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correspondence

Indian Pediatr 2010;47: 361-362

Vitamin B Supplementation to Prevent Neural Tube Defects?


V Latha and M Sridhar,

Apollo Childrens Hospital, 15 Shafee Mohammed Road, Thousand Lights, Chennai 600 006, India.
Email: [email protected] 
 


Periconceptional folic acid is recommended for preventing neural tube defects(NTD)(1). Reports suggest that supplementation with vitamin B
12 is also necessary for the purpose(2). We present 2 patients with NTD, where the mothers had evidence of vitamin B12 deficiency.

Case 1. A 5-month-old boy presented with significant pallor and poor feeding. He was born to a 29-year-old mother with history of previous 5 abortions (3 with fetal anomalies) and one early neonatal death. She had received supplements of folic acid 5 mg once daily before conception and continued through pregnancy. The baby, delivered at full term, had a lumbar meningomyelocele that required surgery. The patient’s hemoglobin was 3g/dL, and the mother’s hemoglobin was 9 g/dL. Their peripheral smear showed macrocytic normochromic anemia. Vitamin B12 levels in the mother and baby were 136 pg/mL and 47 pg/mL, respectively (normal 200-950 pg/mL); blood levels of folate were normal. The mother was a strict vegetarian with low intake of vitamin B12.

Case 2. A gravida 5, para 3 mother with 2 miscarriages and two live children, delivered a boy at 35 weeks by cesarean section, the indication being severe maternal anemia (hemoglobulin level 5.1 gm/dL) and identification of a NTD in the fetus. Peripheral smear showed macrocytic normochromic anemia, vitamin B12 deficiency (86 pg/mL), and normal blood levels of folate and ferritin. The baby had a thoraco-lumbo-sacral meningomyelocele, which needed surgical intervention soon after birth. There was no history of previous NTD in the family.

In both these cases, the newborn had a neural tube defect, despite maternal folate supplementation and normal serum folate level. Both mothers were however deficient in vitamin B12.

Vitamin B12 is found in foods from animals (fish, meat, poultry, eggs, milk and milk products) and its deficiency is proposed as a cause of NTD(2,3). Supplementation with folic acid, as in the present cases, did not prevent the occurrence of the defects.

A large proportion of Indian population can be classified as vegetarian with dietary exclusion of all animal products. The precise role of maternal vitamin B12 deficiency in occurrence of congenital anomalies and/or recurrent abortions need to be examined. Mechanisms and preventive effect of vitamin B12 supplementation also needs to be studied.

References

1. Wilson RD, Davies G, Désilets V, Reid GJ, Summers A, Wyatt P, et al. The use of folic acid for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can 2003; 25: 959-973.

2. Steen MT, Boddie AM, Fisher AJ, Macmahon W, Saxe D, Sullivan KM, et al. Neural tube defects are associated with low concentrations of cobalamin (vitamin B12) in amniotic fluid. Prenat Diagn 1998; 18: 545-555.

3. Godbole K, Deshmukh U, Yajnik C. Nutrigenetic determinants of neural tube defects in India. Indian Pediatr 2009; 46: 467-475.
 

 

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