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Relationship between Maternal Folate and Vit B12 status, size of the Offspring at Birth and its Growth in Infancy


Funded By:  International Atomic Energy Agency (IAEA), Vienna, Austria
Month & Year of Commencement:  May 2004
Current Status:  Completed

Principal Investigator: Dr. C.S.Yajnik,Director,Diabetes Unit, KEM Hospital and Research Centre,Pune,India
Co-Investigator: Dr. Suhas Otiv, Honorary Associate Consultant, KEM Hospital and Research Centre,Pune,India

Collaborators: Anura V Kurpad, St John’s National Academy of Health Sciences, Sarjapur Road, Bangalore


» Background
» Objectives
» Methodology and Design
» Results

Background

Low birth weight is common in India. It's normally ascribed to small maternal size and 'chronic undernutrition'. It is not clear which components of maternal nutrition are important. In Pune Maternal Nutrition Study, we demonstrated that maternal frequency of intake of green leafy vegetables, fruits and milk is a significant predictor of offspring size. Similarly circulating concentrations of homocysteine (tHcy), folate and vitamin C were significant determinants of offspring size.

Hyperhomocystenemia in mothers was related more to low vitamin B12 status rather than to low folate status. Two thirds of mothers had low vitamin B12 status, very few had low folate status, largely contributed by vegetarianism. In a follow -up study we found that low maternal vit B12 status and normal to high folate status predicted adiposity and insulin resistance in the child. Vitamin B12 status was also predictive of child's neurocognitive performance.


Objectives

  • To assess maternal folate and vitamin B12 status at 28 weeks gestation
  • To measure offspring vit B12 and folate status at birth (cord blood)
  • To measure offspring size and body composition at birth
  • To correlate maternal vit B12 and folate status with offspring vit B12 and folate status, and its size and body composition at birth
  • To measure confounding variables like maternal size, weight gain in pregnancy, changes in total body water (TBW, measured by deuterated water methos) during pregnancy and metabolism in third trimester, as well as paternal size
  • Infant growth during first 1 year of life


Methodology and Design

100 normal pregnancies registered at the rural primary health care centre at Vadu near Pune and 100 normal pregnancies registered at the antenatal clinic of King Edward Memorial Hospital (KEMH) in Pune were studied. Out of these 50 urban and 50 rural women underwent body composition measurements twice in the pregnancy.

Maternal Measurements:

Medical and obstetric details were obtained at each visit. Anthropometric, bioimpedance and deuterated water measurements were performed at 18 and 34 weeks of gestation . Nutritional assessment included 24 hr recall and food frequency questionnaire for vitamin B12 rich items. Blood measurements included: hematological parameters, glucose, insulin, lipids, tHcy , serum folate and serum vitamin B12 concentrations.

Neonatal measurements:

Detail neonatal anthropometry at birth, and cord -blood for hematological parameters, glucose, insulin, tHcy, erythrocyte folate and serum vitamin B12 concentration. A substantial number of babies underwent DXA body composition and ~50 babies also underwent whole body MRI Follow-up measurements (anthropometry, breast feeding, top feeding etc) were done at 3mths, 6mths and 1y age.


Result

  • In vitamin B12 insufficient, folate replete pregnant women, vitamin B12
    supplementation is associated with a reduction of plasma total homocysteine concentration in late pregnancy.
  • The most important finding of this prospective investigation in a vitamin B12 insufficient but folate-replete population is that mother’s vitamin B12 status during pregnancy is a predictor of child’s vitamin B12 and tHcy concentrations at 2y of age.
  • Maternal B12 and folate during pregnancy were positively associated with mental and social development quotients of the offspring. Maternal B12 and folate during intrauterine life may favorably influence brain development and function. Pregnancy
    provides a window of opportunity to enhance fetal psychomotor (motor and mental) development.


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