دورية أكاديمية
أعرض في EDS

Vitamin B12 supplementation during pregnancy for maternal and child health outcomes.

التفاصيل البيبلوغرافية
العنوان: Vitamin B12 supplementation during pregnancy for maternal and child health outcomes.
المؤلفون: Finkelstein JL; Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA., Fothergill A; Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA.; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Venkatramanan S; Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA., Layden AJ; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Williams JL; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Crider KS; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Qi YP; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
المصدر: The Cochrane database of systematic reviews [Cochrane Database Syst Rev] 2024 Jan 08; Vol. 1. Cochrane AN: CD013823. Date of Electronic Publication: 2024 Jan 08.
نوع المنشور: Journal Article; Systematic Review
اللغة: English
بيانات الدورية: Publisher: Wiley Country of Publication: England NLM ID: 100909747 Publication Model: Electronic Cited Medium: Internet ISSN: 1469-493X (Electronic) Linking ISSN: 13616137 NLM ISO Abbreviation: Cochrane Database Syst Rev Subsets: MEDLINE
أسماء مطبوعة: Publication: 2004- : Chichester, West Sussex, England : Wiley
Original Publication: Oxford, U.K. ; Vista, CA : Update Software,
مواضيع طبية MeSH: Abortion, Spontaneous* , Anemia*, Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Pregnancy ; Dietary Supplements ; Outcome Assessment, Health Care ; Vitamin B 12 ; Vitamins
مستخلص: Background: Vitamin B 12 deficiency is a major public health problem worldwide, with the highest burden in elderly people, pregnant women, and young children. Due to its role in DNA synthesis and methylation, folate metabolism, and erythropoiesis, vitamin B 12 supplementation during pregnancy may confer longer-term benefits to maternal and child health outcomes.
Objectives: To evaluate the benefits and harms of oral vitamin B 12 supplementation during pregnancy on maternal and child health outcomes.
Search Methods: We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) on 2 June 2023, and reference lists of retrieved studies.
Selection Criteria: Randomised controlled trials (RCTs), quasi-RCTs, or cluster-RCTs evaluating the effects of oral vitamin B 12 supplementation compared to placebo or no vitamin B 12 supplementation during pregnancy.
Data Collection and Analysis: We used standard Cochrane methods. Four review authors independently assessed trial eligibility. Two review authors independently extracted data from included studies and conducted checks for accuracy. Three review authors independently assessed the risk of bias of the included studies using the Cochrane RoB 1 tool. We used GRADE to evaluate the certainty of evidence for primary outcomes.
Main Results: The review included five trials with 984 pregnant women. All trials were conducted in low- and middle-income countries, including India, Bangladesh, South Africa, and Croatia. At enrolment, 26% to 51% of pregnant women had vitamin B 12 deficiency (less than 150 pmol/L), and the prevalence of anaemia (haemoglobin less than 11.0 g/dL) ranged from 30% to 46%. The dosage of vitamin B 12 supplementation varied from 5 μg/day to 250 μg/day, with administration beginning at 8 to 28 weeks' gestation through to delivery or three months' postpartum, and the duration of supplementation ranged from 8 to 16 weeks to 32 to 38 weeks. Three trials, involving 609 pregnant women, contributed data for meta-analyses of the effects of vitamin B 12 supplementation compared to placebo or no vitamin B 12 supplementation. Maternal anaemia: there may be little to no difference for maternal anaemia by intervention group, but the evidence is very uncertain (70.9% versus 65.0%; risk ratio (RR) 1.08, 95% confidence interval (CI) 0.93 to 1.26; 2 trials, 284 women; very low-certainty evidence). Maternal vitamin B 12 status: vitamin B 12 supplementation during pregnancy may reduce the risk of maternal vitamin B 12 deficiency compared to placebo or no vitamin B 12 supplementation, but the evidence is very uncertain (25.9% versus 67.9%; RR 0.38, 95% CI 0.28 to 0.51; 2 trials, 272 women; very low-certainty evidence). Women who received vitamin B 12 supplements during pregnancy may have higher total vitamin B 12 concentrations compared to placebo or no vitamin B 12 supplementation (mean difference (MD) 60.89 pmol/L, 95% CI 40.86 to 80.92; 3 trials, 412 women). However, there was substantial heterogeneity (I 2 = 85%). Adverse pregnancy outcomes: the evidence is uncertain about the effect on adverse pregnancy outcomes, including preterm birth (RR 0.97, 95% CI 0.55 to 1.74; 2 trials, 340 women; low-certainty evidence), and low birthweight (RR 1.50, 95% CI 0.93 to 2.43; 2 trials, 344 women; low-certainty evidence). Two trials reported data on spontaneous abortion (or miscarriage); however, the trials did not report quantitative data for meta-analysis and there was no clear definition of spontaneous abortion in the study reports. No trials evaluated the effects of vitamin B 12 supplementation during pregnancy on neural tube defects. Infant vitamin B 12 status: children born to women who received vitamin B 12 supplementation had higher total vitamin B 12 concentrations compared to placebo or no vitamin B 12 supplementation (MD 71.89 pmol/L, 95% CI 20.23 to 123.54; 2 trials, 144 children). Child cognitive outcomes: three ancillary analyses of one trial reported child cognitive outcomes; however, data were not reported in a format that could be included in quantitative meta-analyses. In one study, maternal vitamin B 12 supplementation did not improve neurodevelopment status (e.g. cognitive, language (receptive and expressive), motor (fine and gross), social-emotional, or adaptive (conceptual, social, practical) domains) in children compared to placebo (9 months, Bayley Scales of Infant and Toddler Development Third Edition (BSID-III); 1 trial; low-certainty evidence) or neurophysiological outcomes (72 months, event-related potential measures; 1 trial; low-certainty evidence), though children born to women who received vitamin B 12 supplementation had improved expressive language domain compared to placebo (30 months, BSID-III; 1 trial; low-certainty evidence).
Authors' Conclusions: Oral vitamin B 12 supplementation during pregnancy may reduce the risk of maternal vitamin B 12 deficiency and may improve maternal vitamin B 12 concentrations during pregnancy or postpartum compared to placebo or no vitamin B 12 supplementation, but the evidence is very uncertain. The effects of vitamin B 12 supplementation on other primary outcomes assessed in this review were not reported, or were not reported in a format for inclusion in quantitative analyses. Vitamin B 12 supplementation during pregnancy may improve maternal and infant vitamin B 12 status, but the potential impact on longer-term clinical and functional maternal and child health outcomes has not yet been established.
(Copyright © 2024 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
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معلومات مُعتمدة: T32 HD087137 United States HD NICHD NIH HHS
سلسلة جزيئية: ClinicalTrials.gov NCT00641862; NCT03258385
المشرفين على المادة: P6YC3EG204 (Vitamin B 12)
0 (Vitamins)
تواريخ الأحداث: Date Created: 20240108 Date Completed: 20240109 Latest Revision: 20240221
رمز التحديث: 20240221
مُعرف محوري في PubMed: PMC10772977
DOI: 10.1002/14651858.CD013823.pub2
PMID: 38189492
قاعدة البيانات: MEDLINE
الوصف
تدمد:1469-493X
DOI:10.1002/14651858.CD013823.pub2