Breastfeeding and Maternal/Child Vitamin B12 Deficiency

CQ #197 – May 18, 2020
by Anne Eglash MD, IBCLC, FABM
#LACTFACT
Infants with vitamin B12 deficiency due to low vitamin B12 in their mothers’ breastmilk may present with abnormal movements such as tremulousness, tics, and involuntary muscle contractions.
Medical Hypotheses 142(2020) 109796

How does a breastfeeding baby become vitamin B12 deficient, and what are the symptoms?

Vitamins are nutritional substances that our bodies usually cannot make on their own, and are required for our bodies to function properly. Vitamin B12 is essential for proper red cell function, neurologic function, and DNA synthesis. Mothers may be at risk for low vitamin B12 for a variety of reasons. Maternal diet plays a very important role in vitamin B12 status. Dietary sources of vitamin B12 include animal proteins such as chicken, eggs, red meat, fish, and dairy products. Some substances are fortified with B12 such as cereals, nondairy milks, and nutritional yeast (brewer’s yeast). Women who are vegan or vegetarian are at significant risk for vitamin B12 deficiency. Low vitamin B12 can be due to certain medications that decrease vitamin B12 absorption, such as anti-acid medications, especially proton pump inhibitors (e.g. omeprazole, lansoprazole, etc.), and metformin which is most often taken for type 2 diabetes and polycystic ovarian syndrome. Intestinal surgery may decrease vitamin B12 absorption, such as gastric bypass surgery. Certain other health conditions, such as celiac sprue, Crohn’s disease, and pernicious anemia, make it difficult to absorb vitamin B12 from the diet. The Academy of Nutrition and Dietetics recommends supplemental vitamin B12 for vegans and lacto-ovo vegetarians during pregnancy and lactation to make sure that the fetus/nursing infant has sufficient vitamin B12.

The article for this week reports on 13 cases of infants with vitamin B12 deficiency, describing their clinical presentations and in particular their abnormal movements. The abnormal movements were quite varied, and included eyelid twitching and involuntary muscle contractions in various parts of the body. The involuntary contractions happened several times a day or a week. Several of the infants had low tone of the neck or trunk. A few of the 13 infants had a delay in social smile and insufficient eye contact.

Which statements do you believe are accurate regarding vitamin B12 deficiency in breastfeeding mothers and infants? Choose 1 or more:
  1. Neurologic problems in infants with vitamin B12 deficiency often improve and gradually resolve with vitamin B12 supplementation.
  2. Mothers may not have any symptoms of a borderline low or low vitamin B12 level.
  3. When replacing vitamin B12 for infants, they must be given the B12 as shots rather than orally.
  4. A high dose of vitamin B12, such as 1000 times the recommended daily intake, is considered safe.

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