NUTRITIONAL VITAMIN-B12 DEFICIENCY IN A BREAST-FED INFANT FOLLOWING MATERNAL GASTRIC BYPASS

Breastfed infants of women who have had gastric or intestinal bypass procedures may develop nutritional deficiencies. We describe a 10-month-old exclusively breastfed while male infant who presented with vomiting, failure to thrive, and megaloblastic anemia. He was found to have vitamin B-12 deficiency. His mother had undergone a gastric bypass procedure for morbid obesity 2 years prior to her pregnancy with this child. She had subclinical vitamin B-12 deficiency, with an abnormal Schilling test that corrected with the addition of intrinsic factor. Therefore, we believe that the mother's gastric bypass had caused a decrease in available intrinsic factor, resulting in subclinical vitamin B-12 deficiency and decreased breast milk B-12. Although she was asymptomatic, her breastfed infant developed symptomatic B-12 deficiency. This is the first reported case of a maternal gastric bypass resulting in vitamin B-12 deficiency in an infant. These mothers should receive vitamin supplements, including vitamin B-12, during and after pregnancy, and may require parenterally administered vitamin B-12.