Vitamin B-12 deficiency in Guatemalan mothers and infants: Prevalence, predictors and associations with maternal depression and infant development

The objective of this research was to determine the prevalence of deficient plasma vitamin B-12 concentrations in Guatemalan infants and their mothers, and evaluate associations with deficiency. Subjects were 304 Guatemalan infants, 80% of whom were breastfeeding, and their mothers. Exclusion criteria for infants included twins, severe stunting or wasting, reported health problems, severe developmental delay, hemoglobin (Hb) <95 g/L, maternal age <17 y, and maternal pregnancy >3 mo. Socio-economic status and home environment (HOME) data were collected. Infant and maternal anthropometric measures were performed. Vitamin B-12 intake from complementary foods was estimated with a food frequency questionnaire (FFQ), and breastfeeding frequency was reported by mothers. A complete blood count (CBC), and plasma vitamin B-12, folate, ferritin, and C-reactive protein (CRP) were measured. Maternal depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale. The Bayley Scale II Mental, Motor, and Behavioral Rating Scales (BSR), the Preschool Language Scale (PLS), and the Temperament and Atypical Behavior Scale (TABS) were used to assess infant developmental status. Deficient and marginal plasma vitamin B-12 concentrations were found in 29.8% and 19.5% of infants, and 35.7% and 32.5% of mothers, respectively. Anemia was present in 14.5% of infants and 9.8% of mothers. Daily vitamin B-12 intake averaged 3.6 ug in mothers and 2.4 ug from complementary foods in infants. In linear regression analysis, higher maternal plasma vitamin B-12, higher B-12 intake from complementary foods, lower frequency of breastfeeding, and larger household size predicted infant plasma vitamin B-12 concentrations (P < 0.0001). A CES-D score ≥16 was found in 43% of women, and these women had, on average, more children (P < 0.05), a higher BMI (P < 0.05), a lower platelet count (P < 0.05), and a lower plasma vitamin B-12 concentration (P < 0.005) than women with less symptoms. Infants with deficient plasma vitamin B-12 concentrations had poorer performance of motor skills related to secure walking compared to adequate infants (P < 0.005), and those consuming <1.44 ug/d of vitamin B-12 from complementary foods had a lower mean MDI score than infants consuming >1.44 ug/d (P < 0.05). Additional studies and supplementation trials are needed to confirm these associations.