Am J Perinatol 2004; 21(8): 469-475
DOI: 10.1055/s-2004-835964
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

The Risk of Folate and Vitamin B12 Deficiencies Associated with Hyperhomocysteinemia among Pregnant Women

Hyesook Park1 , 3 , Young Ju Kim2 , 3 , Eun Hee Ha1 , 3 , Ki Nam Kim4 , 5 , Namsoo Chang4 , 5
  • 1Departments of Preventive Medicine, Ewha Womans University, Seoul, South Korea
  • 2Obstetrics and Gynecology, Ewha Womans University, Seoul, South Korea
  • 3Medical Research Center, Ewha Womans University, Seoul, South Korea
  • 4Department of Food and Nutritional Sciences, Ewha Womans University, Seoul, South Korea
  • 5Asia Food and Nutrition Research Institute, Ewha Womans University, Seoul, South Korea
Further Information

Publication History

Publication Date:
06 December 2004 (online)

ABSTRACT

The purpose of this study was to compare the folate and vitamin B12 levels in pregnant and nonpregnant women to evaluate the risk for hyperhomocysteinemia and for folate and vitamin B12 deficiencies during pregnancy. Healthy pregnant women (n = 92; 24 to 28 gestational weeks; 18 to 39 years old) and nonpregnant women (n = 176; 18 to 39 years old) were sampled for serum levels of folate, vitamin B12, and homocysteine. Pregnant women were less likely to have folate deficiency (8.0% versus 12.0%) but much more likely to have vitamin B12 deficiency (46.1% versus 0.6%) than nonpregnant women. Those with lower dietary vitamin intakes were more likely to have vitamin B12 deficiency. Serum folate and vitamin B12 were negatively correlated with homocysteine among pregnant women. Pregnant women with folate deficiency were more likely to have hyperhomocysteinemia than those without folate deficiency. The vitamin B12 level associated with hyperhomocysteinemia was lower in pregnant subjects than in nonpregnant subjects in this study, indicating that pregnant women require vitamin B12 supplementation.

REFERENCES

  • 1 Blackburn S, Loper PL The hematologic and hemostatic systems. In: Maternal, Fetal, and Neonatal Physiology: A Clinical Perspective Philadelphia; W.B. Saunders 1992: 159-200
  • 2 Prenatal care. In: Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC Williams Obstetrics Norwalk, CT; Appleton & Lange 1993: 249
  • 3 Wagner C. Biochemical role of folate in cellular metabolism. In: Bailey LB Folate in Health and Disease. New York; Marcel Dekker 1995: 23-42
  • 4 Carretti N G, Ditto A, Guidoni C G. Vitamin B12 levels in pregnancy influence erythropoietin response to anemia.  Eur J Obstet Gynecol Reprod Biol. 1998;  80 63-66
  • 5 Kirke P N, Molloy A M, Daly L E, Burke H, Weir D G, Scott J M. Maternal plasma folate and vitamin B12 are independent risk factors for neural tube defects.  Q J Med. 1993;  86 703-708
  • 6 Savage D, Gangaidzo I, Lindenbaum J et al.. Vitamin B12 deficiency is the primary course of megaloblastic anaemia in Zimbabwe.  Br J Haematol. 1994;  86 844-850
  • 7 Steen M T, Boddie A M, Fisher A J et al.. Neural-tube defects are associated with low concentrations of cobalamin (vitamin B12) in amniotic fluid.  Prenat Diagn. 1998;  18 545-555
  • 8 Goddijn-Wessel T A, Wouters M G, van de Molen E F et al.. Hyperhomocysteinemia: a risk factor for placental abruption or infarction.  Eur J Obstet Gynecol Reprod Biol. 1996;  66 23-29
  • 9 Verhoef P, Stampfer M J, Buring J E et al.. Homocysteine metabolism and risk of myocardial infarction: relation with vitamins B6, B12, and folate.  Am J Epidemiol. 1996;  143 845-859
  • 10 den Heijer M, Koster T, Blom H J et al.. Hyperhomocysteinemia as a risk factor for deep-vein thrombosis.  N Engl J Med. 1996;  334 759-762
  • 11 Dekker G A, de Vries J I, Doelitzsch P M et al.. Underlying disorders with severe early-onset preeclampsia.  Am J Obstet Gynecol. 1995;  173 1042-1048
  • 12 Rajkovic A, Catalano P M, Malinow M R. Elevated homocyst(e)ine levels with preeclampsia.  Obstet Gynecol. 1997;  90 168-171
  • 13 Wouters M G, Boers G H, Blom H J et al.. Hyperhomocysteinemia: a risk factor in women with unexplained recurrent early pregnancy loss.  Fertil Steril. 1993;  60 820-825
  • 14 Burke G, Robinson K, Refsum H, Stuart B, Drumm J, Graham I. Intrauterine growth retardation, perinatal death, and maternal homocysteine levels.  N Engl J Med. 1992;  326 69-70
  • 15 Ray J G, Laskin C A. Folic acid and homocyst(e)ine metabolic defects and the risk of placental abruption, pre-eclampsia and spontaneous pregnancy loss: a systematic review.  Placenta. 1999;  20 519-529
  • 16 De Falco M, Pollio F, Scaramellino M, Pontillo M, Lieto A D. Homocysteinaemia during pregnancy and placental disease.  Clin Exp Obstet Gynecol. 2000;  27 188-190
  • 17 Mills J L, McPartlin J M, Kirke P N et al.. Homocysteine metabolism in pregnancies complicated by neural-tube defects.  Lancet. 1995;  345 149-151
  • 18 Ubbink J B, Vermaak W JF, Bissbort S. Rapid high-performance liquid chromatographic assay for total homocysteine levels in human serum.  J Chromatogr. 1991;  565 441-446
  • 19 Araki A, Sako Y. Determination of free and total homocysteine in human plasma by high-performance liquid chromatography with fluorescence detection.  J Chromatogr. 1987;  422 43-52
  • 20 Lindenbaum J, Rosenberg I H, Wilson P WF, Stabler S P, Allen R H. Prevalence of cobalamin deficiency in the Framingham elderly population.  Am J Clin Nutr. 1994;  60 2-11
  • 21 Allen L H, Casterline J. Vitamin B-12 deficiency in elderly individuals: diagnosis and requirements.  Am J Clin Nutr. 1994;  60 12-14
  • 22 Ronnenberg A G, Goldman M B, Chen D et al.. Preconception homocysteine and B vitamin status and birth outcomes in Chinese women.  Am J Clin Nutr. 2002;  76 1385-1391
  • 23 Herbert V, Das K C. Folic acid and vitamin B-12. In: Shils ME, Olson JA, Shike M Modern Nutrition in Health and Disease. 8th ed. Vol I. Philadelphia; Lea and Febiger 1994: 402-425
  • 24 Caudill M A, Gregory III J F, Hutson A D, Bailey L B. Folate catabolism in pregnant and nonpregnant women with controlled folate intakes.  J Nutr. 1998;  128 204-208
  • 25 Gregory III J F, Caudill M A, Opalko F J, Bailey L B. Kinetics of folate turnover in pregnant women (second trimester) and nonpregnant controls during folic acid supplementation: stable-isotopic labeling of plasma folate, urinary folate and folate catabolites shows subtle effects of pregnancy on turnover of folate pools.  J Nutr. 2001;  131 1928-1937
  • 26 Walker M C, Smith G N, Perkins S L, Keely E J, Garner P R. Changes in homocysteine levels during normal pregnancy.  Am J Obstet Gynecol. 1999;  180 660-664
  • 27 Morris M S, Jacques P F, Selhub J, Rosenberg I H. Total homocysteine and estrogen status indicators in the Third National Health and Nutrition Examination Survey.  Am J Epidemiol. 2000;  152 140-148
  • 28 Steegers-Theunissen R PM, Wathen N C, Eskes T KAB, van Raaij-Selten B, Chard T. Maternal and fetal levels of methionine and homocysteine in early human pregnancy.  Br J Obstet Gynaecol. 1997;  104 20-24
  • 29 Galloway M, Rushworth L. Red cell or serum folate? Results from the National Pathology Alliance benchmarking review.  J Clin Pathol. 2003;  56 924-926
  • 30 McPartlin J, Halligan A, Scott J M, Darling M, Weir D G. Accelerated folate breakdown in pregnancy.  Lancet. 1993;  341 148-149
  • 31 Cikot R JCM, Steegers-Theunissen R PM, Thomas C MG, de Boo T M, Merkus H MWM, Steegers E AP. Longitudinal vitamin and homocysteine levels in normal pregnancy.  Br J Nutr. 2001;  85 49-58

Hyesook ParkM.D. Ph.D. 

Department of Preventive Medicine, College of Medicine

Ewha Womans University

911-1 Mok-6-dong, Yangcheon-Gu, Seoul 158-710, Korea