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OBJECTIVES: To estimate the serum folate insufficiency threshold (sf-IT) corresponding to the red blood cell (RBC) folate insufficiency threshold for optimal neural tube defect (NTD) prevention. METHODS: Participants were 977 women of reproductive age (WRA; 15–40y; not pregnant or lactating) from a population-based biomarker survey in Southern India. Venous blood samples were collected at enrollment. Plasma, serum, and red blood cells were centrifuged, processed, and stored < -80°C until batch analysis. Total vitamin B12 concentrations were measured via chemiluminescence; RBC and serum folate concentrations were measured using the World Health Organization-recommended microbiological assay. Vitamin B12 deficiency was defined as total vitamin B12

BackgroundVitamin B12deficiency during pregnancy has been associated with adverse maternal and infant health outcomes. Few prospective studies have investigated vitamin B12status early in pregnancy, and its links to infant vitamin B12status, particularly in India where the burden of vitamin B12deficiency is estimated to be the highest globally. The objective of this study was to examine the associations of maternal vitamin B12biomarkers with neonatal vitamin B12status.MethodsPregnant women (~12 weeks’ gestation) were enrolled in a perinatal cohort study in Bangalore, India. Total vitamin B12, methylmalonic acid (MMA), and homocysteine concentrations were evaluated in maternal samples at enrollment and in neonates at birth using cord blood. Linear and binomial regression models were used to evaluate the associations of maternal vitamin B12biomarkers with neonatal vitamin B12status and perinatal outcomes.ResultsA total of 63.2% of women had vitamin B12deficiency (12insufficiency (12status (vitamin B120.26μmol/L) at enrollment; 40.8% of neonates had vitamin B12deficiency, 65.6% were insufficiency, and 38.1% had impaired vitamin B12status at birth. Higher maternal vitamin B12concentrations at enrollment were associated with increased neonatal vitamin B12concentrations (β(SE): 0.40 (0.05); p12deficiency (Risk Ratio [RR]: 0.53; 95% CI: [0.43, 0.65]; p12deficiency (RR: 1.97 [1.43, 2.71]; p12status (RR: 1.49 [1.13, 1.97]; p = 0.005) predicted a two-fold increase in the risk of neonatal vitamin B12deficiency at birth.ConclusionsThe prevalence of vitamin B12deficiency was high early in pregnancy and predicted neonatal vitamin B12status. Future research is needed to determine the role of vitamin B12in the development of pregnancy and infant outcomes, and to inform screening and interventions to improve maternal and child health.

OBJECTIVES: To examine the burden of anemia and micronutrient deficiencies among young children living in urban slums of Mumbai, India. METHODS: Participants were children 10–18 months of age (n = 278) residing in urban slums in Mumbai who were screened as part of a randomized feeding trial of biofortified pearl millet. Venous blood was collected by a pediatric phlebotomist and hemoglobin (Hb) concentrations were assessed via Coulter counter. Samples were processed and stored 5.0 mg/L. Iron deficiency anemia was defined as Hb 5.0 mg/L. The prevalence of vitamin B(12) deficiency was 17.0%, 41.8% of children had vitamin B(12) insufficiency, and 19.9% had folate deficiency. Among anemic children, 84.5% had ≥1 micronutrient deficiency and 22.7% had ≥ 2 micronutrient deficiencies. Iron deficiency (RR: 2.15; 95% CI: 1.55, 2.99; P

OBJECTIVES: To conduct a biomarker survey to examine the anemia burden and vitamin B(12) and folate status in women of reproductive age as part of an ongoing periconceptional surveillance program in Southern India. METHODS: Participants were women of reproductive age (15–40 y) who were not pregnant or lactating and resided in households within the 50 km(2) catchment area of our community-based research site in Southern India. Venous blood samples were collected at enrollment (n = 813), and whole blood samples were analyzed for hemoglobin using an automated Coulter counter. Plasma, serum, and red blood cells (RBC) were separated by centrifugation, processed, and stored

OBJECTIVES: To examine biomarkers of heavy metal exposure in women of reproductive age as part of an ongoing periconceptional surveillance program in Southern India. METHODS: Participants were women of reproductive age (15–40 y) who were not pregnant or lactating and resided in households within the 50 km(2) catchment area of our community-based research site. Venous blood samples were collected in metal-free blue top K2EDTA vacutainers, and urine samples were collected in acid-washed containers. Plasma and red blood cells were separated by centrifugation, processed, and stored 5.8 µg/L. A total of 31.1% of participants had detectable chromium plasma concentrations (median (IQR): 2.5 (1.0, 15.0) µg/L), with 15.7% of samples >2.1 µg/L. Concentrations of two or more heavy metals detected in plasma were found in 41.4% of participants: 7.1% lead and mercury, 18.6% lead and chromium, 10.0% mercury and chromium, and 5.7% with all three detected in plasma. No participants in this pilot sub-sample had plasma concentrations of arsenic or cadmium above the detection limit for this method (≥1.0 µg/L). CONCLUSIONS: Findings from this pilot study provide preliminary evidence of heavy metal exposure – including lead, mercury, and chromium – in women of reproductive age in this setting. Because of potential interactions between exposure to heavy metals and folate status that may impact the risk of birth defects, biomarker surveillance of heavy metals remains a critical component of this program. FUNDING SOURCES: Centers for Disease Control and Prevention. AF was supported by the National Institutes of Health #5 T32 HD087137