Pesan utama
- Wanita yang mengonsumsi suplemen vitamin B 12 selama kehamilan mungkin mengalami perbaikan dalam hal status atau kadar vitamin B 12 selama kehamilan atau pascapersalinan, termasuk berkurangnya defisiensi kadar vitamin B 12 dan peningkatan kadar vitamin B 12 , dibandingkan dengan wanita yang tidak mengonsumsi suplemen vitamin B 12 , tetapi bukti ilmiahnya belum jelas.
- Efek mengonsumsi suplemen vitamin B 12 selama kehamilan terhadap luaran hasil kehamilan atau anak-anak mereka tidak diketahui.
Implikasi kesehatan masyarakat
Vitamin B 12 adalah nutrien penting yang membantu menjaga kesehatan pembuluh darah dan sel saraf tubuh. Kekurangan vitamin B 12 merupakan masalah kesehatan masyarakat yang penting, terutama di negara-negara dengan tingkat ekonomi rendah dan menengah, dengan beban kesehatan yang tinggi pada ibu hamil dan anak-anak. Kadar vitamin B 12 yang lebih rendah pada kehamilan dikaitkan dengan risiko lebih besar pada beberapa luaran kehamilan yang merugikan seperti keguguran, pertumbuhan bayi yang lambat di dalam rahim, masalah pada otak atau sumsum tulang belakang bayi (disebut defek tuba neuralis), dan status vitamin B 12 yang lebih rendah pada bayi.
Suplementasi vitamin B 12 selama kehamilan dapat membantu meningkatkan kesehatan dan nutrisi ibu dan bayinya. Namun, hal ini belum diuji dalam tinjauan yang menyeluruh, dan vitamin B 12 bukanlah bagian dari suplemen yang direkomendasikan oleh Organisasi Kesehatan Dunia (WHO; badan khusus PBB yang bertanggung jawab atas kesehatan masyarakat internasional) untuk ibu selama kehamilan.
Apa yang ingin diketahui?
Kami ingin mengetahui apakah mengonsumsi suplemen vitamin B 12 selama kehamilan akan meningkatkan kesehatan dan nutrisi ibu dan bayi yang dikandung.
Apa yang sudah dilakukan?
Kami mencari uji klinis yang menguji manfaat suplementasi vitamin B 12 selama kehamilan. Kami membandingkan dan merangkum hasil uji klinis tersebut dan menilai tingkat keyakinan kami terhadap informasi berdasarkan faktor-faktor seperti metode dan skala uji klinis.
Apa yang ditemukan?
Kami menyertakan lima uji klinis pada 984 ibu hamil. Tiga uji klinis, yang mengikutsertakan 609 ibu hamil, memiliki data yang disertakan dalam analisis. Wanita yang mengonsumsi suplemen vitamin B 12 selama kehamilan memiliki lebih sedikit defisiensi vitamin B 12 dan memiliki kadar vitamin B 12 yang lebih tinggi dibandingkan dengan wanita yang tidak mengonsumsi suplemen vitamin B 12 , tetapi bukti ilmiah tersebut tidak pasti. Tidak ada perbedaan status anemia ibu antara kedua kelompok. Kami tidak dapat menilai efek suplementasi vitamin B 12 pada luaran lain seperti keguguran, defek tuba neuralis, dan kognisi anak (kemampuan anak untuk mendapatkan pengetahuan melalui pemikiran, pemahaman, dan indera) karena terbatasnya atau tidak tersedianya hasil untuk dianalisis.
Apa keterbatasan bukti ilmiah tersebut?
Jumlah uji klinis yang sedikit dan skala kecil merupakan keterbatasan dalam tinjauan ini. Tidak semua uji klinis memberikan data tentang luaran yang kami harapkan untuk bisa diteliti. Kami memiliki tingkat keyakinan yang rendah dengan hasil penelitian tersebut.
Seberapa mutakhir bukti ilmiah ini?
Bukti ilmiah ini menggunakan penelitian hingga Juni 2023.
Oral vitamin B 12 supplementation during pregnancy may reduce the risk of maternal vitamin B 12 deficiency and may improve maternal vitamin B 12 concentrations during pregnancy or postpartum compared to placebo or no vitamin B 12 supplementation, but the evidence is very uncertain. The effects of vitamin B 12 supplementation on other primary outcomes assessed in this review were not reported, or were not reported in a format for inclusion in quantitative analyses. Vitamin B 12 supplementation during pregnancy may improve maternal and infant vitamin B 12 status, but the potential impact on longer-term clinical and functional maternal and child health outcomes has not yet been established.
Vitamin B 12 deficiency is a major public health problem worldwide, with the highest burden in elderly people, pregnant women, and young children. Due to its role in DNA synthesis and methylation, folate metabolism, and erythropoiesis, vitamin B 12 supplementation during pregnancy may confer longer-term benefits to maternal and child health outcomes.
To evaluate the benefits and harms of oral vitamin B 12 supplementation during pregnancy on maternal and child health outcomes.
We searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov , the World Health Organization International Clinical Trials Registry Platform ( ICTRP ) on 2 June 2023, and reference lists of retrieved studies.
Randomised controlled trials (RCTs), quasi-RCTs, or cluster-RCTs evaluating the effects of oral vitamin B 12 supplementation compared to placebo or no vitamin B 12 supplementation during pregnancy.
We used standard Cochrane methods. Four review authors independently assessed trial eligibility. Two review authors independently extracted data from included studies and conducted checks for accuracy. Three review authors independently assessed the risk of bias of the included studies using the Cochrane RoB 1 tool. We used GRADE to evaluate the certainty of evidence for primary outcomes.
The review included five trials with 984 pregnant women. All trials were conducted in low- and middle-income countries, including India, Bangladesh, South Africa, and Croatia. At enrolment, 26% to 51% of pregnant women had vitamin B 12 deficiency (less than 150 pmol/L), and the prevalence of anaemia (haemoglobin less than 11.0 g/dL) ranged from 30% to 46%. The dosage of vitamin B 12 supplementation varied from 5 μg/day to 250 μg/day, with administration beginning at 8 to 28 weeks' gestation through to delivery or three months' postpartum, and the duration of supplementation ranged from 8 to 16 weeks to 32 to 38 weeks. Three trials, involving 609 pregnant women, contributed data for meta-analyses of the effects of vitamin B 12 supplementation compared to placebo or no vitamin B 12 supplementation.
Maternal anaemia: there may be little to no difference for maternal anaemia by intervention group, but the evidence is very uncertain (70.9% versus 65.0%; risk ratio (RR) 1.08, 95% confidence interval (CI) 0.93 to 1.26; 2 trials, 284 women; very low-certainty evidence).
Maternal vitamin B 12 status: vitamin B 12 supplementation during pregnancy may reduce the risk of maternal vitamin B 12 deficiency compared to placebo or no vitamin B 12 supplementation, but the evidence is very uncertain (25.9% versus 67.9%; RR 0.38, 95% CI 0.28 to 0.51; 2 trials, 272 women; very low-certainty evidence). Women who received vitamin B 12 supplements during pregnancy may have higher total vitamin B 12 concentrations compared to placebo or no vitamin B 12 supplementation (mean difference (MD) 60.89 pmol/L, 95% CI 40.86 to 80.92; 3 trials, 412 women). However, there was substantial heterogeneity (I 2 = 85%).
Adverse pregnancy outcomes: the evidence is uncertain about the effect on adverse pregnancy outcomes, including preterm birth (RR 0.97, 95% CI 0.55 to 1.74; 2 trials, 340 women; low-certainty evidence), and low birthweight (RR 1.50, 95% CI 0.93 to 2.43; 2 trials, 344 women; low-certainty evidence). Two trials reported data on spontaneous abortion (or miscarriage); however, the trials did not report quantitative data for meta-analysis and there was no clear definition of spontaneous abortion in the study reports. No trials evaluated the effects of vitamin B 12 supplementation during pregnancy on neural tube defects.
Infant vitamin B 12 status: children born to women who received vitamin B 12 supplementation had higher total vitamin B 12 concentrations compared to placebo or no vitamin B 12 supplementation (MD 71.89 pmol/L, 95% CI 20.23 to 123.54; 2 trials, 144 children).
Child cognitive outcomes : three ancillary analyses of one trial reported child cognitive outcomes; however, data were not reported in a format that could be included in quantitative meta-analyses. In one study, maternal vitamin B 12 supplementation did not improve neurodevelopment status (e.g. cognitive, language (receptive and expressive), motor (fine and gross), social-emotional, or adaptive (conceptual, social, practical) domains) in children compared to placebo (9 months, Bayley Scales of Infant and Toddler Development Third Edition (BSID-III); 1 trial; low-certainty evidence) or neurophysiological outcomes (72 months, event-related potential measures; 1 trial; low-certainty evidence), though children born to women who received vitamin B 12 supplementation had improved expressive language domain compared to placebo (30 months, BSID-III; 1 trial; low-certainty evidence).
Diterjemahkan oleh dr. Mawaddah Ar Rochmah, Ph.D., Sp.N. (Universitas Gadjah Mada). Disunting oleh Prof. dr. Ova Emilia, M.Med.Ed., Sp.OG(K),Ph.D. (Universitas Gadjah Mada). Email Kontak: cochrane-indonesia.fkkmk@ugm.ac.id