The U.S. Centers for Disease Control and Prevention reported in January on the case of two infants who suffer from brain abnormalities due to a B-12 deficiency in the diets of their vegan mothers.
The main source of B-12 for most people is meat, dairy products and eggs. Vegan and vegetarian diets tend to be deficient in B-12 and most responsible vegan and vegetarian literature notes this fact and offers guidance on how to ensure and adequate supply of this important nutrient.
The CDC’s Dr. Maria Elena Jefferds reported on the two infants in the January 31st issue of the CDC’s Morbidity and Mortality Weekly Report. Jefferds describes the first case,
During August 2001, a girl aged 15 months was hospitalized for lethargy and failure to thrive. She was born after a full-term pregnancy complicated by prolonged nausea and vomiting. She was breastfed for 8 months, but the extent (exclusivity) of breast milk consumed relative to other food was unknown. Her mother reported following a vegan diet during the preceding 7 years and took nutritional and vitamin supplements. The cobalamin content of the supplements was unknown. When the child was aged approximately 8 months, organic whole-grain cereals and fruit shakes were introduced, but she had a poor appetite and vomited regularly. Her parents became concerned about her growth and development, and she was evaluated by a pediatrician at age 15 months. The pediatrician diagnosed failure to thrive, developmental delay, and severe macrocytic anemia. The child was hospitalized, and cobalamin deficiency was diagnosed (marked elevation [not quantified] of urine methylmalonic acid; serum B12:100 pg/mL.
And the second case,
During March 2001, a boy aged 30 months with failure to thrive and mild global developmental delays was taken to a genetics clinic. He was born after a full-term pregnancy and breastfed exclusively until age 9 months. The mother reported following a vegetarian diet during the preceding 20 years, with negligible amounts of meat, fish, and dairy products. She reported intermittent intake of a vitamin supplement (TwinLab® Stress B Complex Caps, containing 250 mcg of “cobalamin concentrate,” according to the label). When the boy was age 9 months, the health-care provider and his parents became concerned about the child’s growth and development (Table 1). His diet was supplemented with fruit and dry cereals to improve growth. When this was unsuccessful, he underwent a frenectomy at age 11 months to free tongue movements and improve coordination of swallowing and chewing. Despite this intervention, growth was inadequate. His diet was supplemented with soy- and cow’s milk–based formulas. He tolerated neither and started a multigrain nondairy formula (Multigrain Milk®) in addition to fruit, vegetables, chicken, an unknown vitamin supplement, and a product called Greens Plus® (no cobalamin content listed on label). Because of poor motor and speech development at age 11 months, the child was evaluated by a developmental pediatrician, who ordered genetic and metabolic studies and prescribed speech, occupational, and physical therapies. The child had persistent elevation of urine methylmalonic acid on three occasions but received no treatment for cobalamin deficiency until after the third measurement, which was ordered for a genetics clinic evaluation.
The CDC report noted that the prevalence of B-12 deficiency in children under 4 is not known and, “No clinical practice guidelines exist for diagnosing cobalamin deficiency in young children” since said deficiency results in a number of nonspecific symptoms such as lethargy and deficient growth.
The CDC recommended that,
Health-care providers should be vigilant about the potential for cobalamin deficiency in breastfed children of vegetarian mothers. Potential cobalamin deficiency should be included in the differential diagnosis when assessing young children of vegetarian mothers who have symptoms consistent with cobalamin deficiency, including failure to thrive, developmental delay, neurologic/psychiatric manifestations, and hematologic abnormalities (4).
Health-care providers who care for mothers in the preconceptional, prenatal, and postpartum periods and their young children should ask pregnant and lactating mothers about their diets to identify those who are vegetarians. Pregnant and lactating women should eat foods rich in cobalamin or take a daily supplement containing at least the recommended dietary intake of cobalamin (Table 2). For those eating no or very limited food of animal origin or a known cobalamin source, a cobalamin assessment is indicated. If lactating mothers are cobalamin deficient, their infants should be evaluated for cobalamin deficiency and treated appropriately.
Of course more research into pregnant vegan and vegetarian women might also be helpful, but such research is often attacked as little more than an attempt to undermine vegan and vegetarian diets (such as Jeff Nelson’s tirade against the very thought of funding research to examine choline deficiencies in pregnant vegetarian and vegan women).
Babies’ mental delay tied to moms’ vegan diet. Alison McCook, Reuters, January 30, 2003.
Neurologic Impairment in Children Associated with Maternal Dietary Deficiency of Cobalamin — Georgia, 2001. Morbidity and Mortality Weekly Report, Centers for Disease Control, 52(04);61-64.