Mesej utama
- Wanita yang mengambil suplemen vitamin B 12 semasa hamil mungkin telah meningkatkan status vitamin B 12 semasa hamil atau postpartum termasuk pengurangan ketakcukupan vitamin B 12 dan paras vitamin B 12 yang lebih tinggi dibandingkan wanita yang tidak mengambil suplemen vitamin B 12 , tetapi bukti tidak dapat dipastikan.
- Kesan pengambilan suplemen vitamin B 12 semasa hamil ke atas kesihatan lain pada wanita atau anak-anak mereka adalah tidak diketahui.
Implikasi kesihatan awam
Vitamin B 12 ialah nutrien penting yang membantu mengekalkan kesihatan darah dan sel saraf tubuh anda. Kekurangan vitamin B 12 adalah masalah kesihatan awam yang penting terutamanya di negara-negara berpendapatan rendah dan sederhana dengan beban yang tinggi dalam kalangan ibu-ibu mengandung dan kanak-kanak. Paras vitamin B 12 yang rendah semasa hamil telah dikaitkan dengan risiko yang lebih besar untuk hasil yang buruk semasa hamil seperti keguguran, pertumbuhan bayi yang tidak sihat di dalam rahim, masalah otak dan saraf tunjang bayi (dipanggil kecacatan tiub neural) dan status vitamin B 12 yang lebih rendah dalam kalangan bayi.
Penambahan vitamin B 12 semasa hamil boleh membantu meningkatkan kesihatan dan nutrisi wanita dan bayi mereka. Walau bagaimanapun, ini belum lagi dikaji dalam ulasan yang dijalankan dengan baik dan vitamin B 12 bukanlah sebahagian daripada suplemen yang disyorkan oleh Pertubuhan Kesihatan Sedunia (WHO; agensi khusus Pertubuhan Bangsa-Bangsa Bersatu yang bertanggungjawab untuk kesihatan awam antarabangsa) bagi wanita semasa hamil.
Apakah yang kami ingin tahu?
Kami ingin mengetahui jika pengambilan suplemen vitamin B 12 semasa hamil akan meningkatkan kesihatan dan nutrisi wanita dan bayi mereka.
Apakah yang kami lakukan?
Kami telah mencari kajian klinikal yang mengkaji pengambilan supplemen B 12 semasa hamil. Kami membandingkan dan merumuskan keputusan kajian dan menilai tahap keyakinan kami terhadap maklumat tersebut berdasarkan faktor-faktor seperti kaedah dan saiz kajian.
Apakah yang telah kami temui?
Kami memasukkan lima kajian melibatkan 984 ibu-ibu mengandung. Data daripada tiga kajian yang melibatkan 609 ibu-ibu mengandung diambil kira dalam analisis. Wanita yang mengambil suplemen vitamin B 12 semasa hamil lebih jarang mengalami ketakcukupan vitamin B 12 dan paras vitamin B 12 lebih tinggi berbanding wanita yang tidak mengambil suplemen B 12 , tetapi bukti ini adalah tidak kukuh. Tiada perbezaan antara kumpulan bagi ibu yang mengalami anemia. Kami tidak dapat menilai kesan pengambilan supplemen vitamin B 12 pada keadaan yang lain seperti keguguran, kecacatan tiub neural dan kognitif kanak-kanak (keupayaan kanak-kanak untuk meningkatkan pengetahuan melalui pemikiran, pemahaman dan deria) disebabkan hasil kajian yang terhad atau tiada langsung untuk dianalisis.
Apakah batasan bukti?
Bilangan dan saiz kajian yang kecil merupakan batasan-batasab dalam ulasan ini. Tidak semua kajian memberikan data tentang dapatan yang kami ingin tahu. Kami sangat tidak pasti tentang dapatannya.
Sejauh mana bukti ini terkini?
Bukti adalah terkini sehingga Jun 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).
Sila hubungi cochrane@rumc.edu.my untuk sebarang pertanyaan berkaitan terjemahan ini. Diterjemahkan oleh Salizawati Muhamad Salhimi (Pusat Pengajian Sains Farmasi, Universiti Sains Malaysia). Disunting oleh Kamisah Ariffin (Universiti Teknologi MARA).