Ebru Yılmaz KESKİN, Başar DEMİR, Mahir İĞDE, Banu Gülcan ÖKSÜZ

Samsun ve Çevresindeki Gebelerde B12 Vitamini Eksikliğinin Sıklığı

Amaç: B12 vitamini eksikliği, süt çocukluğu döneminde ağır demiyelinizan santral sinir sistemi bozukluğuna neden olabilir. Olguların çoğu, B12 vitamini depoları yetersiz annelerden doğan ve sadece anne sütü ile beslenen bebeklerdir. Yenidoğan bebeklerde, B12 vitamini durumunun temel belirleyicisi, annenini B12 depolarıdır. Bu nedenle, çalışmamızda, bölgemizdeki term gebelerde B12 vitamini durumunu değerlendirmeyi amaçladık. Materyal ve Metod: Toplam 62 gebe kadında, doğumdan 1-24 sa önce rutin tetkiklere ek olarak serum B12, folat ve plazma homosistein değerleri ölçüldü. Ayrıca, B12 eksikliği bulgusu olan annelerin yenidoğan bebekleri değerlendirilmek üzere çocuk hematolojisi polikliniğine yönlendirildi. Bulgular: 36 (%58,1) gebe kadının serum B12 değeri düşük (9,99 µmol/L) birlikteliği mevcuttu. Değerlendirilen 20 yenidoğanın tamamının fizik muayene bulguları normaldi. B12 replasmanı sonrasında tüm olgularda serum B12 ve plazma homosistein değerleri normal olarak bulundu. Tartışma: Samsun ve çevresindeki yenidoğanlarda, annedeki eksikliğe ikincil B12 vitamini eksikliği, düşünüldüğünden daha sık olabilir. Geniş ölçekli tarama çalışmaları ile bu durumun prevalansı daha hassas şekilde belirlenebilir ve koruyucu önlemlerin daha etkili şekilde alınması sağlanabilir.Anahtar Kelimeler:

Anahtar Kelimeler:

yenidoğan, B12 vitamini, homosistein, gebelik, maternal

Prevalence of Vitamin B12 Deficiency Among Pregnant Women in Samsun Province of Turkey

Purpose: Vitamin B12 deficiency in infancy can cause severe demyelinating central nervous system disorder. Most cases are exclusively breast-fed infants born to mothers with deficient vitamin B12 stores. As maternal vitamin B12 stores are the main determinant of neonatal vitamin B12 status, we aimed to determine the vitamin B12 status of pregnant women at term in our region. Materials and Methods: Serum vitamin B12, folate and plasma homocysteine concentrations in addition to routine testings were measured 1-24 hour(s) before delivery in 62 pregnant women. Besides, infants born to mothers with laboratory evidence of vitamin B12 deficiency were referred to pediatric hematology unit for evaluation. Results: Thirty-six (58.1%) women had a low serum vitamin B12 level (9.99 µmol/L). All of the 20 infants examined had normal neurodevelopmental findings. Vitamin B12 supplementation resulted in normalization of vitamin B12 and homocysteine levels in all the cases. Conclusion: The frequency of neonatal vitamin B12 deficiency secondary to maternal deficiency may be higher than thought in Samsun province of Turkey. Large-scale screening studies may reveal its prevalence more accurately, and may help in taking preventive measurements.

Keywords:

Key Words: neonatal, vitamin B12, homocysteine, pregnancy, maternal,

PDF

___

Ludwig ML, Matthews RG. Structure-based perspectives on B12-dependent enzymes. Annu Rev Biochem. 1997;66:269-313.
Stabler SP. Clinical practice. Vitamin B12 deficiency. N Engl J Med. 2013;368:149-60.
Balci YI, Ergin A, Karabulut A, Polat A, Dogan M, Kucuktasci K. Serum Vitamin B12 and Folate Concentrations and the Effect of the Mediterranean Diet on Vulnerable Populations. Pediatr Hematol Oncol. 2014;31:62-7.
Karaoglu L, Pehlivan E, Egri M, Deprem C, Gunes G, Genc MF, Temel I. The prevalence of nutritional anemia in pregnancy in an east Anatolian province, Turkey. BMC Public Health. 2010;10:329.
Koc A, Kocyigit A, Soran M, Demir N, Sevinc E, Erel O, Mil Z. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vitamin B12 deficiency in Sanliurfa province of Turkey. Eur J Nutr. 2006;45:291-7.
Halicioglu O, Sutcuoglu S, Koc F, Ozturk C, Albudak E, Colak A, Sahin E, Asik Akman S. Vitamin B12 and folate statuses are associated with diet in pregnant women, but not with anthropometric measurements in term newborns. J Matern Fetal Neonatal Med. 2012;25:1618-21.
Ackurt F, Wetherilt H, Loker M, Hacibekiroglu M. Biochemical assessment of nutritional status in preand post-natal Turkish women and outcome of pregnancy. Eur J Clin Nutr. 1995;49:613-22.
Bailey D, Bevilacqua V, Colantonio DA, Pasic MD, Perumal N, Khun Chan M, Adeli K. Pediatric WithinDay Biological Variation and Quality Specifications for 38 Biochemical Markers in the CALIPER Cohort. Clin Chem, in press. 2014;60:518-29. doi: 1373/clinchem.2013.214312. von Schenck U, Bender-Gotze C, Koletzko B. Persistence of neurological damage induced by dietary vitamin B-12 deficiency in infancy. Arch Dis Child. 1997;77:137-9.
Lindenbaum J, Healton EB, Savage DG, Brust JC, Garrett TJ, Podell ER, Marcell PD, Stabler SP, Allen RH. Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med 1988;318:1720-8.
Koebnick C, Heins UA, Dagnelie PC, Wickramasinghe SN, Ratnayaka ID, Hothorn T, Pfahlberg AB, Hoffmann I, Lindemans J, Leitzmann C. Longitudinal concentrations of vitamin B(12) and vitamin B(12)-binding proteins during uncomplicated pregnancy. Clin Chem. 2002;48:928-33.
Morkbak AL, Hvas AM, Milman N, Nexo E. Holotranscobalamin remains unchanged during pregnancy. Longitudinal changes of cobalamins and their binding proteins during pregnancy and postpartum. Haematologica. 2007;92:1711-2.
Pardo J, Peled Y, Bar J, Hod M, Sela BA, Rafael ZB, Orvieto R. Evaluation of low serum vitamin B(12) in the non-anaemic pregnant patient. Hum Reprod. 2000;15:224-6.
Selhub J. Folate binding proteins. Mechanisms for placental and intestinal uptake. Adv Exp Med Biol. 1994;352:141-9.
Stabler SP, Allen RH, Savage DG, Lindenbaum J. Clinical spectrum and diagnosis of cobalamin deficiency. Blood. 1990;76:871-81.
Pennypacker LC, Allen RH, Kelly JP, Matthews LM, Grigsby J, Kaye K, Lindenbaum J, Stabler SP. High prevalence of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc. 1992;40:1197-1204.
Nexo E, Hoffmann-Lucke E. Holotranscobalamin, a marker of vitamin B-12 status: analytical aspects and clinical utility. Am J Clin Nutr. 2011;94:359-365.
Campbell CD, Ganesh J, Ficicioglu C. Two newborns with nutritional vitamin B12 deficiency: challenges in newborn screening for vitamin B12 deficiency. Haematologica. 2005;90:ECR45.
Guerra-Shinohara EM, Paiva AA, Rondo PH, Yamasaki K, Terzi CA, D'Almeida V. Relationship between total homocysteine and folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12. BJOG. 2002;109:784-91.
Haliloglu B, Aksungar FB, Celik A, Ilter E, Coksuer H, Ozekici U. Negative correlation between D-dimer and homocysteine levels during pregnancy and the postpartum period: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2010;153:23-6.
Holmes VA, Wallace JM, Alexander HD, Gilmore WS, Bradbury I, Ward M, Scott JM, McFaul P, McNulty H. Homocysteine is lower in the third trimester of pregnancy in women with enhanced folate status from continued folic acid supplementation. Clin Chem. 2005;51:629-34.
Holmes VA. Changes in haemostasis during normal pregnancy: does homocysteine play a role in maintaining homeostasis? Proc Nutr Soc. 2003;62:479-93.
Infante-Rivard C, Rivard GE, Yotov WV, Theoret Y. 200 Perinatal reference intervals for plasma homocysteine and factors influencing its concentration. Clin Chem. 2002;48:1100-02.
Malinow MR, Rajkovic A, Duell PB, Hess DL, Upson BM. The relationship between maternal and neonatal umbilical cord plasma homocyst(e)ine suggests a potential role for maternal homocyst(e)ine in fetal metabolism. Am J Obstet Gynecol 1998;178:228-33.
Monsen AL, Refsum H, Markestad T, Ueland PM. Cobalamin status and its biochemical markers methylmalonic acid and homocysteine in different age groups from 4 days to 19 years. Clin Chem 2003;49:2067-75.
Karademir F, Suleymanoglu S, Ersen A, Aydinoz S, Gultepe M, Meral C, Ozkaya H, Gocmen I. Vitamin B12, folate, homocysteine and urinary methylmalonic acid levels in infants. J Int Med Res. 2007;35:3843
Hubner U, Schorr H, Eckert R, Geisel J, Herrmann W. Stability of plasma homocysteine, Sadenosylmethionine, and S-adenosylhomocysteine in EDTA, acidic citrate, and Primavette collection tubes. Clin Chem. 2007;53:2217-8.
Turgeon CT, Magera MJ, Cuthbert CD, Loken PR, Gavrilov DK, Tortorelli S, Raymond KM, Oglesbee D, Rinaldo P, Matern D. Determination of total homocysteine, methylmalonic acid, and 2-methylcitric acid in dried blood spots by tandem mass spectrometry. Clin Chem. 2010;56:1686-5.
Yazışma Adresi / Address for Correspondence: Dr. Ebru Yılmaz Keskin Samsun Education and Research Hospital, Pediatric Hematology and Oncology 55100 İlkadım, SAMSUN
E-mail: ebruyilmaz81@hotmail.com G eliş tarihi/Received on : 09.06.2014
Kabul tarihi/Accepted on: 30.06.2014