Low plasma vitamin B12 in pregnancy is associated with gestational 'diabesity' and later diabetes.
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.
Krishnaveni
G V
GV
Holdsworth Memorial Hospital, Mandi Mohalla, Post Box 38, Mysore 570021, India. gv.krishnaveni@gmail.com
Hill
J C
JC
Veena
S R
SR
Bhat
D S
DS
Wills
A K
AK
Karat
C L S
CL
Yajnik
C S
CS
Fall
C H D
CH
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
D005492:Folic Acid; D014805:Vitamin B 12
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