What

to look for in
vitamin B12
supplements
Breast feeding and
vegetarianism
A mothers vitamin B12 intake during
breast-feeding is important because her
breast milk is her infants only source of
B12. For children of vegetarian mothers
who did not supplement with vitamin
B12, research shows that those
breastfed at two years had higher
homocysteine concentrations than
those who were not breastfed at two
years (4). Sufficient B12 during
breastfeeding is important because B12
deficiency in infants can lead to
cognitive problems such intellectual
and psychomotor delay (3).

The vitamin B12 RDA is 2.8

g/day for lactating women,
0.4 g/day for infants 0-6
months, and 0.5 g/day for
infants 6-12 months (2).
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When selecting supplements, USP

certified supplements come highly
recommended because they certify
products that adhere to a set of
standards that
assess identity,
strength, quality,
and purity of a
substance (1).

References
1. USP Dietary Supplement Standards. U.S. Pharmacopeial
Convention Web site.
http://www.usp.org.ezproxy1.lib.asu.edu/dietary-
supplements/overview. Updated 2013. Accessed 04/22, 2013.
2. Advanced nutrition and human metabolism. Belmont, CA:
Wadsworth Cengage Learning; 2009.
3. Chalouhi C, F aesch S, Anthoine-Milhomme M, Fulla Y, D ulac O,
Chron G. Neurological consequences of vitamin B12 deficiency
and its treatment. Pediatr Emerg Care. 2008;24(8):538-541.
4. Lubree HG, Katre PA, Joshi SM, et al. Child's homocysteine
concentration at 2 years is influenced by pregnancy vitamin B12
and folate status. Journal of Developmental O rigins of Health and
Disease. 2012;3(1):32-38.
5. Vollset SE, R efsum H, Irgens LM, et al. Plasma total
homocysteine, pregnancy complications, and adverse pregnancy
outcomes: the Hordaland Homocysteine study. Am J Clin Nutr.
2000;71(4):962.

Arizona State University
Phoenix,
AZ

Pregnancy and
Vegetarianism:
Vitamin B12
An education pamphlet for
medical professionals

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2

Vitamin B12 and

Folate interaction
The best sources of folate are
mushrooms, green v egetables, and
legumes. As v egetarian diets are
often high in folate and low in
vitamin B12, B12 deficiency is often
more of a concern than folate
deficiency in pregnant vegetarian
mothers. Because vitamin B12 is
necessary to metabolize dietary
folate (different from supplemental
folate) into a form usable by the
body (same as supplemental folate),
B12 deficiency can be detected by
measuring folate intermediates.
However, high amounts of
supplemental folate in the diet (such
as from prenatal vitamins) can mask
a vitamin B12 deficiency and prevent
outward symptoms from appearing,
even if internal homocysteine
concentrations are high (2).

What is Vitamin B12? Why is it important?

Vitamin B12, also known
as cobalamin (at left), is
a B vitamin found only
in animal products. The
best sources of vitamin
B12 are meat, poultry,
clams, and egg yolk.
Milk and other dairy
products do contain B12, but not
as much as the foods listed
above. Vitamin B12 is necessary for two major
processes in the body: converting homocysteine
(tHCY) to methionine, and converting L-
methylmalonyl CoA to succinyl CoA (2). The
production of methionine from homocysteine is
particularly important during fetal development.
The conversion of homocysteine to methionine is
important because high amounts of
homocysteine in pregnancy have been linked to

infant consequences such as low birth weight,

premature delivery, and neural tube defects. In
addition, high amounts of homocysteine in
pregnancy have been linked to maternal
consequences such as preeclampsia (5). Using a
stepwise regression analysis, researchers have
concluded that increased m aternal vitamin B12
and B12 supplementation at 34 weeks decreased
a childs tHcy concentration at two years (4).
It is important to note, however, that high
concentrations of homocysteine in the body can
also be caused by a folate deficiency (5).

The vitamin B12 RDA for pregnant

women is 2.6 g/day. The folate RDA for
pregnant women is 600 g/day (2).