Abstract
Background: To evaluate vitamin B12 and folate status in pregnancy and their relationship with maternal obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Methods: A retrospective case-control study of 344 women (143 GDM, 201 no-GDM) attending a district general hospital and that had B12 and folate levels measured in the early 3rd trimester was performed. Maternal history including early pregnancy body mass index (BMI) and neonatal data (birthweight, sex, and gestational age) was recorded for all subjects. Results: 26% of the cohort had B12 levels <150 pmol/L (32% vs. 22% in the two groups respectively, p < 0.05) while 1.5% were folate deficient. After adjusting for confounders, 1st trimester BMI was negatively associated with 3rd trimester B12 levels. Women with B12 insufficiency had higher odds of obesity and GDM (aOR (95% CI) 2.40 (1.31, 4.40), p = 0.004, and 2.59 (1.35, 4.98), p = 0.004, respectively), although the latter was partly mediated by BMI. In women without GDM, the lowest quartile of B12 and highest quartile of folate had significantly higher adjusted risk of fetal macrosomia (RR 5.3 (1.26, 21.91), p = 0.02 and 4.99 (1.15, 21.62), p = 0.03 respectively). Conclusion: This is the first study from the UK to show that maternal B12 levels are associated with BMI, risk of GDM, and additionally may have an independent effect on macrosomia. Due to the increasing burden of maternal obesity and GDM, longitudinal studies with B12 measurements in early pregnancy are needed to explore this link.
Highlights
The burden of maternal obesity (defined as body mass index (BMI) greater than 30 kg/m2 ) is rapidly increasing, affecting nearly 20% of pregnant women in the UK [1]
Out of approximately 8400 deliveries in the hospital between 2010 and 2013 that were screened, 344 women (143 gestational diabetes mellitus (GDM), 201 no-GDM) who met the inclusion criteria and had B12 levels measured in the 3rd trimester of pregnancy were included
Of the 201 no-GDM women, 45% had glucose tolerance test (GTT) as per National Institute for Health and Care Excellence (NICE) selective screening criteria [23] and the characteristics of these women are summarised in the Supplementary
Summary
The burden of maternal obesity (defined as body mass index (BMI) greater than 30 kg/m2 ) is rapidly increasing, affecting nearly 20% of pregnant women in the UK [1]. Vitamin B12 (B12) and folate are essential micronutrients required for the synthesis of DNA, protein, and lipids, in a series of cellular reactions collectively known as one-carbon metabolism [5,6]. One step in this process is the conversion of homocysteine (Hcy) to a methyl donor, methionine, for which B12 and folate are necessary cofactors. To evaluate vitamin B12 and folate status in pregnancy and their relationship with maternal obesity, gestational diabetes mellitus (GDM), and offspring birthweight. Maternal history including early pregnancy body mass index (BMI) and neonatal data (birthweight, sex, and gestational age) was recorded for all subjects. Women with B12 insufficiency had higher odds of obesity and GDM (aOR (95% CI) 2.40
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