Thomas Susan, Thomas Tinku, Bosch Ronald J, Ramthal Asha, Bellinger David C, Kurpad Anura V, Duggan Christopher P, Srinivasan Krishnamachari
Division of Mental Health & Neurosciences, St John's National Academy of Health Sciences, St John's Research Institute, Bengaluru, Karnataka, 560034, India.
Division of Epidemiology, Biostatistics and Population Health, St John's Research Institute, Bengaluru, Karnataka, India.
Matern Child Health J. 2019 Feb;23(2):155-163. doi: 10.1007/s10995-018-2605-z.
Objectives To examine the effects of oral maternal vitamin B12 supplementation during pregnancy and early lactation on cognitive development in children. Method We studied 218 children born to mothers enrolled in a placebo-controlled, randomized trial of vitamin B12 supplementation during pregnancy through 6 weeks post-partum. Cognitive functions were assessed at 30 months using the Bayley Scales of Infant Development- 3rd edition (BSID III). The association of maternal sociodemographic characteristics, maternal biochemical status during pregnancy, birth weight and home environment with each sub-domain of BSID-III was examined using linear regression analysis. Separate multiple linear regression analyses for each of the BSID-III sub-domains with maternal trimester specific nutritional biomarker status was conducted. Results Children of mothers who received oral vitamin B12 supplementation had significantly higher scores on expressive language compared to children of mothers who received placebo (β = 0.14, P = 0.03). Children of mothers with elevated serum total homocysteine (tHcy) in the second and third trimesters of pregnancy had significantly lower scores on expressive language (β = - 0.18, P = 0.03 and β = - 0.19, P = 0.02, respectively) and gross motor domains (β = - 0.23, P = 0.008 and β = - 0.30, P = 0.001, respectively) of BSID-III adjusted for treatment arm and multiple confounders, compared with children whose mothers did not have elevated tHcy. Conclusions for practice Maternal B12 supplementation during pregnancy was associated with higher expressive language scores in children at 30 months. Elevated maternal tHcy levels during pregnancy had negative associations with expressive language and gross motor domains of BSID-III. Larger trials of maternal B12 supplementation are needed to confirm these findings.
研究孕期及哺乳期早期母亲口服补充维生素B12对儿童认知发育的影响。方法：我们对218名儿童进行了研究，这些儿童的母亲参与了一项从孕期至产后6周补充维生素B12的安慰剂对照随机试验。在30个月时使用贝利婴幼儿发展量表第三版（BSID-III）评估认知功能。采用线性回归分析研究母亲的社会人口学特征、孕期母亲的生化状态、出生体重和家庭环境与BSID-III各子领域之间的关联。针对BSID-III的每个子领域，分别与孕期各阶段特定的母亲营养生物标志物状态进行多元线性回归分析。结果：与接受安慰剂的母亲所生儿童相比，接受口服维生素B12补充剂的母亲所生儿童在表达性语言方面得分显著更高（β = 0.14，P = 0.03）。孕期第二和第三阶段血清总同型半胱氨酸（tHcy）升高的母亲所生儿童，在调整治疗组和多个混杂因素后，与母亲tHcy未升高的儿童相比，在BSID-III的表达性语言（分别为β = -0.18，P = 0.03和β = -0.19，P = 0.02）和大运动领域（分别为β = -0.23，P = 0.008和β = -0.30，P = 0.001）得分显著更低。实践结论：孕期母亲补充维生素B12与儿童30个月时更高的表达性语言得分相关。孕期母亲tHcy水平升高与BSID-III的表达性语言和大运动领域呈负相关。需要进行更大规模的母亲补充维生素B12试验来证实这些发现。
