title: Low plasma vitamin B12 in pregnancy is associated with gestational 'diabesity' and later diabetes.
abstract: OBJECTIVE
  This study was designed to test the hypothesis that low plasma vitamin B(12) concentrations combined with high folate concentrations in pregnancy are associated with a higher incidence of gestational diabetes (GDM) and later diabetes.
  
  
  METHODS
  Women (N = 785) attending the antenatal clinics of one hospital in Mysore, India, had their anthropometry, insulin resistance (homeostasis model assessment-2) and glucose tolerance assessed at 30 weeks' gestation (100 g oral glucose tolerance test; Carpenter-Coustan criteria) and at 5 years after delivery (75 g OGTT; WHO, 1999). Gestational vitamin B(12) and folate concentrations were measured in stored plasma samples.
  
  
  RESULTS
  Low vitamin B(12) concentrations (<150 pmol/l, B(12) deficiency) were observed in 43% of women and low folate concentrations (<7 nmol/l) in 4%. B(12)-deficient women had higher body mass index (p < 0.001), sum of skinfold thickness (p < 0.001), insulin resistance (p = 0.02) and a higher incidence of GDM (8.7% vs 4.6%; OR 2.1, p = 0.02; p = 0.1 after adjusting for BMI) than non-deficient women. Among B(12)-deficient women, the incidence of GDM increased with folate concentration (5.4%, 10.5%, 10.9% from lowest to highest tertile, p = 0.04; p for interaction = 0.2). Vitamin B(12) deficiency during pregnancy was positively associated with skinfold thickness, insulin resistance (p < 0.05) and diabetes prevalence at 5 year follow-up (p = 0.009; p = 0.008 after adjusting for BMI). The association with diabetes became non-significant after excluding women with previous GDM (p = 0.06).
  
  
  CONCLUSIONS
  Maternal vitamin B(12) deficiency is associated with increased adiposity and, in turn, with insulin resistance and GDM. Vitamin B(12) deficiency may be an important factor underlying the high risk of 'diabesity' in south Asian Indians.
authors.affiliation: Holdsworth Memorial Hospital, Mandi Mohalla, Post Box 38, Mysore 570021, India. gv.krishnaveni@gmail.com
authors.forename: G V
authors.initials: GV
authors.lastname: Krishnaveni
authors.forename: J C
authors.initials: JC
authors.lastname: Hill
authors.forename: S R
authors.initials: SR
authors.lastname: Veena
authors.forename: D S
authors.initials: DS
authors.lastname: Bhat
authors.forename: A K
authors.initials: AK
authors.lastname: Wills
authors.forename: C L S
authors.initials: CL
authors.lastname: Karat
authors.forename: C S
authors.initials: CS
authors.lastname: Yajnik
authors.forename: C H D
authors.initials: CH
authors.lastname: Fall
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005492:Folic Acid / Q000097:blood; D005951:Glucose Tolerance Test; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007333:Insulin Resistance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood; D011256:Pregnancy Outcome; D012959:Socioeconomic Factors; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications; D055815:Young Adult
chemical_list: D005492:Folic Acid; D014805:Vitamin B 12
references.citation: Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73
references.pmid: 7148898
references.citation: J Clin Pathol. 1991 Jul;44(7):592-5
references.pmid: 1856292
references.citation: Clin Chem. 1987 Jan;33(1):52-4
references.pmid: 3542297
references.citation: Diabetes Res Clin Pract. 2007 Dec;78(3):398-404
references.pmid: 17640759
references.citation: Diabetes Care. 2005 Nov;28(11):2750-5
references.pmid: 16249551
references.citation: Am J Clin Nutr. 2007 Nov;86(5):1302-9
references.pmid: 17991639
references.citation: J Chromatogr B Biomed Appl. 1995 Jul 21;669(2):352-7
references.pmid: 7581911
references.citation: Diabetologia. 2001 Sep;44(9):1094-101
references.pmid: 11596662
references.citation: J Clin Epidemiol. 1995 Aug;48(8):1077-85
references.pmid: 7775995
references.citation: J Clin Endocrinol Metab. 1999 Jul;84(7):2329-35
references.pmid: 10404798
references.citation: Proc Natl Acad Sci U S A. 2007 Dec 11;104(50):19995-20000
references.pmid: 18056804
references.citation: Food Nutr Bull. 2007 Dec;28(4):435-8
references.pmid: 18274171
references.citation: J Assoc Physicians India. 2006 Oct;54:775-82
references.pmid: 17214273
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: N Engl J Med. 2004 Feb 26;350(9):865-75
references.pmid: 14985484
references.citation: Proc Natl Acad Sci U S A. 2008 Feb 5;105(5):E7; author reply E8
references.pmid: 18234852
references.citation: Diabetologia. 2008 Jan;51(1):29-38
references.pmid: 17851649
references.citation: Proc Nutr Soc. 1992 Aug;51(2):219-24
references.pmid: 1438330
references.citation: Diabetes Care. 2004 May;27(5):1047-53
references.pmid: 15111519
references.citation: Diabetes Nutr Metab. 2001 Oct;14(5):253-8
references.pmid: 11806465
references.citation: Diabetes Care. 2005 Dec;28(12):2919-25
references.pmid: 16306555
references.citation: J Assoc Physicians India. 2004 Sep;52:707-11
references.pmid: 15839447
references.citation: Am J Clin Nutr. 2001 Aug;74(2):233-41
references.pmid: 11470726
references.citation: Diabetes Care. 2001 Aug;24(8):1403-10
references.pmid: 11473077
references.citation: Acta Obstet Gynecol Scand. 2004 Jun;83(6):543-7
references.pmid: 15144335
references.citation: Clin Chem. 2004 Feb;50(2):423-32
references.pmid: 14670827
references.citation: Acta Obstet Gynecol Scand. 2005 Feb;84(2):159-65
references.pmid: 15683377
references.citation: Indian J Med Sci. 2007 Jun;61(6):361-71
references.pmid: 17558103
references.citation: Proc Natl Acad Sci U S A. 2007 Dec 4;104(49):19351-6
references.pmid: 18042717
references.citation: Eur J Clin Nutr. 2006 Jun;60(6):791-801
references.pmid: 16404414
references.citation: Clin Chem. 2004 Oct;50(10):1769-84
references.pmid: 15319318
references.citation: J Nutr. 2004 Jan;134(1):205-10
references.pmid: 14704320
references.citation: Diab Vasc Dis Res. 2007 Jun;4(2):143-50
references.pmid: 17654449
references.citation: Eur J Haematol. 2006 Jun;76(6):521-5
references.pmid: 16548919