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Nutritional vitamin B12 deficiency in a breastfed infant following maternal gastric bypass
1Department of Pediatrics, St. Louis University School of Medicine, Missouri.
Insights
Maternal gastric bypass can lead to vitamin B12 deficiency in exclusively breastfed infants. Supplementation is crucial for mothers with this history to prevent infant malnutrition and anemia.
Area of Science:
- Pediatrics
- Nutritional Science
- Gastroenterology
Background:
- Gastric bypass surgery can alter nutrient absorption.
- Maternal nutritional status impacts breast milk composition.
- Vitamin B12 deficiency can cause severe infant health issues.
Observation:
- A 10-month-old exclusively breastfed infant presented with vomiting, failure to thrive, and megaloblastic anemia.
- The infant was diagnosed with vitamin B12 deficiency.
- The infant's mother had undergone gastric bypass surgery two years prior to conception.
Findings:
- The mother had subclinical vitamin B12 deficiency, indicated by an abnormal Schilling test corrected with intrinsic factor.
- The gastric bypass likely reduced intrinsic factor, leading to maternal vitamin B12 deficiency and decreased levels in breast milk.
- This resulted in symptomatic vitamin B12 deficiency in the exclusively breastfed infant.
Implications:
- This is the first reported case linking maternal gastric bypass to infant vitamin B12 deficiency.
- Pregnant and postpartum women with a history of gastric bypass require vitamin B12 monitoring and supplementation.
- Parenteral vitamin B12 may be necessary for affected mothers to ensure adequate infant nutrition.
Abstract:
Breastfed infants of women who have had gastric or intestinal bypass procedures may develop nutritional deficiencies. We describe a 10-month-old exclusively breastfed white male infant who presented with vomiting, failure to thrive, and megaloblastic anemia. He was found to have vitamin B12 deficiency. His mother had undergone a gastric bypass procedure for morbid obesity 2 years prior to her pregnancy with this child. She had subclinical vitamin B12 deficiency, with an abnormal Schilling test that corrected with the addition of intrinsic factor. Therefore, we believe that the mother's gastric bypass had caused a decrease in available intrinsic factor, resulting in subclinical vitamin B12 deficiency and decreased breast milk B12. Although she was asymptomatic, her breastfed infant developed symptomatic B12 deficiency. This is the first reported case of a maternal gastric bypass resulting in vitamin B12 deficiency in an infant. These mothers should receive vitamin supplements, including vitamin B12, during and after pregnancy, and may require parenterally administered vitamin B12.