Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh
Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh
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DOI：
10.1007/s00394-015-0845-x
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发表时间：
2016-02-01
影响因子：
5
通讯作者：
Raqib, Rubhana
中科院分区：
文献类型：
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作者：
Siddiqua, Towfida J.;Ahmad, Shaikh M.;Raqib, Rubhana
维生素B12（B12）状况不佳与孕期和婴儿期的不良后果相关。关于补充B12对免疫功能的影响知之甚少。本研究旨在评估产前和产后补充B12对母亲和婴儿的B12状况生物标志物以及疫苗特异性反应的影响。在一项双盲、安慰剂对照试验中，孟加拉国女性（n = 68，年龄18 - 35岁，血红蛋白<110 g/L，怀孕11 - 14周）被随机分配在孕期和产后3个月每天接受250μg B12或安慰剂，同时补充60 mg铁 + 400μg叶酸。女性在怀孕26 - 28周时接种甲型流感（H1N1）大流行疫苗。分析母亲（基线、分娩后72小时、产后3个月）、新生儿和婴儿（3个月）的血液中的血红蛋白、B12、甲基丙二酸（MMA）、总同型半胱氨酸（tHcy）、铁蛋白和血清转铁蛋白受体、C - 反应蛋白（CRP）以及α - 1 - 酸性糖蛋白（AGP）。还对母乳中的维生素B12进行了评估。测定血浆和初乳/母乳中的H1N1特异性抗体。在基线时，26%的女性缺乏B12（<150 pmol/L），40%处于边缘状态（150 - 220 pmol/L），43%的MMA升高（>271 nmol/L），31%的tHcy升高（>10 μmol/L）。补充B12增加了血浆、初乳和母乳中的B12（p < 0.05），并降低了新生儿、母亲以及3个月婴儿的MMA（p < 0.05）。与安慰剂相比，补充B12显著增加了母亲血浆和初乳中H1N1特异性IgA反应，并降低了AGP和CRP升高的婴儿比例。在孕期和哺乳期补充250μg/天的B12极大地改善了母亲、婴儿和母乳的B12状况。母亲补充B12仅改善了母亲自身的H1N1疫苗特异性反应，并可能减轻婴儿的炎症反应。
Poor vitamin B12 (B12) status is associated with adverse outcomes in pregnancy and infancy. Little is known about effects of B12 supplementation on immune function. The present study aimed to evaluate effects of pre- and postnatal B12 supplementation on biomarkers of B12 status and vaccine-specific responses in mothers and infants.In a blinded, placebo-controlled trial, Bangladeshi women (n = 68, age 18-35 years, hemoglobin < 110 g/L, 11-14 weeks pregnant) were randomized to receive 250 mu g/day B12 or a placebo throughout pregnancy and 3-month postpartum along with 60 mg iron + 400 mu g folate. Women were immunized with pandemic influenza A (H1N1) vaccine at 26- to 28-week gestation. Blood from mothers (baseline, 72-h post-delivery, 3-month postpartum), newborns and infants (3-month) was analyzed for hemoglobin, B12, methylmalonic acid (MMA), total homocysteine (tHcy), ferritin and serum transferrin receptor, C-reactive protein (CRP) and alpha-1-acid glycoprotein (AGP). Vitamin B12 was also assessed in breast milk. H1N1-specific antibodies were determined in plasma and colostrum/breast milk.At baseline, 26 % women were B12 deficient (< 150 pmol/L), 40 % had marginal status (150-220 pmol/L), 43 % had elevated MMA (> 271 nmol/L), and 31 % had elevated tHcy (> 10 mu mol/L). Supplementation increased B12 in plasma, colostrums and breast milk (p < 0.05) and lowered MMA in neonates, mothers and infants at 3 months (p < 0.05). B12 supplementation significantly increased H1N1-specific IgA responses in plasma and colostrums in mothers and reduced proportion of infants with elevated AGP and CRP compared with placebo.Supplementation with 250 mu g/day B12 during pregnancy and lactation substantially improved maternal, infant and breast milk B12 status. Maternal supplementation improved H1N1 vaccine-specific responses in mothers only and may alleviate inflammatory responses in infants.