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Meta-Analysis
. 2015 Jun 3;2015(6):CD000179.
doi: 10.1002/14651858.CD000179.pub3.

Pyridoxine (vitamin B6) supplementation during pregnancy or labour for maternal and neonatal outcomes

Rehana A Salam  1 , Nadeem F Zuberi, Zulfiqar A Bhutta
Affiliations
Meta-Analysis

Pyridoxine (vitamin B6) supplementation during pregnancy or labour for maternal and neonatal outcomes

Rehana A Salam et al. Cochrane Database Syst Rev. .

Abstract

Background: Vitamin B6 plays vital roles in numerous metabolic processes in the human body, such as nervous system development and functioning. It has been associated with some benefits in non-randomised studies, such as higher Apgar scores, higher birthweights, and reduced incidence of pre-eclampsia and preterm birth. Recent studies also suggest a protection against certain congenital malformations.

Objectives: To evaluate the clinical effects of vitamin B6 supplementation during pregnancy and/or labour.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 March 2015) and reference lists of retrieved studies.

Selection criteria: We included randomised controlled trials comparing vitamin B6 administration in pregnancy and/or labour with: placebos, no supplementations, or supplements not containing vitamin B6.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. For this update, we assessed methodological quality of the included trials using risk of bias and the GRADE approach.

Main results: Four trials (1646 women) were included. The method of randomisation was unclear in all four trials and allocation concealment was reported in only one trial. Two trials used blinding of participants and outcomes. Vitamin B6 as oral capsules or lozenges resulted in decreased risk of dental decay in pregnant women (capsules: risk ratio (RR) 0.84; 95% confidence interval (CI) 0.71 to 0.98; one trial, n = 371, low quality of evidence; lozenges: RR 0.68; 95% CI 0.56 to 0.83; one trial, n = 342, low quality of evidence). A small trial showed reduced mean birthweights with vitamin B6 supplementation (mean difference -0.23 kg; 95% CI -0.42 to -0.04; n = 33; one trial). We did not find any statistically significant differences in the risk of eclampsia (capsules: n = 1242; three trials; lozenges: n = 944; one trial), pre-eclampsia (capsules n = 1197; two trials, low quality of evidence; lozenges: n = 944; one trial, low-quality evidence) or low Apgar scores at one minute (oral pyridoxine: n = 45; one trial), between supplemented and non-supplemented groups. No differences were found in Apgar scores at five minutes, or breastmilk production between controls and women receiving oral (n = 24; one trial) or intramuscular (n = 24; one trial) loading doses of pyridoxine at labour. Overall, the risk of bias was judged as unclear. The quality of the evidence using GRADE was low for both pre-eclampsia and dental decay. The other primary outcomes, preterm birth before 37 weeks and low birthweight, were not reported in the included trials.

Authors' conclusions: There were few trials, reporting few clinical outcomes and mostly with unclear trial methodology and inadequate follow-up. There is not enough evidence to detect clinical benefits of vitamin B6 supplementation in pregnancy and/or labour other than one trial suggesting protection against dental decay. Future trials assessing this and other outcomes such as orofacial clefts, cardiovascular malformations, neurological development, preterm birth, pre-eclampsia and adverse events are required.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 1 Pre‐eclampsia.
1.2
1.2. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 2 Eclampsia.
1.3
1.3. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 3 Dental decay (increase in decayed, missing or filled teeth).
1.4
1.4. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 4 Breastmilk production (g/kg/day).
1.5
1.5. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 5 Mean birthweight (kg).
1.6
1.6. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 6 Low Apgar score at 1 minute.
1.7
1.7. Analysis
Comparison 1 Pyridoxine (B6) versus control, Outcome 7 Low Apgar score at 5 minutes.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Hillman 1963 {published data only}
    1. Hillman R, Cabaud P, Nilsson D, Arpin P, Tufano R. Pyridoxine supplementation during pregnancy. Clinical and laboratory observations. American Journal of Clinical Nutrition 1963;12:427‐30. - PubMed
    1. Hillman RW, Cabaud PG, Schenone RA. The effects of pyridoxine supplements on the dental caries experience of pregnant women. American Journal of Clinical Nutrition 1962;10:512‐5. - PubMed
Schuster 1984 {published data only}
    1. Schuster K, Bailey LB, Mahan CS. Effect of maternal pyridoxine‐HCl supplementation on the vitamin B‐6 status of mother and infant and on pregnancy outcome. Journal of Nutrition 1984;114:977‐88. - PubMed
Swartwout 1960 {published data only}
    1. Swartwout JR, Unglaub WG, Smith RC. Vitamin B6, serum lipids and placental arteriolar lesions in human pregnancy. A preliminary report. American Journal of Clinical Nutrition 1960;8:434‐44. - PubMed
Temesvari 1983 {published data only}
    1. Temesvari P, Szilagyi I, Eck E, Boda D. Effects of an antenatal load of pyridoxine (Vitamin B6) on the blood oxygen affinity and prolactin levels in newborn infants and their mothers. Acta Paediatrica Scandinavica 1983;72:525‐9. - PubMed

References to studies excluded from this review

Coelingh Benninck 1979 {published data only}
    1. Coelingh Bennink HJT, Stolte LAM, Riet HG, Hart H, Haspels AA. A decrease in the incidence of gestational diabetes by prophylactic treatment with vitamin B6 [abstract]. 9th World Congress of Gynecology and Obstetrics; 1979 Oct 26‐31; Tokyo, Japan. 1979:269.
Lumeng 1976 {published data only}
    1. Lumeng L, Cleary RE, Wagner R, Yu P‐L, Li T‐K. Adequacy of Vitamin B6 supplementation during pregnancy: a prospective study. American Journal of Clinical Nutrition 1976;29:1376‐83. - PubMed

Additional references

Alaimo 1998
    1. Alaimo K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM, et al. Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: third national health and nutrition examination survey, phase 1, 1988‐91. Advance Data: Vital and Health Statistics of the Centers for Disease Control and Prevention/National Center for Health Statistics. Hyattsville, MD: Department of Health and Human Services; Center for Disease Control and Prevention; National Center for Health Statistics, 1994:1‐28.
Arija 2004
    1. Arija V, Cuco G, Vila J, Iranzo R, Fernandez‐Ballart J. Food consumption, dietary habits and nutritional status of the population of Resus: follow‐up from preconception throughout pregnancy and after birth [Consumo, hábitos alimentarios y estado nutricional de la población de Reus en la etapa preconcepcional, el embarazo y el posparto]. Medical Clinics (Barcelona) 2004;123(1):5‐11. - PubMed
Austin 2004
    1. Austin RC, Lentz SR, Werstuck GH. Role of hyperhomocysteinemia in endothelial dysfunction and atherothrombotic disease. Cell Death and Differentiation 2004;11(Suppl 1):S56‐S64. - PubMed
Boda 1981
    1. Boda D, Temesvári P, Eck, E. Influence of pyridoxine on the oxygen transport function of blood in the neonatal period in clinical and experimental conditions. Padiatrie und Padologie 1981;17(2):149‐155. - PubMed
Chaney 2002
    1. Chaney SG. Chapter 27: Principles of nutrition II: Micronutrients. Section 27.6: Energy releasing water soluble vitamins. In: Delvin TM editor(s). Textbook of Biochemistry with Clinical Correlations. 5th Edition. Wiley‐Liss (a Wiley & Sons, Inc. publication), 2002:1148‐53.
Chang 1999
    1. Chang SJ. Adequacy of maternal pyridoxine supplementation during pregnancy in relation to the vitamin B6 status and growth of neonates at birth. Journal of Nutritional Science Vitaminology (Tokyo) 1999;45(4):449‐58. - PubMed
Czeizel 2004
    1. Czeizel AE, Puho E, Banhidy F, Acs N. Oral pyridoxine during pregnancy: potential protective effect for cardiovascular malformations. Drugs 2004;5(5):259‐69. - PubMed
de la Calle 2003
    1. Calle M, Usandizaga R, Sancha M, Magdaleno F, Herranz A, Cabrillo E. Homocysteine, folica acid and B‐group vitamins in obstetrics and gynaecology. European Journal of Obstetrics & Gynecology and Reproductive Biology 2003;107:125‐34. - PubMed
DRI 1998
    1. Food, Nutrition Board. Institute of Medicine. Chapter 7: Vitamin B6. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. A Report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, other B Vitamins, and Choline and Subcommittee on Upper Reference Levels of Nutrients. National Academy Press, 1998:150‐95.
Dror 2012
    1. Dror DK, Allen LH. Interventions with vitamins B6, B12 and C in pregnancy. Paediatric and Perinatal Epidemiology 2012;26(S1):55‐74. - PubMed
GRADE 2014 [Computer program]
    1. McMaster University. GRADEpro. [Computer program on www.gradepro.org]. Version 2015. McMaster University, 2014.
Gupta 1990
    1. Gupta T, Sharma R. An antilactogenic effect of pyridoxine. Journal of Indian Medical Association 1990;88(12):336‐7. - PubMed
Hansen 2001
    1. Hansen CM, Shultz TD, Kwak H‐K, Memon HS, Leklem JE. Assessment of vitamin B‐6 status in young women consuming a controlled diet containing four levels of vitamin B‐6 provides and estimated average requirement and recommended dietary allowance. Journal of Nutrition 2001;131:1777‐86. - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
IFIC 1998
    1. International Food Information Council. Nutrient requirements get a makeover the evolution of the recommended dietary allowances. http://www.ific.org/foodinsight/1998/so/rdafi598.cfm (accessed December 2005).
Kang‐Yoon 1992
    1. Kang‐Yoon SA, Kirksey A, Giacoia G, Kerstin W. Vitamin B‐6 status of breast‐fed neonates: influence of pyridoxine supplementation on mothers and neonates. American Journal of Clinical Nutrition 1992;56:548‐58. - PubMed
Kant 1990
    1. Kant AK, Block G. Dietary vitamin B‐6 intake and food sources in the US population: NHANES II; 1976‐1980. American Journal of Clinical Nutrition 1990;54(4):707‐16. - PubMed
Krapels 2004
    1. Krapels IP, Rooij IA, Ocke MC, Cleef BA, Kuijpers‐Jagtman AM, Steegers‐Theunissen RP. Maternal dietary B vitamin intake, other than folate, and the association with orofacial cleft in the offspring. European Journal of Nutrition 2004;43(1):7‐14. - PubMed
Masino 2002
    1. Masino SA, Kahle JS. Vitamin B6 therapy during childbearing years: cause for caution?. Nutritional Neuroscience 2002;5(4):241‐2. - PubMed
Matthews 2014
    1. Matthews A, Haas DM, O'Mathúna DP, Dowswell T, Doyle M. Interventions for nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2014, Issue 3. [DOI: 10.1002/14651858.CD007575.pub3] - DOI - PubMed
Morris 2008
    1. Morris MS, Picciano MF, Jacques PF, Selhub J. Plasma pyridoxal 5′‐phosphate in the US population: the National Health and Nutrition Examination Survey, 2003–2004. American Journal of Clinical Nutrition 2008;87(5):1446‐54. - PubMed
NDP 1990
    1. Committee on Nutritional Status During Pregnancy and Lactation. Food and Nutrition Board. Institute of Medicine. Water‐soluble vitamins. Nutrition During P: Part I: Weight Gain, Part II: Nutrient Supplements. National Academy of Sciences, 1990:351‐79.
Ramakrishna 1999
    1. Ramakrishna T. Vitamins and brain development. Physiological Research 1999;48(3):175‐87. - PubMed
Rapisarda 1981
    1. Rapisarda E, Longo A. Effects of zinc and vitamin B6 in experimental caries in rats. Minerva Stomatologica 1981;30(4):317‐20. - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Rocamora 2003
    1. Irles Rocamora JA, Iglesias Bravo EM, Aviles Mejias S, Bernal Lopez E, Valle Galindo PB, Moriones Lopez L, et al. Nutritional value of the diet in healthy pregnant women. Results of a nutrition survey of pregnant women [Valor nutricional de la dieta en embarazadas sanas: Resultados de una encuesta dietética en gestantes]. Nutricion Hospitalaria 2003;18(5):248‐52. - PubMed
Roepke 1979
    1. Roepke JL, Kirksey A. Vitamin B6 nutriture during pregnancy and lactation. I. Vitamin B6 intake, levels of the vitamin in biological fluids, and condition of the infant at birth. American Journal of Clinical Nutrition 1979;32(11):2249‐56. - PubMed
Ronnenberg 2002
    1. Ronnenberg AG, Goldman MB, Chen D, Aitken IW, Willett WC, Selhub J, et al. Preconception homocysteine and B vitamin status and birth outcomes in Chinese women. American Journal of Clinical Nutrition 2002;76(6):1385‐91. - PubMed
RxMed 2005
    1. Vitamin B6: general monograph. http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS‐%20Mon... (accessed December 23, 2005).
Schunemann 2009
    1. Schunemann HJ. GRADE: from grading the evidence to developing recommendations. A description of the system and a proposal regarding the transferability of the results of clinical research to clinical practice [GRADE: Von der Evidenz zur Empfehlung. Beschreibung des Systems und Losungsbeitrag zur Ubertragbarkeit von Studienergebnissen]. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen 2009;103(6):391‐400. - PubMed
Thaniyavarn 1982
    1. Thaniyavarn S, Taylor KG, Singh S, Doyle RJ. Pyridine analogs inhibit the glucosyltransferase of streptococcus mutans. Infection and Immunity 1982;37(3):1101‐11. - PMC - PubMed
Truswell 1999
    1. Truswell AS. Vitamins. ABC of Nutrition. 3rd Edition. London: BMJ Books, 1999:57‐64.
Var 2014
    1. Var C, Keller S, Tung R, Freeland D, Bazzano AN. Supplementation with vitamin B6 reduces side effects in Cambodian women using oral contraception. Nutrients 2014;6(9):3353‐62. - PMC - PubMed
Whitney 2002
    1. Whitney EN, Rolfes SR. The water soluble vitamins: B vitamins and Vitamin C. Understanding Nutrition. 9th Edition. Wadsworth. Thomson Learning, 2002:306‐46.
Wibowo 2012
    1. Wibowo N, Yuditiya P, Akihiko S, Antonio F, Victor T, Saptawati B. Vitamin B 6 supplementation in pregnant women with nausea and vomiting. International Journal of Gynecology & Obstetrics 2012;116(3):206‐10. - PubMed

References to other published versions of this review

CDSR 1997
    1. Mahomed K, Gulmezoglu AM. Pyridoxine (vitamin B6) supplementation in pregnancy. Cochrane Database of Systematic Reviews 1997, Issue 2. [DOI: 10.1002/14651858.CD000179] - DOI - PubMed
Thaver 2006
    1. Thaver D, Saeed MA, Bhutta ZA. Pyridoxine (vitamin B6) supplementation in pregnancy. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD000179.pub2] - DOI - PubMed

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