Comparison of serum vitamin B12 levels in exclusively breastfed and mixed-fed term infants aged 3-6 months: a hospital-based observational study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20261897Keywords:
Breastfeeding, Infant nutrition, Mixed feeding, Neurodevelopment, Serum vitamin B12, Vitamin B12 deficiencyAbstract
Background: Vitamin B12 is essential for DNA synthesis, neurological development, red blood cell productio- and myelination during infancy. Infants depend mainly on maternal stores and breast milk during the first few months of life. Maternal deficiency is common in vegetarian populations and may predispose infants to deficiency.
Methods: This hospital-based observational study was conducted in the Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, from July 2024 to December 2025. A total of 80 term infants aged 3-6 months were enrolled. Forty infants were exclusively breastfed and forty infants were mixed-fed. Serum vitamin B12 levels, complete blood count parameters, feeding history and maternal dietary practices were assessed.
Results: Mean serum vitamin B12 was significantly lower in exclusively breastfed infants (379.90±205.60 pg/ml) compared with mixed-fed infants (514.85±227.73 pg/ml). Vitamin B12 deficiency (<200 pg/ml) was found in 22.5% of exclusively breastfed infants and 5% of mixed-fed infants. Maternal vegetarian diet was significantly associated with lower infant vitamin B12 levels. Exclusive breastfeeding was identified as an independent predictor of vitamin B12 deficiency.
Conclusions: Exclusively breastfed infants, particularly those born to vegetarian mothers, are at increased risk of vitamin B12 deficiency. Early screening, maternal nutritional counselling and timely supplementation may help prevent long-term hematological and neurological complications.
References
Bjørke-Monsen AL. Defining optimal cobalamin status for neonates and infants. Food Nutr Bull. 2024;45(1):S16-22.
Chandyo RK, Ulak M, Kvestad I, Hysing M, Shrestha M, Ranjitkar S, et al. Cobalamin and folate status among breastfed infants in Bhaktapur, Nepal. Nutrients. 2018;10(5):597.
Jain S, Beg S, Verma A. To study the relationship between vitamin B12 deficiency in breast-fed infants and their mothers and its clinico-hematological manifestations: a cross-sectional study. Int J Life Sci Biotechnol Pharma Res. 2023;12:671-7.
Solvik BS, Bakken KS, McCann A, Ueland PM, Henjum S, Strand TA. Breastfeeding and biomarkers of folate and cobalamin status in Norwegian infants: a cross-sectional study. J Nutr Sci. 2024;13:e40.
Kadiyala A, Palani A, Rajendraprasath S, Venkatramanan P. Prevalence of vitamin B12 deficiency among exclusively breast-fed term infants in South India. J Trop Pediatr. 2021;67(1):114.
Specker BL, Black A, Allen L, Morrow F. Vitamin B12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic acid concentrations in their infants. Am J Clin Nutr. 1990;52(6):1073-6.
Daniels L, Gibson RS, Diana A, Haszard JJ, Rahmannia S, Luftimas DE, et al. Micronutrient intakes of lactating mothers and their association with breast milk concentrations and micronutrient adequacy of exclusively breastfed Indonesian infants. Am J Clin Nutr. 2019;110(2):391-400.
Ask TF, Ranjitkar S, Ulak M, Chandyo RK, Hysing M, Strand TA, et al. The association between heart rate variability and neurocognitive and socio-emotional development in Nepalese infants. Front Neurosci. 2019;13:411.
Pawlak R, Vos P, Shahab-Ferdows S, Hampel D, Allen LH, Perrin MT. Vitamin B-12 content in breast milk of vegan, vegetarian, and nonvegetarian lactating women in the United States. Am J Clin Nutr. 2018;108(3):525-31.
WHO. United Nations Children’s Fund. Indicators for assessing infant and young child feeding practices: definitions and measurement methods. Geneva: World Health Organization and UNICEF, 2021. Available at: https://www.who.int/publications/i/item/9789240018389. Accessed on 20 March 2026.
Pernicious Anaemia Society. Vitamin B12 absorption. Available at: https://perniciousanemia.org/b12/absorption/. Accessed on 20 March 2026.
Hatabah D, Krieger R, Brown LA, Harris F, Korman R, Reyes L, et al. Cobalamin deficiency in children and adolescents with sickle cell disease. Nutrients. 2025;17(3):597.
Saint-Cyr M, Waldrop SW, Krebs NF. Nutritional requirements. In: Kliegman RM, St Geme JW III, Blum NJ, Tasker RC, Wilson KM, Schuh AM, Mack CL, editors. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia: Elsevier; 2023:388.
Downloads
Published
How to Cite
Issue
Section
