Riboflavin and metabolically related B vitamins in pregnancy: impacts on maternal blood pressure, anaemia risk and offspring health

Abstract

Riboflavin deficiency is more common within high-income settings than widely recognised and may be a particular problem during pregnancy, when dietary requirements are increased. Limited evidence suggests that even a moderate riboflavin deficiency may be implicated in the development of hypertension and anaemia; two common and serious conditions associated with pregnancy. The overall aim of this thesis was to investigate the role of riboflavin and metabolically related B vitamins in pregnancy and their impact on maternal blood pressure (BP), anaemia risk and offspring health. A critical review of the literature was conducted which highlighted that riboflavin may be beneficial in the prevention and treatment of hypertension, specifically in adults with the common methylenetetrahydrofolate reductase (MTHFR)C677T polymorphism (TT genotype), but that evidence from pregnancy cohorts is lacking. This review also revealed that the TT genotype was associated with an up to220% and 90% increased risk of developing preeclampsia and hypertension in pregnancy, respectively. The first original investigation within this thesis examined the role of riboflavin on blood pressure (BP) in the form of a randomised controlled trial(RCT), targeting genetically at-risk women during pregnancy. The findings provide the first RCT evidence to show that riboflavin, alone or in combination with folate, is effective in attenuating the rise in diastolic BP and heart rate during pregnancy among women with the TT genotype. The second investigation, a follow-up study of offspring from this RCT, provided the first, albeit preliminary evidence, that maternal riboflavin supplementation significantly lowers the systolic and diastolic BP of infants at 15weeks, with corresponding improvements in neurodevelopmental performance at 3years of age, as assessed using the Bayley’s Scale of Infant and Toddler Development.  A second review of the literature found that riboflavin and vitamin B6 may play a role in the prevention of anaemia, but that evidence from cohorts of pregnant women, and particularly from high-income settings, are greatly lacking. A final study addressed the relationship of riboflavin and vitamin B6 status during pregnancy in relation to haemoglobin (Hb) and risk of anaemia. This study identified high rates of biochemical riboflavin deficiency among pregnant women (32%), which were associated with lower Hb concentrations and a two-fold greater risk of developing anaemia during pregnancy. This study also demonstrated the metabolic dependency of vitamin B6 on riboflavin for the first time within the context of pregnancy, suggesting riboflavin’s role in the maintenance of B6 status.

In conclusion, the findings of this thesis suggest that the achievement of optimal riboflavin status in pregnancy may be important for maintaining healthy BP, heartrate, and Hb concentrations, and may also play a role in offspring health and development.

Thesis embargoed until 30 June 2026

Date of Award	Jun 2024
Original language	English
Supervisor	Kristina Pentieva (Supervisor), Helene Mc Nulty (Supervisor) & Mary Ward (Supervisor)