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. 2022 Jul 11:9:923569.
doi: 10.3389/fnut.2022.923569. eCollection 2022.

Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women

Mônica Araujo Batalha  1 , Paula Normando Dos Reis Costa  1 , Ana Lorena Lima Ferreira  1 , Nathalia C Freitas-Costa  1 , Amanda C Cunha Figueiredo  1 , Setareh Shahab-Ferdows  2 , Daniela Hampel  2   3 , Lindsay H Allen  2   3 , Rafael Pérez-Escamilla  4 , Gilberto Kac  1
Affiliations

Maternal Mental Health in Late Pregnancy and Longitudinal Changes in Postpartum Serum Vitamin B-12, Homocysteine, and Milk B-12 Concentration Among Brazilian Women

Mônica Araujo Batalha et al. Front Nutr. .

Abstract

Background: Little is known regarding the association between mental health distress during pregnancy and postpartum maternal serum biomarkers of vitamin B-12 status and milk B-12 concentration.

Objective: To evaluate the association between depressive and anxiety symptoms in the third trimester of pregnancy and changes in postpartum serum B-12, homocysteine, and B-12 milk concentration.

Methods: A total of 101 women (18-40 years) were studied in a prospective cohort with data at the third trimester of pregnancy (baseline) and three postpartum time-points (TPs): 2-8 days (TP1), 28-50 days (TP2), and 88-119 days (TP3) postpartum. B-12 concentrations in milk were measured by competitive chemiluminescent enzyme immunoassay at TP1, TP2, and TP3. Serum B-12 and homocysteine concentrations were evaluated at baseline, TP1, TP2, and TP3 by chemiluminescent immunoassays. Depressive and anxiety symptoms were measured with the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory at baseline. Spearman's correlation test and multiple linear mixed-effect models were performed.

Results: The prevalence of depressive and anxiety state symptoms was 35.6 and 39.6% at baseline. High prevalence of low milk B-12 concentration (<310 pmol/L) were observed at TP1 (53.2%), TP2 (71.4%), and TP3 (71.1%). Women with anxiety symptoms at baseline presented higher median concentrations of serum homocysteine at TP1 and lower concentrations of serum and milk B-12 at TP2 compared with women without anxiety symptoms [8 (7; 9) vs. 6 (5; 8) and 266 (188; 369) vs. 332 (272; 413)]. Milk B-12 concentrations were positively and significantly correlated with maternal serum B-12 concentrations at different TP. Women with anxiety symptoms at baseline exhibited a decrease in daily postpartum homocysteine concentrations compared to women without anxiety symptoms (β = -0.002, SE = 0.001, p = 0.024).

Conclusion: Anxiety symptoms at the end of pregnancy were associated with longitudinal changes in maternal serum homocysteine concentrations during the first 3 months postpartum.

Keywords: anxiety; depression; homocysteine; human milk; lactation; pregnancy; vitamin B12.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Median concentrations of serum B-12, serum homocysteine, and milk B-12 by maternal mental health status in Rio de Janeiro, Brazil. Mann–Whitney's test was performed to compare medians (IQR) of biological samples (serum vitamin B-12, serum homocysteine, and milk vitamin B-12) at the 3rd trimester of pregnancy, 2-8 d, 28-50 d, and 88-119 d postpartum between women with and without depressive or anxiety symptoms at 3rd trimester of pregnancy (baseline), p < 0.05. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), yes (EPDS ≥11, n = 36) and no (EPDS <11, n = 65) (A–C). Anxiety state was assessed by the State-Trait Anxiety Inventory (STAI), yes (STAI ≥40, n = 40), and no (STAI <40, n = 61) (D–F). Hcy, homocysteine.
Figure 2
Figure 2
Longitudinal predictions of maternal serum homocysteine, serum B-12, and milk B-12 concentrations according to the presence of depressive symptoms in the 3rd trimester of pregnancy in Rio de Janeiro, Brazil. β Coefficient interactions (βinteraction) and standard error (SE) were estimated. These parameters were used to evaluate the changes of having depressive symptoms on the trajectory of each biological sample. Depressive symptoms were assessed by the Edinburgh Postnatal Depression Scale (EPDS), yes (EPDS ≥11, n = 36) and no (EPDS <11, n = 65). (A) Log serum homocysteine: βinteraction = −0.001 (0.001); p = 0.194, and the model was adjusted for maternal age, education, pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum folate concentration at the 3rd trimester of pregnancy. (B) Log serum B-12: βinteraction = −0.001 (0.002); p = 0.445, and the model was adjusted for maternal age, education, pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum folate concentration at the 3rd trimester of pregnancy (C) Log milk-B-12: βinteraction = −0.003 (0.004); p = 0.455, and the model was adjusted for pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum B-12 concentration at the 3rd trimester of pregnancy. Hcy, homocysteine.
Figure 3
Figure 3
Longitudinal predictions of maternal serum homocysteine, serum B-12, and milk B-12 concentrations according to the presence of anxiety symptoms in the 3rd trimester of pregnancy in Rio de Janeiro, Brazil. β Coefficient interactions (βinteraction) and standard error (SE) were estimated. These parameters were used to evaluate the changes of having anxiety symptoms on the trajectory of each biological sample. Anxiety state was assessed by the State-Trait Anxiety Inventory (STAI), yes (STAI ≥40, n = 40) and no (STAI <40, n = 61). (A) Log serum homocysteine: βinteraction = −0.002 (0.001); p = 0.024, and the model was adjusted for maternal age, education, pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum folate concentration at the 3rd trimester of pregnancy. (B) Log serum B-12: βinteraction = −0.000 (0.001); p = 0.797, and the model was adjusted for maternal age, education, pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum folate concentration at the 3rd trimester of pregnancy (C) Log milk-B-12: βinteraction = 0.002 (0.004); p = 0.585, and the model was adjusted for pre-pregnancy BMI, B-vitamin (including folate) supplement intake during pregnancy, and serum B-12 concentration at the 3rd trimester of pregnancy. Hcy, homocysteine.
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