maternal vitamin b deficiency Archives

Sudden Infant Death Syndrome, Autism, and Maternal Thiamine Deficiency

Published on April 16, 2018

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SIDS, Autism, Maternal Thiamine Deficiency

I have addressed this problem before on this website. However, in the Wall Street Journal on Tuesday, March 27: an article appeared entitled “A Study of Sudden Infant Deaths Divides Doctors“. It goes on to say “The finding on sudden and unexpected infant deaths is surprising, says Joel Bass, of the pediatrics department at Newton Wellesley Hospital in Newton Mass”, the first author of the study, who said “that’s more than one newborn baby dying of SUID [sudden and unexpected infant death] a day”. Oddly enough, the article indicates that “among the possible causes, some researchers point to the promotion of certain hospital practices to encourage breast-feeding. But some doctors vehemently disagree with that theory”. Apparently, the theory alluded to the practice of encouraging skin-to-skin care between mother and infant during breast feeding. I had not read the article so I do not understand how this connection was made. What arrested my attention was the reference to breast-feeding, long encouraged by pediatricians as the best way to feed newborn infants. How could skin-to-skin contact be involved? However, an article was published in 2011 in which the author had carefully examined the nutrient content of breast milk in the United States (Shamberger, 2011). It reminded me of an extremely important article that was written in the 1940s.

Breast Milk Toxicity Syndrome

It may be remembered that Hong Kong at that time was a British protectorate. A medical officer of health was sent out from Britain to Hong Kong to investigate a relatively common occurrence of sudden death in breast-fed infants of Chinese mothers. This death commonly occurred between three and four months of age and happened in infants that, from their appearance, were considered to be the healthiest in the family. Fehily, the author, was able to show that the breast milk was deficient in vitamin B1 and it was well known by early researchers of beriberi that this form of infant death was virtually pathognomonic (indication of cause) of the infantile form of this disease. In fact it was well known by these early researchers that there was no other disease of infancy that behaved like this. Fehily herself was struck by the exact likeness to “cot death”, the term used in England for what we call Sudden Infant Death Syndrome in the United States today.

Autism Rates for Each State Connected to Maternal Nutrient Status

The paper published in 2011, referred to above, was in consideration of the cause of autism, not SIDS. The author had studied the rate of autism associated with nutrition. The paper stated that autism rates in the United States are increasing at a rate of 15% per year. The study abstract reported that the design of the study used nutritional epidemiology and an ecologic study design. In other words, he studied public health data and the nutrient content of breast milk. The objective was to try to link the possible cause of autism to nutrition by creating autism rates for the 50 states of America and comparing them with published measures of infant nutrition. These included the duration of exclusive breast-feeding and participation in the Women, Infants and Children (WIC) program. The results were impressive. The states with the highest WIC participation have significantly lower autism rates (P <0.02).

In contrast, there was a direct correlation with the increasing percentage of women exclusively breast-feeding from the years 2000 to 2004. Infants who were solely breast-fed had diets that contained less thiamine, riboflavin, and vitamin D than the minimal daily requirements. Although the author was studying the rates of autism and was not in the least interested in SIDS, his study supports the finding of vitamin deficiency in breast milk, in turn supporting the possible relationship between breast-feeding and SIDS. Of course, the modern medical model would find it objectionable to hypothesize a cause common to two diseases, although both autism and SIDS have a slight male dominance and are diseases that occur during rapid growth, particularly of the brain.

My Particular Interest in SIDS

Many years ago, because of clinical experience, I became interested in SIDS. At about that time, the idea of threatened SIDS had become an acceptable diagnosis, whereas previously it had been considered that the death was truly sudden and completely unpredictable. I can remember two parents who had brought their infant to see me. They had observed him in his crib when he had stopped breathing. When one of them picked him up he started breathing again. They took him to the nearest emergency room where he was pronounced completely fit and the situation was dismissed. The parents were so scared that one of them took turns to sit up all night to watch in case this thing should happen again.

This is exactly the clinical situation that I began to experience with other infants. A monitor had been invented that could be attached to an infant that would sound an alarm if either his heart slowed or his breathing stopped. It had become well-known that picking the infant up or giving him a little slap on the buttock would instantly return him to a normal state (SIDS is more common in male infants). To cut a long story short, my colleagues and I performed a lot of clinical research on these threatened SIDS babies. We had found that a machine known as brainstem auditory evoked potential (BAEP) gave abnormal readings . This strongly suggested that the mechanism was an electrochemical dysfunction in the brainstem. This is the part of the brain that connects with the spinal cord and it contains the controls for automatic breathing. Let me explain this a little.

Most of us are not aware that our essential breathing is controlled by centers in the brainstem when we are unconscious, as in sleep. The condition known as sleep apnea is a failure of this mechanism (apnea is a temporary cessation of breathing). It was during my library research that I discovered the 1944 paper by Fehily. It seemed only to be common sense to look at the possible association of thiamine deficiency as the underlying biochemical cause. We treated several infants with thiamine injections that seemed in every case to stop their episodes of apnea. I received a visit from a university researcher in Australia. His group had been studying SIDS and they had come to the same conclusion. I was so impressed by their work that I took sabbatical leave in Australia with Dr. Read who was the leader of the group. Abnormal brainstem responses in infants at risk of SIDS was reported at about the same time. The authors said that this suggested immature development of brainstem. A recent publication found an association between maternal alcohol consumption and SIDS. The relationship of thiamine deficiency in brain and alcohol consumption is well-known. It is not too difficult to imagine that the concentration of alcohol in the blood of the mother would have an exaggerated effect in the brain of the fetus, perhaps injecting a risk factor for the infant after birth.

Conclusion

Can a parent who has not experienced the sudden death of a precious infant at the age of 3 to 4 months even imagine the horror and the enormous stress imposed on such a parent? We now know that there are quite nonspecific symptoms that may appear in an infant who threatens SIDS. They are sometimes unusually irritable and a “runny nose” may be mistaken for a cold, but such symptoms may be so slight as to be ignored. I must emphasize that the lower part of the brain that organizes automatic body functions, including breathing, is peculiarly sensitive to thiamine deficiency. If the infant is breast-fed with thiamine deficient breast milk as the 2011 study suggests, studies that I have reported here would make sense. Even if only a few of the cases were due to this biochemical phenomenon, giving some thiamine on suspicion can do no harm.

A diet history from the mother might offer clues, particularly emphasizing whether there is ingestion of sugar in all its different forms. If I were a physician in charge of such a pregnancy, I would not hesitate to add thiamine supplementation, starting as early as three months of gestation, as advised in the book written by an American obstetrician/gynecologist by the name of John B Irwin, M.D. He had found that supplementary thiamine removed the complications of pregnancy such as toxemia and even prevented premature delivery. It might well provide a nutritional legacy for the infant. Of course, I am not suggesting that alcohol ingestion by the mother is THE cause of SIDS. However, I am suggesting that the present widespread use of unhealthy nutrition may well be at fault for both SIDS and autism. Genetic risk, coupled with some form of stress (e.g. mattress flame retardants, a cold virus) and vitamin deficiency breast-feeding, might be more or less important individually, or more than one of the three items collectively.

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Maternal Vitamin B: From Periconception and Beyond

by Chandler Marrs, PhD

Published on July 17, 2014

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A wise midwife recently told me that in 1960’s the B vitamins were part and parcel of a healthy pregnancy, not just folate (vitamin B9), that we stress now, but the entire complex of B vitamins, including: thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin (B7), folate (B9) and the cobalamins (vitamin B12). Thiamine (also referred to as thiamin) was viewed as critical for maternal and fetal health and used within the midwifery community to ensure not only a healthy pregnancy, but a healthy postpartum. In many non-industrialized regions, thiamine is still supplemented for maternal and fetal health and maternal thiamine deficiencies are still recognized as critical impediments to health. Not so in the Western, industrialized world. Here, most resources and education seem set on prenatal folate; so much that it is difficult to escape folic acid supplementation in everyday foods. Despite heavy fortification and regular use of prenatal vitamins, we see increasing evidence of nutrient deficiencies in pregnant mamas and most especially, in their children. Some of these deficiencies are visibly obvious, as least to those who look, such as the increased incidence of neural tube defects in children of women who are low in vitamin B12, but sufficient, even abundant in folate or B9. While other deficits are not so obvious, at least not immediately.

Maternal vitamin B status is important to the pregnancy at hand but also for the child’s long term health, as many of the B vitamins are capable of activating or deactivating gene programs in the children. Maternal vitamin B deficiencies can induce long-term epigenetic changes in the children, and likely, grandchildren. Maternal (and probably paternal too) vitamin B deficiencies silence genes in their off-spring that significantly increase the risk of insulin resistance, high blood pressure and a host of metabolic disorders through adulthood. Nutrition, in addition to its vital role as a source of energy for our cells, is the guidepost for DNA activation and inactivation. The balance of nutrients tell our cells how to function or not function, as the case may be. This information is carried from parents to offspring, across generations. It is this genetic control derived from lifestyle and nutrients that forms the basis of health for our children, and so it becomes something as parents we must pay attention to.

The B Vitamins are Important for Mom’s Health

For the moms, latent deficiencies in core nutrients will become unmasked with the increasing energy demands of pregnancy as many nutrients are shuttled preferentially toward placental and fetal needs, depleting maternal stores. Following delivery, the demands of lactation will further deplete maternal nutrient status and depending upon the vitamin in question, adversely affect her health and/or her child’s health. Reports link maternal thiamine deficiency to hyperemesis gravidarum – severe vomiting across the pregnancy, in some instances leading to a full blown Wernicke’s Encephalopathy. Maternal vitamin B12 deficiency is linked to an increased risk of developing preeclampsia, intra-uterine growth retardation, preterm labor, but also, low vitamin B12 puts mom at risk for developing a myriad of neurocognitive, neuromuscular and psychiatric symptoms associated with B12 deficiencies both during pregnancy and postpartum .

How Prevalent is Maternal Vitamin B Deficiency?

Since there are few reference ranges for vitamin status during pregnancy, with most ranges based upon non-pregnant women, and since much of the research in nutrition is conducted in non-industrialized, poorer countries, it is difficult to assess how many outwardly healthy, western women carry nutritional deficiencies into pregnancy and postpartum. A 2002 study reported the vitamin profile in 563 pregnant New Jersey women at different points across the pregnancy. They found a trend towards too much folate, riboflavin, biotin and pantothenate (vitamin B5) and too little niacin, thiamin, vitamins A, B6, B12, suggesting that prenatal vitamins neither appropriately nor sufficiently address maternal nutrient demands.

A study of healthy pregnant women in Spain found that 32-68% of the women tested were deficient in thiamine, riboflavin or pyridoxine. Interestingly, the severity of deficiency correlated with oral contraceptive use, specifically with the length of oral contraceptive washout period prior to becoming pregnant. That is, when the woman became pregnant shortly after stopping oral contraceptives, she was more likely to exhibit a vitamin deficiency than if she had to waited to become pregnant and allowed her body to readjust to the non-oral contraceptive state. Additionally, the researchers found that if the woman was deficient in one of these nutrients, she was more likely to be deficient in each of them. Although not measured in this study, we know from other studies that many medications, including oral contraceptives, metformin and statins, decrease vitamin B12 significantly.

These reports, combined with the current trends in obesity, type 2 diabetes and the inherent nutritional shortcomings in the Western diet, suggest that it is likely that nutritional deficits and even nutritional imbalances are more common than are recognized.

Maternal Vitamin B Status Before Pregnancy Affects Health of the Male Offspring

A study carried out in sheep found clear evidence linking maternal vitamin B9 and B12 status pre-conception to the health the male offspring later in life. This particular study compared the offspring from sheep fed a nutritionally normal diet to those fed a slightly deficient diet, but one that was still within accepted nutritional parameters, from eight weeks before conception, throughout the pregnancy and six days postpartum. While the pregnancy proceeded normally in both groups and both male and female offspring appeared normal and healthy at birth, continued monitoring across the lifespan of the sheep, showed remarkable changes in the health of the adult males conceived on the nutritionally deficient diets. These males were heavier, had significantly disrupted immune function, impaired glucose metabolism and increased blood pressure, than the females and in comparison to the offspring whose moms had more nutritionally sound diets. This slight change, towards the lower end of what is considered a nutritionally normal diet, had significant influence on long term health in the male offspring. This study also identified clear epigenetic markers in the offspring conceived with dietary deficiency.

Maternal Vitamin B Status, Breast Milk and Infant Health

Maternal vitamin demands do not end postpartum. Lactation increases the demand for maternal nutrients. Deficits in maternal vitamin status impacts infant health and development as well as maternal health and recovery. It should be clear that maternal vitamin deficiencies negatively affect maternal health. Even so, there has been some contention regarding the relationship between maternal vitamin status, fetal development, the quality of breast milk and subsequent infant health and development.

A review of studies assessing vitamin status in breast milk found widespread deficiency, with levels below what is considered adequate intake for proper infant development in most of the samples. The B vitamins (thiamine, riboflavin, B6, B12 and choline) were particularly inadequate.

What was particularly interesting about this study is that researchers found that nutrient deficiencies affect maternal health more so than infant health. Nutrients can be categorized into two groups, those that respond favorably to maternal supplementation with higher milk concentrations (Group 1) and those that do not (Group 2). Group 1 nutrients included thiamine, riboflavin, B6, B12, choline, retinol, vitamin A, vitamin D, selenium and iodine. These nutrietns are secreted into breast milk and depleted rapidly in breast milk when maternal nutrient status is low. Deficiencies in these nutrients can be supplemented and passed on through the breast milk. In this way, maternal nutrient status directly affects the quality of the milk. Group 2 nutrients (folate, calcium, iron, copper and zinc), on the other hand, do not respond as well to supplementation. Breast milk concentrations of these nutrients remain relatively unchanged by maternal status, even when maternal status is declining. Supplementation with Group 2 nutrients affects maternal health more so than infant health.

Take Away

Fetal and infant health and development can be severely impaired by maternal nutrient deficiencies during pregnancy and during breastfeeding. The period across which maternal nutrient status affects the health of her offspring should be extended to well before conception. The B vitamins are especially important to proper development and long term health and appear to regulate genetic expression via epigenetic mechanisms. Recognizing and treating the potential nutritional deficiencies in modern, western diets, may go a long way towards reducing maternal illness while improving fetal, infant, child and adult health for generations. A growing body of evidence, and indeed, common sense suggest that while vitamin B9 or folate is critically important to maternal and fetal health, deficiencies in the remaining B vitamins and other nutrients may be equally important.