Hyperhomocysteinemia in recurrent pregnancy loss and the effect of folic acid and vitamin B12 on homocysteine levels: a prospective analysis

Authors

  • Indrani Mukhopadhyay Department of Obstetrics and Gynecology, Command Hospital AF, Bangalore, Karnataka, India
  • V. Pruthviraj Department of Obstetrics and Gynecology, Command Hospital AF, Bangalore, Karnataka, India
  • Rao P. S. Department of Obstetrics and Gynecology, Command Hospital AF, Bangalore, Karnataka, India
  • Manash Biswas Department of Obstetrics and Gynecology, Military Hospital, Roorkee, Uttarakhand, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20172013

Keywords:

Folic acid, Hyperhomocysteinemia, Recurrent pregnancy loss, Vitamin B12

Abstract

Background: Recurrent pregnancy loss (RPL) affects about 5% of women. High levels of homocysteine, termed hyperhomocysteinemia, have been implicated in a number of pathologic processes in the venous and arterial vascular systems. Hyperhomocysteinemia in pregnant women has been associated with deep venous thrombosis, recurrent miscarriage, abruption placentae, preeclampsia, neural tube defects, and fetal growth restriction. This study aims at determining association between hyperhomocysteinemia and recurrent pregnancy loss and also association of folic acid (vitamin B 9) and vitamin B 12 with hyperhomocysteinemia (HHCY), in reducing its levels in the body and thus preventing obstetric complications.

Methods: A prospective study of pregnant mothers booked at our hospital over a period of two years with history of unexplained RPL were included in the study and their serum homocysteine levels were assessed. Hyperhomocysteinemia (>12 micromol/l) patients were treated with folic acid and vitamin B12 supplements and homocysteine levels were assessed again, post treatment.

Results: Out of the 100 patients who were assessed, 32% of RPL patients had hyperhomocysteinemia. Folic acid and VitB12 supplementation reduced homocysteine levels and this was found to be statistically significant.

Conclusions: Hyperhomocysteinemia is associated with RPL. Vitamin supplementation to those with hyperhomocysteinemia, decreases homocysteine levels.

References

Van den Boogaard E, Kaandorp SP, Franssen MT, Mol BW, Leschot NJ, Wouters CH et al. Consecutive or non-consecutive recurrent miscarriage: is there any difference in carrier status? Hum Reprod. 2010;25:1411-4.

Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertil Steril. 2012;98:5.

Klai S, Fekih-Mrissa N, El Housaini S, Kaabechi N, Nsiri B, Rachdi R et al. Association of MTHFR A1298C polymorphism (but not of MTHFR C677T) with elevated homocysteine levels and placental vasculopathies. Blood Coagul Fibrinolysis. 2011;22(5):374-8.

Alhalaki W, aldin Altanoukhi I, Alhalabi M. The association of hyperhomocysteinemia with recurrent pregnancy loss. Researchgate.net. 2016July;305318605.

Mantovani E, Filippini F, Bortolus R, Franchi M. Folic acid supplementation and preterm birth: results from observational studies. Biomed Res Int. 2014;2014:481914.

Bergen NE, Jaddoe VW, Timmermans S, Hofman A, Lindemans J, Russcher H, Raat H, Steegers-Theunissen RP, Steegers EA. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: the Generation R Study. BJOG. 2012;119(6):739-51.

Cheng ZJ, Yang X, Wang H. Hyperhomocysteinemia and endothelial dysfunction. Curr Hypertens Rev. 2009;5(2):158-65.

D'Uva M, Di Micco P, Strina I, Alviggi C, Iannuzzo M, Ranieri A et al. Hyperhomocysteinemia in women with unexplained sterility or recurrent early pregnancy loss from Southern Italy: a preliminary report. Thrombosis J. 2007;5(1):10.

Govindaiah V, Naushad SM, Prabhakara K, Krishna PC, Devi AR. Association of parental hyperhomocysteinemia and C677T Methylene tetrahydrofolate reductase (MTHFR) polymorphism with recurrent pregnancy loss. Clini Biochem. 2009;42(4):380-6.

Armitage JM, Bowman L, Clarke RJ, Wallendszus K, Bulbulia R, Rahimi K et al. Effects of homocysteine lowering with folic acid plus Vitamin B12 vs placebo on mortality and major morbidity in myocardial infarction survivors: a randomised trial. JAMA. 2010;303(24):2486-94.

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Published

2017-05-25

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Original Research Articles