Study." The American Journal of Clinical Nutrition, vol. 98, no. 6, 2013, pp. 1450-8.
Dwarkanath P, Barzilay JR, Thomas T, et al. High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. Am J Clin Nutr. 2013;98(6):1450-8.
Dwarkanath, P., Barzilay, J. R., Thomas, T., Thomas, A., Bhat, S., & Kurpad, A. V. (2013). High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. The American Journal of Clinical Nutrition, 98(6), pp. 1450-8. doi:10.3945/ajcn.112.056382.
Dwarkanath P, et al. High Folate and Low Vitamin B-12 Intakes During Pregnancy Are Associated With Small-for-gestational Age Infants in South Indian Women: a Prospective Observational Cohort Study. Am J Clin Nutr. 2013;98(6):1450-8. PubMed PMID: 24108785.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High folate and low vitamin B-12 intakes during pregnancy are associated with small-for-gestational age infants in South Indian women: a prospective observational cohort study. AU - Dwarkanath,Pratibha, AU - Barzilay,Julie R, AU - Thomas,Tinku, AU - Thomas,Annamma, AU - Bhat,Swarnarekha, AU - Kurpad,Anura V, Y1 - 2013/10/09/ PY - 2013/10/11/entrez PY - 2013/10/11/pubmed PY - 2014/4/8/medline SP - 1450 EP - 8 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 98 IS - 6 N2 - BACKGROUND: Folic acid supplementation in those with a low vitamin B-12 intake or status may have adverse effects. These effects are unknown with regard to birth outcome in pregnant Indian women who are routinely supplemented with high doses of folic acid. OBJECTIVE: The objective was to examine the association of unbalanced vitamin B-12 and total folate (folic acid supplement + dietary folate) intakes during pregnancy with outcomes in small-for-gestational-age (SGA) infants. DESIGN: This was a prospective observational cohort study of 1838 pregnant women in South India. Low intake of dietary vitamin B-12 in the presence of high total folate intake was examined as the ratio of vitamin B-12 intake to total folate intake. RESULTS: The inadequacy of vitamin B-12 intake (<1.2 μg/d) assessed by a food-frequency questionnaire in the first, second, and third trimesters of pregnancy was 25%, 11%, and 10%, respectively. Multivariate log binomial regression showed that low vitamin B-12 and folate intakes in the first trimester were independently associated with a higher risk of SGA. In a subgroup of women with high supplemental folic acid intakes in the second trimester, those with the lowest tertile of vitamin B-12:folate ratio had a higher risk of SGA outcome than did those in the highest tertile (adjusted RR: 2.73; 95% CI: 1.17, 6.37). A similar trend was observed in the analysis of blood micronutrient status in a random subset (n = 316) of the sample. CONCLUSIONS: These findings suggest that, in addition to vitamin B-12 and folate deficiencies alone, there may be adverse birth outcomes associated with unbalanced vitamin B-12 and folate intakes or status during pregnancy. These findings have important implications for the antenatal B vitamin supplementation policy in India. This trial was registered at the Clinical Trial Registry of India as 2013/07/005342. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/24108785/High_folate_and_low_vitamin_B_12_intakes_during_pregnancy_are_associated_with_small_for_gestational_age_infants_in_South_Indian_women:_a_prospective_observational_cohort_study_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.112.056382 DB - PRIME DP - Unbound Medicine ER -