Q J Med 2003; 96: 289-295
© 2003 Association of Physicians
Vitamin B12 insufficiency and the risk of fetal neural tube defects
From the Division of Obstetrical Medicine, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada, and 1 Laboratory of Paediatrics and Neurology, Department of Paediatrics, University Hospital Nijmegen, Nijmegen, The Netherlands
Received 5 November 2002 and in revised form 4 February 2002
Background: Although maternal folate insufficiency is a risk factor for fetal neural tube defects (NTDs), there is controversy about whether vitamin B12 (B12) insufficiency is also associated with an increased risk of NTDs.
Aim: To investigate whether low maternal B12 is associated with an increased risk of fetal NTDs.
Design: Systematic review.
Methods: A systematic search of Medline between 1980 and October 2002, with an examination of the citations of all retrieved studies. Studies were included that: (i) used a cohort or case-control design; (ii) included case mothers with a prior or current NTD-affected pregnancy; (iii) assessed a group of unaffected ‘controls’; and (iv) measured the vitamin B12 status of all participants.
Results: Overall, 17 case-control studies were included, mean sample size 33 cases and 93 controls. In 5/6, mean amniotic fluid B12 concentration was significantly lower in case mothers than in controls. Of 11 that measured maternal serum or plasma B12, three observed a significantly lower mean concentration in case mothers vs. controls, while five others found a non-significant lower trend in the case group. One study observed a significantly higher mean concentration of maternal serum methylmalonic acid among the maternal cases, while another found a non-significant lower mean concentration of plasma holo-transcobalamin. Five studies estimated the risk of NTDs in relation to low B12 or B12-related metabolic markers: it was significantly increased in three studies, with a non-significant trend in the fourth.
Discussion: There seems to be a moderate association between low maternal B12 status and the risk of fetal NTDs. However, several design limitations, and the inclusion of few study participants, may have under-represented this. A large observational study, using reliable and valid indicators of B12 status in early pregnancy, could best assess the association between B12 insufficiency and the risk of fetal NTDs.
Address correspondence to Dr J.G. Ray. e-mail: jray515445{at}aol.com
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