Association of maternal and cord vitamin B12 levels with anthropometry in term neonates born to malnourished mothers in coastal South India

Background Malnourished pregnant women are at increased risk of micronutrient deficiency. We assessed the vitamin B12 status in both malnourished and normally nourished pregnant women and their neonates. Additionally, we studied the association between maternal B12 levels, cord B12 levels and neonatal anthropometry. Methods This cross-sectional study enrolled 63 malnourished and 63 normally nourished mothers and neonates. Maternal and cord blood samples were collected at the time of delivery for estimation of vitamin B12 levels. Maternal and cord vitamin B12 levels were compared using the Mann–Whitney U test. Neonatal anthropometry was correlated with maternal and cord B12 levels using Spearman’s correlation. Data were analyzed using SPSS version 25. Results Mean maternal age was 26.58 yrs. The median cord B12 levels were lower than the maternal B12 levels. Maternal B12 levels showed a strong positive correlation with cord B12 levels (rho = 0.879; p < 0.001). Maternal (p < 0.001) and cord (p < 0.001) vitamin B12 levels were significantly lower in the malnourished group than in the normally nourished group. In malnourished group, 66.8% mothers and 95.2% neonates were Vitamin B12 deficient, whereas 1.5% mothers and 4.7% neonates were vitamin B12 deficient in normally nourished group. In the malnourished group, maternal B12 levels were positively correlated with birth weight (rho 0.363, p = 0.003) and length (rho 0.330, p =0.008), whereas cord B12 levels were positively correlated with birth weight in the normally nourished group. (rho 0.277 p= 0.028) Conclusion High rates of vitamin B12 deficiency were observed in malnourished mothers and neonates. There was a positive correlation between birth weight, length, and maternal vitamin B12 levels in malnourished mothers. These findings emphasize the need to address maternal malnutrition and vitamin B12 deficiency to improve neonatal health.


Introduction
Vitamin B12, also known as cobalamin, is a micronutrient essential for cell growth and differentiation. 1 This essential vitamin plays a crucial role in various biochemical processes, particularly in the synthesis of DNA, in conjunction with folic acid. 2 Adequate levels of vitamin B12 during early childhood promote growth and prevent cognitive impairment.Vitamin B12 is commonly found in animal-based food products such as dairy, fish, eggs, and poultry.Consuming these foods is an effective way to acquire vitamin B12 from the diet. 3ile the vegetarian population is at a heightened risk of deficiency, it is also prevalent among non-vegetarians. 3Vitamin B12 deficiency is a major health concern worldwide.Pregnant women and young children are at an increased risk of facing this deficiency. 4Regional disparities in the occurrence of vitamin B12 deficiency throughout pregnancy have been observed, indicating varying levels of risks across different regions. 5[8][9][10] Deficiency of vitamin B12 is also implicated in increased risk of gestational diabetes mellitus. 11Vitamin B12 levels in expectant mothers are thought to influence the vitamin B12 status of the fetus and infant.Vitamin B12 deficient mothers may produce breast milk with insufficient levels of vitamin B12, and their exclusively breast-fed infants may develop symptoms in the postnatal period.These infants may have apathy, anorexia, irritability, failure to thrive, delayed or regression of milestones, pancytopenia, hypotonia, and seizures.3][14][15][16] A systematic review by Rogne et al. reported no clear linear relationship between birth weight and maternal vitamin B12 levels during pregnancy.However, deficiency was linked to a higher number of neonates born with low birth weight. 17[14][15][16] Pregnant women experiencing malnutrition face a heightened risk of micronutrient deficiencies, pregnancy complications, and perinatal outcomes. 18There are limited data regarding the occurrence of vitamin B12 deficiency in malnourished expectant mothers and its impact on neonatal outcomes.We aimed to assess the vitamin B12 status in malnourished and normally nourished pregnant women and to study the association between maternal B12 levels and cord B12 levels and neonatal anthropometry.

Study setting and period
This cross-sectional study was conducted in a community maternity facility affiliated with the Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.The study was conducted between August 2020 and July 2021.

Study design
This cross-sectional study followed the standard Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement guidelines. 19The reporting guidelines contain the completed STROBE checklist. 20

Study participants
The first group consisted of malnourished mothers and their neonates.The other group was comprised of normally nourished mothers and their neonates.

Inclusion criteria
All term neonates born to normal and malnourished mothers under singleton pregnancies.

REVISED Amendments from Version 1
Introduction was restructured to provide a clear overview of topic and the research objectives.
Discussion was restructured to provide more comprehensive analysis of the findings.New data were added to tables to provide more detailed information and support research findings.
Tables were rearranged for better readability.(e) Women with diabetes mellitus.
(f) Women with pre-existing cardiovascular hypertension or renal disorders.
(g) Pregnant women receiving multivitamin supplements other than routine iron and folic acid.
(j) Neonates with major congenital anomalies.

Sample size and technique
The sample size was determined based on a prior study by Finkelstein JL, et al., which reported the extent of vitamin B12 deficiency in South Indian pregnant women was 51%. 21With 95% confidence interval, 80% power, and a 5% level of significance.The sample size was calculated to be 63 for each group.A random sampling technique was used to reduce selection bias.

Operational definition
Malnourished mother: A mother with a pre-pregnancy weight of less than 45 kg documented in antenatal records. 22all for gestational age (SGA) is defined as birth weight < 10 th percentile for gestation. 23tamin B12 level 24 Normal >300 pg/ml Insufficiency 200-300 pg/ml Deficiency <200 pg/ml

Ethics and data collection
Our research adhered to the ethical principles of world medical association Helsinki declaration of 1964 and later amendments.The study was carried out after obtaining permission from the Institutional Ethical Committee of KMC Mangalore, Manipal Academy of Higher Education (approval number IEC KMC MLR-08/2020/249 letter dated 20/08/2020), and necessary permissions were sought from hospital authorities.Based on the inclusion and exclusion criteria, suitable subjects were approached and provided with a participant information sheet.The purpose of the study was explained in their native language, and consent was obtained from those willing to participate.After obtaining consent, the participants were recruited for the study.Participation in the study was voluntary, and the complete anonymity of the research participants was maintained.We ensured confidentiality of the collected data.
Maternal and neonatal details were obtained from antenatal and hospital records.Neonatal anthropometric measurements were performed by an investigator.Weight was measured to the nearest 0.01 kg using an electronic weighing machine, while the length of the newborn was estimated using an infantometer to the nearest to 0.1 cm, and the circumference of the head was calculated using a non-stretchable tape nearest to 0.1 cm.Based on birth weight and gestational age, the babies were categorized as Large, Small, and Appropriate for Gestational Age.Maternal and neonatal details were documented using a semi-structured pretested pro forma.

Sample collection
At the time of delivery, approximately 4 ml of maternal venous blood was collected in plain glass tubes, and 4 ml of blood from the umbilical cord was directly obtained via venipuncture of the umbilical vein.The specimens were then immediately placed on ice.Centrifugation was performed at a rate of 4000 revolutions per minute for 5 min.Subsequently, the plasma was separated and stored at -80°C pending analysis.

Test procedure
Serum vitamin B12 levels were measured using a vitamin B12 ELISA kit (Epitope Diagnostics, San Diego, CA 92121, USA) at the Department of Biochemistry, KMC Centre for Basic Sciences, Bejai, Mangalore.In this assay, antibodies specific to vitamin B12 were bound to the surface of a microtiter plate.Standards or samples containing vitamin B12 and conjugated vitamin B12-peroxidase were added to the wells of a microtiter plate.Free vitamin B12 and enzyme labelled vitamin B12 compete for the binding sites on the antibodies.Following one hour of incubation at room temperature, the wells were washed with a diluted washing solution to eliminate any unbound materials.Subsequently, the substrate solution was added and incubated for 20 min, leading to the development of a blue color.This color development was inhibited by adding a stop solution, after which it turned yellow.Color intensity was measured photometrically at 450 nm.The concentration of vitamin B12 displayed an inverse relationship with the color intensity observed in the test sample.

Outcome variables
Percentage of maternal and cord B12 levels in normal, insufficient and deficient category.
Relation between maternal and cord B12 level and neonatal anthropometry.

Statistical analysis
The collected data were entered into the Statistical Package for IBM (SPSS) Statistics for Windows version 25.0.Armonk, NY: IBM Corp. for analysis.Anthropometric and demographic data were expressed as means and standard deviations or proportions.Vitamin B12 levels are expressed as medians and interquartile ranges.Maternal and neonatal characteristics were compared in both groups using the independent sample t-test and chi-square test.Vitamin B12 levels were compared between groups using the Mann-Whitney U test.Correlations between maternal and cord B12 levels and neonatal anthropometries were assessed using the Spearman correlation test.

Results
Of the 126 pregnant women enrolled, 63 were malnourished and 63 were normal nourished.The mean age of the study subject was 26.58 (AE 3.79) years.The mean pre-pregnancy weight was 48.68 (AE 6.17) kg.Among these women, 75 (59.5%)were primigravidas.mixed diet was followed by 117 (92.9%) women, and all women consumed milk.Among the neonates, 64 (50.8%) were male and 62 (49.Comparison of maternal anthropometric measurements among malnourished and normal nourished mothers is depicted in Table 2. Birth weight, length, and head circumference of neonates born to malnourished mothers were lower than those of neonates born to mothers with normal nourishment.Sixteen (25.4%) neonates of malnourished mother group were SGA.A comparison of the anthropometric parameters of neonates born to malnourished and normal-nourished mothers is shown in Table 2.The median cord B12 value was considerably lower than the maternal B12 value, as shown in Table 3.There was a strong positive correlation between maternal and cord B12 levels (rho 0.829, p <0.001).Spearman correlation test for maternal BMI and vitamin B12 levels showed a positive correlation between the two measures (rho 0.590, p <0.001).Both maternal and cord B12 levels were significantly lower in the malnourished group than in the normal-nourished group (Table 4).In malnourished group, 66.8% mothers and 95.2% neonates were vitamin B12 deficient.In normal nourished group, only 1.5% mothers and 4.7% neonates were deficient.The maternal and cord B12 levels in both groups are shown in Table 4. Odd's ratio for malnourished mothers to have vitamin B12 deficiency was 160 (95% CI 39.43, 649.27).In the malnourished group, the maternal B12 level showed a positive correlation with birth weight (rho 0.363, p = 0.003) and length (rho 0.330, p = 0.008), whereas in the normally nourished group, the cord B12 level was positively correlated with birth weight (rho 0.277 p = 0.028) (Table 5), respectively.

Discussion
Vitamin B12 deficiency is widespread globally, and affects various populations.A study by Ramírez-Vélez et al in a sample representative of pregnant Colombian women, revealed that 18.6% of the population was deficient in vitamin B12 and 41.3% exhibited insufficient vitamin B12. 25 In a nutritional intervention study, that enrolled moderately malnourished Malawian mothers, 20.9% of the participants were deficient in vitamin B12. 26 A study by Yildizdas et al in Turkey reported high rate of maternal vitamin deficiency of 96.3%. 27ere is a significant occurrence of vitamin B12 deficiency in Indian women during pregnancy.Studies from western and northern parts of India have reported the highest occurrence of vitamin B12 deficiency during pregnancy, ranging from 70-74%. 5A community based cross sectional study by Barney et al., enrolling pregnant women in rural South India, reported an extent of 55% vitamin B12 deficiency.They found obesity and being in the first trimester of pregnancy to be independent risk factors. 28A study conducted by Katre et al. in Pune, which recruited pregnant women at 17 weeks of gestation, indicated that approximately 80% of rural and 65% of urban women exhibited low Vitamin B12 status. 29 prospective cohort study involving pregnant women aged 18-45 years from urban hospitals in Bangalore reported low plasma vitamin B12 levels in 48.6% of women. 30In the present study, 66.8% of women and 95.2% of neonates in the malnourished group exhibited vitamin B12 deficiency.
Despite general assumption that non-vegetarian diet provides sufficient vitamin B12, recent research has reported vitamin B12 deficiency in non-vegetarian population.
A review by Sukumaran et al. suggested that even within non-vegetarian populations, vitamin B12 insufficiency during pregnancy is frequently observed. 31Similar results were observed in our study, where there was a high prevalence of maternal vitamin B12 deficiency in a coastal community with high fish consumption.Food taboos targeting pregnant and postpartum women are widely prevalent in India and Southeast Asian countries which may contribute to this deficiency. 32,33tamin B12 levels change during pregnancy across the trimesters.Concentrations of vitamin B12 decreased from the first trimester to the third trimester, as reported by Sukumaran et al. 31 Similar observations were reported by Sobowale et al. from Bangladesh. 34A cohort study involving healthy pregnant adolescent women from New York revealed decreasing levels of maternal serum cobalamin levels from mid gestation to delivery. 35Hence cord B12 levels may not reflect maternal levels across the trimesters.
Low maternal vitamin B12 levels have resulted in lower neonatal B12 status as reported by previous studies.A study by Adaikalakoteswari et al. found that the offspring of mothers with low B12 levels exhibited significantly lower levels of vitamin B12 than did those of mothers with normal B12 levels. 12A Study by Finkelstein e t al., who recruited pregnant women at approximately 12 weeks gestation from South India, revealed that vitamin B12 deficiency was prevalent in approximately 63% of women during early pregnancy. 35This deficiency serves as predictor of neonatal vitamin B12 status.Specifically, lower maternal serum vitamin B12 levels were associated with a two-fold increased risk of neonatal vitamin B12 deficiency at birth. 36The present study also reported a positive correlation between maternal and cord vitamin B12 levels, with cord B12 levels being lower than maternal B12 levels.In contrast, a study by Yildizdas et al.
involving Turkish mothers and neonates, reported that micronutrient levels in the cord blood surpassed maternal levels. 27e relationships between maternal vitamin B12 and, cord B12 and neonatal anthropometry are heterogenous.In a study by Yildizdas et al., there was a negative correlation between birth weight, head circumference, and cord blood Cbl levels.Interestingly, maternal Cbl levels did not show any correlation with neonatal anthropometry. 27In a retrospective study by Yuan et al. in Eastern China involving 11,549 pregnant women, it was found that elevated maternal serum vitamin B12 levels were correlated with higher birth weight and an increased risk of new born being large. 7Sukumar et al. reported that there is no consistent relationship between vitamin B12 sufficiency and LBW. 31 MAASTHI birth cohort study by Deepa et al. in South India revealed no association between vitamin B12 status and birth weight. 30y et al. reported a negative association between cord Cbl and birth weight.The heaviest babies had lower cord Cbl levels.A similar negative association was also observed between birth length and head circumference. 37A secondary analysis of 709 Canadian mother newborn dyads by Tan et al. revealed that maternal serum vitamin B12 biomarkers did not show any association with birth weight or head circumference. 38In the present study, maternal B12 levels in malnourished women showed a positive correlation with birth weight (rho 0.363, p = 0.003) and length (rho 0.330, p = 0.008) but not with head circumference.
Limitations: This study was conducted in a tertiary care hospital, which may restrict the generalizability of its findings to a broader community.Maternal vitamin B12 levels measured only at the time of delivery may not reflect fluctuations throughout pregnancy.A smaller sample size raises concerns regarding the applicability of the results.The presence of coexisting micronutrient deficiencies in malnourished women poses a risk of confounding bias in the interpretation of results.
In conclusion, the present study revealed high rates of vitamin B12 deficiency in malnourished mothers and their neonates.Additionally, there was a positive correlation between birth weight, length, and maternal vitamin B12 levels in malnourished mothers.These findings emphasize the need to address maternal malnutrition and vitamin B12 deficiency to improve neonatal health.
expertise to confirm that it is of an acceptable scientific standard.

Introduction:
Please modify the introduction structure (the paragraph doesn't have the main sentence of each).Some paragraphs are too short (less than three sentences) 1.

Methods:
Please clarify the study design, is there a case-control or cross-sectional study? 1.
Why exclude severe anaemia, is there any specific reason?2.
Malnourished is define as a pre-pregnancy body weight less than 45kg.Why use body weight rather than pre-pregnancy body mass index? 3.

Results:
Explain the reason why in the table presentation authors use different display outcomes (table 2 (mean and SD), table 3 (median and interquartile range). 1.
Tables 2-5can be merged as 1 table and Tables 6-7 can be merged as 1 table.

3.
From the study authors can analyze RR or OR 4.

Discussion:
What Is the key finding of this study?1.
Please modify the discussion structure (the paragraph doesn't have the main sentence of each).Some paragraphs are too short (less than three sentences).

2.
The data shows that maternal vitamin B12 positively correlated with Birth weight and length among malnourished women.However, this correlation is not significant with cord vitamin B12, what is that mean and implication?

3.
Are there any maternal characteristics that effect the main outcome as confounding factors?

Is the work clearly and accurately presented and does it cite the current literature? Partly
Is the study design appropriate and is the work technically sound?Yes

If applicable, is the statistical analysis and its interpretation appropriate? Partly
Are all the source data underlying the results available to ensure full reproducibility?Yes

Are the conclusions drawn adequately supported by the results? Partly
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Nutritional epidemiology, anemia, food security I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
- -----------------Author reply : Introduction has been modified as per the suggestion First paragraph-Role of Vitamin B12 in health , sources Second paragraph-Deficiency and health burden , prevalence and regional disparities of deficiency Third paragraph -Vitamin B12 deficiency adverse outcomes in pregnancy , and effect of maternal deficiency on child health Fourth paragraph -Need for the present study and aims of the study ------------------Reviewer Comment: Methods 1. Please clarify the study design, is there a case-control or cross-sectional study?
Author reply Cross sectional study 2. Why exclude severe anaemia, is there any specific reason?
The median cord B12 value was considerably lower than the maternal B12 value and there was a strong positive correlation between maternal and cord B12 values 2.
Both maternal and cord B12 levels were significantly lower in the malnourished group than in the normal-nourished group 3.
In malnourished group , maternal vitamin B12 positively correlated with Birth weight and length.Cord B12 showed no correlation with neonatal anthropometry 4.

------------------Reviewer Comment:
2. Please modify the discussion structure (the paragraph doesn't have the main sentence of each).Some paragraphs are too short (less than three sentences).------------------Author reply : We have modified the discussion as per the suggestion ------------------Reviewer Comment: 3. The data shows that maternal vitamin B12 positively correlated with Birth weight and length among malnourished women.However, this correlation is not significant with cord vitamin B12, what is that mean and implication?------------------Author reply : Maternal Vitamin B12 levels during pregnancy may directly influence growth of fetus , leading to higher birth weight and increased length.This implies that adequate maternal Vitamin B12 level is crucial for fetal growth.Low levels of maternal vitamin B12, at certain stages of gestation, can lead to adverse outcomes, such as low birth weight and shorter neonates.Previous studies have reported declining concentrations of maternal vitamin B12 from first trimester to the third trimester.Cord blood Vitamin B12 levels reflect status of Vitamin B12 of neonate at birth.Absence of correlation with cord Vitamin B12 means that Cord Vitamin B12 may not be a direct measure of ongoing maternal B12 influence during pregnancy.Critical periods of Vitamin B12 influence may occur at certain stages of gestation which may not be captured by Cord blood B12 value.This implies the need to maintain adequate maternal Vitamin B12 levels throughout pregnancy for better neonatal outcome.------------------Reviewer Comment: 4. Are there any maternal characteristics that effect the main outcome as confounding factors?------------------Author reply : Co existing micronutrient deficiencies in malnourished mothers may effect the main outcome as confounding factors.This has been mentioned in limitations.-----------------

Rathika Damodara Shenoy
1 American University of Antigua, Antigua, USA 2 American University of Antigua, Antigua, USA The cross-sectional study compares the maternal and cord blood B12 levels in normally nourished and malnourished mothers at term.The authors report lower maternal and cord blood B12 values in the malnourished group and a strong positive correlation between the measures.The correlations between B12 values and newborn anthropometry are weak to none.The results reveal that a significant proportion, about 53%, of women in the study population have insufficient or deficient B12 status despite a mixed diet.It may be worthwhile to compare the maternal demography of the two groups (like Table 2 on newborn data).The authors can investigate if maternal BMI and B12 correlation will provide additional information.The limitations are listed by the authors.The main takeaway from the study is the high prevalence of maternal B12 deficiency in a coastal fish-eating community.Food taboos targeting pregnant and postpartum women are widely prevalent in India and South Asian countries. 1,2The authors should investigate qualitative and quantitative diet information, the coexistence of iron deficiency, and the clinical relevance in future studies with a larger sample size.

SUCHETHA S RAO
Review comment : The cross-sectional study compares the maternal and cord blood B12 levels in normally nourished and malnourished mothers at term.The authors report lower maternal and cord blood B12 values in the malnourished group and a strong positive correlation between the measures.The correlations between B12 values and newborn anthropometry are weak to none.The results reveal that a significant proportion, about 53%, of women in the study population have insufficient or deficient B12 status despite a mixed diet.It may be worthwhile to compare the maternal demography of the two groups (like Table 2 on newborn data).Author reply : Thank you for reviewing our article and giving valuable suggestions.We have modified the article as per your suggestions.We have compared the maternal demography and details are added to table 2 along with newborn data Review comment : The authors can investigate if maternal BMI and B12 correlation will provide additional information.Author reply : Spearman correlation test for BMI and Vitamin B12 level was done.There was a positive correlation between the two measures.( rho 0.590 , p <0.001)This observation has been added to result.
Review comment :The limitations are listed by the authors.The main takeaway from the study is the high prevalence of maternal B12 deficiency in a coastal fish-eating community.Food taboos targeting pregnant and postpartum women are widely prevalent in India and South Asian countries.1,2Author reply : Thank you for highlighting the significance of food taboos for possible contribution towards maternal Vitamin B12 deficiency along with references.We have added this to discussion.

Review comment
The authors should investigate qualitative and quantitative diet information, the coexistence of iron deficiency, and the clinical relevance in future studies with a larger sample size.Author reply We will plan for future studies

Competing Interests: None
The benefits of publishing with F1000Research: Your article is published within days, with no editorial bias • You can publish traditional articles, null/negative results, case reports, data notes and more • The peer review process is transparent and collaborative • Your article is indexed in PubMed after passing peer review • Dedicated customer support at every stage • For pre-submission enquiries, contact research@f1000.com Any further responses from the reviewers can be found at the end of the article Exclusion criteria (a) Pregnant women <18 years and > 35 years.(b) Pregnancy-induced hypertension/preeclampsia. (c) Maternal history of smoking and substance abuse.(d)Women with chorionic disease.

- Reviewer Comment: 4 .
From the study authors can analyze RR or OR

1 .
What Is the key finding of this study?
-Competing Interests: None Reviewer Report 22 June 2024 https://doi.org/10.5256/f1000research.165288.r289097© 2024 Shenoy R.This is an open access peer review report distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References 1 .
Labonté JM, Kroeun H, Sambo S, Rem N, et al.: Restricting diet for perceived health benefit: A mixed-methods exploration of peripartum food taboos in rural Cambodia.Matern Child Nutr.2023; 19 (3): e13517 PubMed Abstract | Publisher Full Text 2. Kareem O, Mufti S, Nisar S, Tanvir M, et al.: Prevalence of Thiamine Deficiency in Pregnancy and its impact on fetal outcome in an area endemic for thiamine deficiency.PLoS Negl Trop Dis.2023; 17 (5): e0011324 PubMed Abstract | Publisher Full Text Is the work clearly and accurately presented and does it cite the current literature?Yes Is the study design appropriate and is the work technically sound?YesAre sufficient details of methods and analysis provided to allow replication by others?PartlyIf applicable, is statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesAre the conclusions drawn adequately supported by the results?YesCompeting Interests: No competing interests were disclosed.Reviewer Expertise: Perinatology, Metabolic disorders, Dysmorphology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.Author Response 17 Jul 2024

Table 1 .
Maternal and neonatal characteristics.
2) were female.The mean gestational age of the neonates was 38.39 (AE 1.19) weeks.Mean birth weight was 2.77 (AE 0.35) kg and 22 (17.5%)neonates belonged to small for gestation age (SGA) category.Maternal and neonatal characteristics are shown in Table 1.

Table 2 .
Maternal and neonatal characteristics among normally nourished and malnourished mothers.

Table 3 .
Maternal and cord vitamin B12 levels.

Table 4 .
Maternal and cord vitamin B12 level and categories in normally nourished and malnourished mothers.

Table 5 .
Correlation of maternal,cord vitamin B12 and neonatal anthropometry in normal nourished and malnourished women.

- Reviewer Comment: Results: 1
.Explain the reason why in the table presentation authors use different display outcomes (table 2 (mean and SD), table 3 (median and interquartile range).
and 5 as one table ( new table no 4 ) We have merged table 6 and 7 as one table ( new table no 5 )