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Updated: Jan 11, 2026

Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes
Published on: June 28, 2024
Maternal cobalamin deficiency causing infantile seizures and developmental regression
Nadav Weinstock1, Jacqueline Wood2, Emily DeBoy3
1Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA nweinst5@jh.edu.
Insights
Maternal pernicious anemia caused vitamin B12 deficiency in an infant, leading to failure to thrive and seizures. Prompt vitamin B12 repletion corrected metabolic issues and improved neurological symptoms.
Area of Science:
- Pediatric Neurology
- Metabolic Disorders
- Nutritional Deficiencies
Background:
- An 11-month-old boy presented with failure to thrive, seizures, developmental regression, and oral lesions.
- Metabolic derangements including elevated propionylcarnitine, homocysteine, and methylmalonic acid were observed.
Purpose of the Study:
- To investigate the cause of unexplained neurological and metabolic symptoms in an infant.
- To determine the role of cobalamin (vitamin B12) metabolism in the infant's condition.
Main Methods:
- Rapid whole exome sequencing (WES) and metabolic studies were performed.
- Evaluation included assessment of infant's and mother's vitamin B12 levels and autoantibodies.
Main Results:
- Infant's WES revealed no pathogenic variants in cobalamin metabolism genes.
- Maternal vitamin B12 was undetectable; she was diagnosed with pernicious anemia.
- Infant showed complete metabolic correction and neurological improvement after vitamin B12 repletion.
Conclusions:
- Maternal vitamin B12 deficiency due to pernicious anemia can manifest as severe metabolic and neurological disease in infants.
- Early diagnosis and treatment with vitamin B12 are crucial for favorable outcomes in affected infants.
Abstract:
We report the case of an 11-month-old boy, presenting with 6 months of failure to thrive, progressive seizures, developmental regression and aversion to solid foods. He also developed systemic symptoms including oral mucocutaneous lesions, neutropenia and anaemia. Notable evaluations included an abnormal electroencephalogram and a thin corpus callosum. Initial diagnostic work-up for epileptic encephalopathy included rapid whole exome sequencing (WES) and metabolic studies. His propionylcarnitine, plasma homocysteine and methylmalonic acid were markedly elevated, with normal vitamin B12, raising concern for an inborn error of cobalamin metabolism or nutritional B12 deficiency. His WES was normal, with no pathogenic variants detected in genes affecting cobalamin metabolism. Maternal vitamin B12 was subsequently found to be undetectable, and the mother was found to have autoantibodies to intrinsic factor and was diagnosed with pernicious anaemia. The child was started on vitamin B12 repletion, resulting in complete correction of metabolic derangements and multimodal neurologic improvements.
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