Reply to “Infantile Acquired Vitamin B12 Deficiency”
30 October 2018
12 December 2018
26 January 2019 (eFirst)
Many thanks for your response and valuable comments regarding addressing the issue of preventing vitamin B12 deficiency in infants of mothers with deficiency, and thereby prevention of the consequences this could have on the neurodevelopment and growth of these infants.
We agree with your assertion that addressing this issue, first and foremost, needs to keep in mind the specific needs of the population. Vitamin B12 deficiency has been found to be highly prevalent in communities worldwide where animal-source food consumption is low and where vitamin B12 supplementation of foods is low. The World Health Organization recommendations for dietary intake are an increase from daily recommended intake of 2.4 to 2.6 micrograms/day during pregnancy, and 2.8 micrograms/day during lactation, as estimated body requirements are highest during pregnancy and lactation. 
We agree that health care resources aimed at prevention could be better utilized in communities with high prevalence of vitamin B12 deficiency, in devising methods of improving vitamin B12 intake amongst at-risk individuals, such as pregnant and lactating women. The advantages of a supplementation program are that it targets a defined at-risk population and is generally cost-effective. A robust health care system and public education are also needed to support this.
Supplementation/fortification of foods with vitamin B12 may be more suitable for communities with higher prevalence of vitamin B12 deficiency due to low consumption of animal-source food, and limited resources, rather than the more expensive metabolite assays which may be more suitable for communities where prevalence is not as high. Supplementation may, however, have the disadvantage that it will not improve vitamin B12 status in mothers with nondietary causes of vitamin B2 deficiency, such as pernicious anemia.
Supplementation of vitamin B12 to pregnant women has been shown to improve vitamin B12 status in their infants in areas with high prevalence of vitamin B12 deficiency, and effects of supplementation on neurodevelopmental outcomes in infants, an outcome of paramount importance, have been considered. 
We agree with you that institution of vitamin B12 supplementation programs for pregnant women in populations at high risk of dietary vitamin B12 deficiency would be well worth considering.
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