Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Maternal nutrition, infants and children

Imbalance of folic acid and vitamin B12 is associated with birth outcome: an Indian pregnant women study

European Journal of Clinical Nutrition volume 68, pages 726–729 (2014)Cite this article

Subjects

Abstract

Background/objectives:

Maternal nutrient supplementation in developing countries is generally restricted to provision of iron and folic acid. Along with folic acid, vitamin B12 is also an important determinant of fetal growth and development. During pregnancy, the increased requirement of folic acid is met with supplementation, while vitamin B12 remains untreated and possibly deficient. The objective of our study was to study the combined effect of maternal plasma folate and vitamin B12, and their ratio on birth anthropometrics.

Subjects/methods:

We carried out an observational study on 49 full-term pregnant women at KEM Hospital, Pune, India, during 2006–2008, and measured plasma folate, vitamin B12 and homocysteine in venous blood at 36 weeks of gestation. Neonatal anthropometrics (birth weight, length, head circumference, abdominal circumference, mid arm circumference, chest circumference, triceps skinfold and subscapular skinfold thickness) were measured within 24 h of birth.

Results:

Maternal plasma folate and vitamin B12 were not correlated to neonatal anthropometrics. The combined association of folate and vitamin B12 expressed as folate to vitamin B12 ratio was correlated to the neonatal anthropometrics. Imbalance in the maternal micronutrients with increasing ratio of folate to vitamin B12 was associated with an increase in plasma homocysteine (P=0.014), lowering of neonatal birth weight (P=0.009), birth length (P=0.034), head circumference (P=0.018) and chest circumference (P=0.009), while no significant association to other anthropometrics was observed.

Conclusions:

Supplementation of vitamin B12 in addition to supplementation of folic acid in pregnancy may be important for improving birth weight, birth length, head circumference and chest circumference.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Neggers YH, Goldenberg RL, Tamura T, Cliver SP, Hofman HJ . The relationship between maternal dietary intake and infant birth weight. Acta Obstet Gynecol Scand 1997; 165: S71–S75.

    Google Scholar 

  2. Walj NJ, Law MR, Morris JK, Wald DS . Quantifying the effect of folic acid. Lancet 2001; 358: 2069–2073.

    Article  Google Scholar 

  3. Yajnik CS, Deshpande SS, Jackson AA, Refsum H, Rao S, Fisher DJ et al. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in offspring: the Pune Maternal Nutrition Study. Diabetologia 2008; 51: 29–38.

    Article  CAS  Google Scholar 

  4. Yajnik CS, Lubree HG, Thuse NV, Ramdas LV, Deshpande SS, Deshpande V et al. Oral vitamin B12supplementation reduces plasma total homocysteine concentration in women in India. Asia Pac J Clin Nutr 2007; 16: 103–109.

    CAS  PubMed  Google Scholar 

  5. Green R, Miller JW . Folate deficiency beyond megaloblastic anemia: hyperhomocysteinemia and other manifestations of dysfunctional folate status. Semin Haematol 1999; 36: 47–64.

    CAS  Google Scholar 

  6. Swanson DA, Liu ML, Baker PJ, Garrett L, Stitzel M, Jianmin WU et al. Targeted disruptions of the methionine synthase gene in mice. Mol Cell Biol 2001; 21: 1058–1065.

    Article  CAS  Google Scholar 

  7. Ueland PM, Bjrke Monsen AL . Hyperhomocysteinemia and B-vitamin deficiencies in infants and children. Clin Chem Lab Med 2003; 41: 1418–1426.

    Article  CAS  Google Scholar 

  8. Obeid R, Herrmann W . Homocysteine folic acid and vitamin B12in relation to pre and postnatal health aspects. Clin Chem Lab Med 2005; 43: 1052–1057.

    Article  CAS  Google Scholar 

  9. Ronnenberg AG, Goldman MB, Chen D, Aitken IW, Willett WC, Selhub J et al. Preconception homocysteine and B vitamin status and birth outcomes in Chinese women. Am J Clin Nutr 2002; 76: 1385–1391.

    Article  CAS  Google Scholar 

  10. Yajnik CS, Deshpande SS, Panchanadikar AV, Naik SS, Deshpande JA, Coyaji KJ et al. Maternal total homocysteine concentration and neonatal size in India. Asia Pac J Clin Nutr 2005; 14: 179–181.

    CAS  Google Scholar 

  11. Murphy MM, Scott JM, Arija V, Molloy AM, Fernandez- Ballart JD . Maternal homocysteine before conception and throughout pregnancy predicts foetal homocysteine and birth weight. Clin Chem 2004; 50: 1406–1412.

    Article  CAS  Google Scholar 

  12. Cohen J . Statistical Power Analysis for the Behavioral Sciences 2nd edn Lawrence Earlbaum Associates: Hillsdale, NJ, 1998, pp 273–406.

    Google Scholar 

  13. Steijns LS, Braams-Wiatrowska JK, Luiting HJ, van der Weide J . Evaluation of nonisotopic binding assays for measuring vitamin B 12 and folate in serum. Clin Chem Acta 1996; 248: 135–141.

    Article  CAS  Google Scholar 

  14. Lonati S, Novembrino C, Ippolito S, Accinni R, Galli C, Troonen H et al. Analytical performance and method comparison study of the total homocysteine fluorescence polarization immunoassay (FPIA) on AxSYM analyzer. Clin Chem Lab Med 2004; 42: 228–234.

    Article  CAS  Google Scholar 

  15. Uma Khanduri Archna, Sharma Arti Joshi . Occult folate and cobalamin deficiency in Indians. Natl Med J Ind 2005; 18: 4.

    Google Scholar 

  16. Naik S, Joglekar C, Bhat D, Lubree H, Rege S, Raut K et al. Marked gender difference in plasma total homocysteine concentrations in Indian adults with low vitamin B12 . Int J Vitamin Nutr Res 2011; 81: 306–316.

    Article  CAS  Google Scholar 

  17. Rao S, Yajnik CS, Kanade A, Fall CH, Margetts BM, Jackson AA et al. Intake of Micronutrient-rich foods in rural Indian mothers is associated with the size of their babies at birth: Pune Maternal Nutrition Study. J Nutr 2001; 131: 1217–1224.

    Article  CAS  Google Scholar 

  18. Gopalan C . Low birthweight: Significance and Implications. In: Sachdev HPS, Chaudhary P (eds) Nutrition in Children: Developing Country Concerns. Imprint: New Delhi, India, 1994, pp 1–33.

    Google Scholar 

  19. Barker DJ . Fetal origin of coronary heart disease. Br Med J 1995; 311: 171–174.

    Article  CAS  Google Scholar 

  20. Martin H, Lindblad B, Norman M . Endothelial function in newborn infants is related to folate levels and birthweight. Pediatrics 2007; 119: 1152–1158.

    Article  Google Scholar 

  21. Barker DJ . Adult consequences of fetal growth restriction. Clin Obstet Gynecol 2006; 49: 270–283.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the Indian Council of Medical Research, New Delhi, grant number 63/3/Indo-US/2006-RHN, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grant number R03HD052138, for funding the work. We also thank the research and medical staff at the KEM Hospital for enrolment and sample collection. We thank Dr CS Yajnik and Dr K Kumaran of the Diabetes Unit, KEM Hospital, Pune, for their valuable comments and suggestions on the paper. We also thank Dr Mehmood Sayyad for his help in statistical analysis of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the ICMR or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Interdisciplinary School of Health Sciences, University of Pune, Pune, India

    M Gadgil, K Joshi & B Patwardhan

  2. Department of Paediatrics, KEM Hospital Research Centre, KEM Hospital, Pune, India

    A Pandit & R Joshi

  3. Department of Gynaecology, KEM Hospital, Pune, India

    S Otiv

  4. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

    J T Brenna

Authors
  1. M Gadgil
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Pandit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S Otiv
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Joshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J T Brenna
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B Patwardhan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to K Joshi or J T Brenna.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on European Journal of Clinical Nutrition website

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gadgil, M., Joshi, K., Pandit, A. et al. Imbalance of folic acid and vitamin B12 is associated with birth outcome: an Indian pregnant women study. Eur J Clin Nutr 68, 726–729 (2014). https://doi.org/10.1038/ejcn.2013.289

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.289

Keywords

This article is cited by

Search

Advanced search

Quick links