Abstract
BackgroundVitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM). Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression.MethodsWe included women who visited the hospital at 6-weeks postpartum for a regular checkup. Inclusion criteria were age (18–50 years), and willingness to donate venous sample for analysis. Exclusion criteria included previous history of mood disorders or antidepressant medication use, and any systemic illness like hypothyroidism, epilepsy, diabetes, and hypertension. Based on EPDS score of 10 as a cutoff, 217 women with probable postpartum depression (PPD) and equal number of age and BMI matched controls were included.Plasma total vitamin B12, holotranscobalamin (holotc), homocysteine (hcy), methyl malonic acid (MMA), 5-methyl tetrahydrofolate (THF), SAM and serotonin levels were estimated using commercially available ELISA kits. Combined B12 (cB12) score was calculated from study parameters. Multivariate analysis was performed to assess the risk of probable postpartum depression.ResultsTotal vitamin B12 and combined B12 score were found to be significantly lower (p = 0.001) and MMA (p = 0.002) and 5-methyl THF (p < 0.001) levels were higher in women with probable depression than women without probable PPD. Women in the lowest vitamin B12 quartile had 4.53 times higher likelihood of probable postpartum depression (p < 0.001). Multivariate analysis demonstrated that decreasing vitamin B12 (OR = 0.394; 95% CI: 0.189–0.822) and cB12 (OR = 0.293; 95% CI: 0182–0.470) and increasing MMA (OR = 2.14; 95% CI: 1.63–2.83) and 5-methyl THF levels (OR = 3.29; 95% CI: 1.59–6.83) were significantly associated with the risk of probable PPD.ConclusionLow vitamin B12 may contribute to depressive symptoms in vulnerable postpartum period.
Highlights
Vitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM)
Vitamin B12 is involved in methionine regeneration and methylation reactions, which occur at a high rate during fetal development, and influence the synthesis and neuronal availability of serotonin/ 5- hydroxyl tryptamine (5-HT)
Population characteristics Mothers with probable postpartum depression were more likely to belong to middle socioeconomic group (p = 0.002), have had more than one child (p = 0.002), were dissatisfied with their marriage (p < 0.001) & the gender of the child (p = 0.004), have had an unplanned pregnancy (p < 0.001), and have had higher rates of cesarean section (p = 0.014)
Summary
Vitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule S-Adenosyl Methionine (SAM). Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression. Numerous studies have explored the relationship of nutritional factors like omega-3, fatty acids, zinc, B-vitamins with perinatal depression [2]. Lower levels of vitamin B12 have been suggested to mediate depression in general population [3] and during the perinatal period [2]. Apart from its direct effect, an increase in homocysteine (hcy), which accumulates in vitamin B12 deficiency can precipitate depressed mood, by increasing reactive oxygen species and further inducing neuronal apoptosis [4]. Deficiencies in vitamin B12 can become overt during pregnancy and lactation, when demands of growing fetus and delayed repletion impose significant nutritional demand [5, 6]
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