B12 is a really critical vitamin, particularly in pregnant and breastfeeding women. We've known for a long time that women who are vegetarians have a higher risk of B12 deficiency, which may impact their fetus, and breastfed infants. Thus, measuring B12 levels in pregnant vegetarians is probably wise, as well as in the infant. Supplementing these moms with an occassional B12 injection is easy and cheap, and really fixes the problem. But vegetarinism is not always the problem, it could be because the mother lacks the absorption intrinsic factors in her gut to allow oral absorption of B12. Thus, breastfed infants of these moms with low B12, should be closely followed to be certain they have the proper "B12 intrinsic factors" in the gut to allow them to absorb B12. TWH
Pan Afr Med J. 2018 Jun 20;30:152. doi: 10.11604/pamj.2018.30.152.12046. eCollection 2018.
Psychomotor regression due to vitamin B12 deficiency.
A vitamin B12 deficiency in infants is rare, but may sometimes be seen in breastfed babies of strict vegetarian mothers. Vitamin B12, also known as cobalamin, is only found in meat and other animal products. Most babies have a sufficient supply as long as the mother was not deficient herself. Symptoms and signs of vitamin B12 deficiency appear between the ages of 2 to 12 months and include vomiting, lethargy, failure to thrive, hypotonia, and arrest or regression of developmental skills. Urinary concentrations of methylmalonic acid and homocystine are characteristically elevated in vitamin B12 deficiency. Early treatment for a vitamin B12 deficiency in an infant involves immediate administration of vitamin B12 to the baby and the breastfeeding mother. The infant and mother will each receive an injection of vitamin B12 containing 1,000 mcg or more of the vitamin, and the mother will continue to receive injections every month to raise her own stores. After the initial injection, the baby will often receive future vitamin B12 through food sources. We present a case of vitamin B12 deficiency in a 9-month-old girl presented with psychomotor regression, hypotonia and lethargy. The child was exclusively breast-fed from birth by a mother who was on strict vegetarian diet and belong to a low socio-economic status. Laboratory data revealed bicytopenia with macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The Brain CT revealed a cerebral atrophy and delayed myelination. Vitamin B12 supply was effective on anaemia and psychomotor delay. This case figures out the importance of an early diagnosis in front of psychomoteur regression and hypotonia, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency mainly in the setting of maternal nutritional deficiency.
Vitamin B12 deficiency; breastfeeding; hyperhomocysteinemia; hypotonia; psychomotor regression