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Risk score to stratify miscarriage risk levels in preconception women. Sci Rep 2021; 11:12111. [PMID: 34103654 PMCID: PMC8187346 DOI: 10.1038/s41598-021-91567-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/28/2021] [Indexed: 12/03/2022] Open
Abstract
Spontaneous miscarriage is one of the most common complications of pregnancy. Even though some risk factors are well documented, there is a paucity of risk scoring tools during preconception. In the S-PRESTO cohort study, Asian women attempting to conceive, aged 18-45 years, were recruited. Multivariable logistic regression model coefficients were used to determine risk estimates for age, ethnicity, history of pregnancy loss, body mass index, smoking status, alcohol intake and dietary supplement intake; from these we derived a risk score ranging from 0 to 17. Miscarriage before 16 weeks of gestation, determined clinically or via ultrasound. Among 465 included women, 59 had miscarriages and 406 had pregnancy ≥ 16 weeks of gestation. Higher rates of miscarriage were observed at higher risk scores (5.3% at score ≤ 3, 17.0% at score 4–6, 40.0% at score 7–8 and 46.2% at score ≥ 9). Women with scores ≤ 3 were defined as low-risk level (< 10% miscarriage); scores 4–6 as intermediate-risk level (10% to < 40% miscarriage); scores ≥ 7 as high-risk level (≥ 40% miscarriage). The risk score yielded an area under the receiver-operating-characteristic curve of 0.74 (95% confidence interval 0.67, 0.81; p < 0.001). This novel scoring tool allows women to self-evaluate their miscarriage risk level, which facilitates lifestyle changes to optimize modifiable risk factors in the preconception period and reduces risk of spontaneous miscarriage.
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2
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Chaudhry SH, Taljaard M, MacFarlane AJ, Gaudet LM, Smith GN, Rodger M, Rennicks White R, Walker MC, Wen SW. The role of maternal homocysteine concentration in placenta-mediated complications: findings from the Ottawa and Kingston birth cohort. BMC Pregnancy Childbirth 2019; 19:75. [PMID: 30782144 PMCID: PMC6381683 DOI: 10.1186/s12884-019-2219-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 02/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Homocysteine is an intermediate metabolite implicated in the risk of placenta-mediated complications, including preeclampsia, placental abruption, fetal growth restriction, and pregnancy loss. Large cohort and case-control studies have reported inconsistent associations between homocysteine and these complications. The purpose of this study was to investigate whether elevated maternal plasma homocysteine concentration in the early to mid-second trimester is associated with an increased risk of placenta-mediated complications. We examined the following potential moderating factors that may explain discrepancies among previous studies: high-risk pregnancy and the MTHFR 677C>T polymorphism. Methods We analyzed data from participants recruited to the Ottawa and Kingston (OaK) Birth Cohort from 2002 to 2009 in Ottawa and Kingston, Canada. The primary outcome was a composite of any placenta-mediated complication, defined as a composite of small for gestational age (SGA) infant, preeclampsia, placental abruption, and pregnancy loss. Secondary outcomes were, individually: SGA infant, preeclampsia, placental abruption, and pregnancy loss. We conducted multivariable logistic regression analyses with homocysteine as the primary continuous exposure, adjusting for gestational age at the time of bloodwork and explanatory maternal characteristics. The functional form, i.e., the shape of the homocysteine association with the outcome was examined using restricted cubic splines and information criteria (Akaike’s/Bayesian Information Criterion statistics). Missing data were handled with multiple imputation. Results 7587 cohort participants were included in the study. Maternal plasma homocysteine concentration was significantly associated (linearly) with an increased risk of both the composite outcome of any placenta-mediated complication (p = 0.0007), SGA (p = 0.0010), severe SGA, and marginally with severe preeclampsia, but not preeclampsia, placental abruption and pregnancy loss. An increase in homocysteine concentration significantly increased the odds of any placenta-mediated complication (odds ratio (OR) for a 5 μmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23–2.16) and SGA (OR 1.76, 95% CI 1.25–2.46). Subgroup analyses indicated some potential for modifying effects of the MTHFR 677C>T genotype and high-risk pregnancy, although the interaction was not statistically significant (high-risk subgroup OR 2.37, 95% CI 1.24–4.53, p-value for interaction =0.14). Conclusions Our results suggest an independent effect of early to mid-pregnancy elevated maternal homocysteine on placenta-mediated pregnancy complications. Electronic supplementary material The online version of this article (10.1186/s12884-019-2219-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shazia H Chaudhry
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Health Canada, Ottawa, Ontario, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
| | - Laura M Gaudet
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Graeme N Smith
- Department of Obstetrics & Gynaecology, Division of Maternal-Fetal Medicine, Queen's University, Kington, Ontario, Canada.,Kingston General Hospital Research Institute, Kington, Ontario, Canada
| | - Marc Rodger
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Mark C Walker
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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3
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Sharif ME, Mohamedain A, Ahmed AA, Nasr AM, Adam I. Folic acid level and preterm birth among Sudanese women. Matern Health Neonatol Perinatol 2017; 3:25. [PMID: 29214043 PMCID: PMC5709970 DOI: 10.1186/s40748-017-0065-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) is the major health problem world-wide; there are few published studies on PTB and folic acid. METHODS The study was conducted to assess the serum level of folic acid in PTB. A case-control study was conducted at Saad Abualila maternity hospital (Khartoum, Sudan) during the period of March through December 2015. Women who delivered live singleton babies were dived in two groups; the cases were women who had PTB "delivery before completed 37weeks but after 24 weeks of pregnancy" and the controls were women who delivered at term (37-42 weeks). Medical and obstetrics history was gathered using questionnaire. Serum folic acid was measured. RESULTS One hundred and twelve (56 in arm of the study) women were enrolled to the study. There was no significant difference between the cases and the controls in their age, parity, hemoglobin, body mass index, education and occupation. The median (interquartile) level of folic acid was significantly lower in the cases (PTB) than the level in the controls, 4.8(2.8-8.2) vs. 9.5(8.6-12.0) ng/ml. In binary regression, folic acid level was associated with lower risk of PTB (OR=0.64; 95%=0.53-0.77, P < 0.001). There was a significant positive correlation between gestational age and folic acid level (r = 0.447, P<0.001). CONCLUSION Thus serum folic acid level was significantly lower in women with PTB. Folic acid level was associated with lower risk of PTB.
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Affiliation(s)
- Manal E. Sharif
- Faculty of Medicine, Al-Neelain University, P.O Box 12702, 11111 Khartoum, Sudan
| | - Ahmed Mohamedain
- Faculty of Medicine, University of Khartoum, P.O Box 102, 11111 Khartoum, Sudan
- Department of Biomedical Sciences, King Faisal University, Alhasa, Kingdom of Saudi Arabia
| | - AbdelBagi A. Ahmed
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Abubakr M. Nasr
- Faculty of Medicine, University of Khartoum, P.O Box 102, 11111 Khartoum, Sudan
| | - Ishag Adam
- Faculty of Medicine, University of Khartoum, P.O Box 102, 11111 Khartoum, Sudan
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Ahmadi R, Ziaei S, Parsay S. Association between Nutritional Status with Spontaneous Abortion. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:337-342. [PMID: 28042413 PMCID: PMC5134748 DOI: 10.22074/ijfs.2016.4577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/23/2016] [Indexed: 11/20/2022]
Abstract
Background Spontaneous abortion is the most common adverse pregnancy outcome.
We aimed to investigate a possible link between nutrient deficiencies and the risk of
spontaneous abortion. Materials and Methods This case-control study included the case group (n=331) experiencing a spontaneous abortion before 14 weeks of pregnancy and the control group
(n=331) who were healthy pregnant women over 14 weeks of pregnancy. The participants
filled out Food Frequency Questionnaire (FFQ), in which they reported their frequency
of consumption for a given serving of each food item during the past three months, on a
daily, weekly or monthly basis. The reported frequency for each food item was converted
to a daily intake. Then, consumption of nutrients was compared between the two groups. Results There are significant differences between the two groups regarding consumed
servings/day of vegetables, bread and cereal, meat, poultry, fish, eggs, beans, fats, oils
and dairy products (P=0.012, P<0.001, P=0.004, P<0.001, P=0.019, respectively). There
are significant differences between the two groups in all micronutrient including folic
acid, iron, vitamin C, vitamin B6, vitamin B12 and zinc (P<0.001). Conclusion Poor nutrientions may be correlated with increased risk of spontaneous abortion.
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Affiliation(s)
- Rahimeh Ahmadi
- Department of Midwifery and Reproductive Health, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Saeideh Ziaei
- Department of Midwifery and Reproductive Health, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Sosan Parsay
- Department of Midwifery and Reproductive Health, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
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Marangoni F, Cetin I, Verduci E, Canzone G, Giovannini M, Scollo P, Corsello G, Poli A. Maternal Diet and Nutrient Requirements in Pregnancy and Breastfeeding. An Italian Consensus Document. Nutrients 2016; 8:E629. [PMID: 27754423 PMCID: PMC5084016 DOI: 10.3390/nu8100629] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/19/2016] [Accepted: 10/08/2016] [Indexed: 12/11/2022] Open
Abstract
The importance of lifestyle and dietary habits during pregnancy and breastfeeding, for health of mothers and their offspring, is widely supported by the most recent scientific literature. The consumption of a varied and balanced diet from the preconceptional period is essential to ensure both maternal well-being and pregnancy outcomes. However, the risk of inadequate intakes of specific micronutrients in pregnancy and lactation is high even in the most industrialized countries. This particularly applies to docosahexaenoic acid (DHA), iron, iodine, calcium, folic acid, and vitamin D, also in the Italian population. Moreover, the risk of not reaching the adequate nutrient supply is increased for selected groups of women of childbearing age: those following exclusion diets, underweight or overweight/obese, smokers, adolescents, mothers who have had multiple or close pregnancies, and those with previous unfavorable pregnancy outcomes.
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Affiliation(s)
| | - Irene Cetin
- Department of Mother and Child Hospital Luigi Sacco, Center for Fetal Research Giorgio Pardi, Department of Biomedical and Clinical Sciences University of Milan-Italian Society of Perinatal Medicine (SIMP), Milano 20157, Italy.
| | - Elvira Verduci
- Department of Pediatrics, Department of Health Sciences, San Paolo Hospital, University of Milan-Italian Society of Pediatrics (SIP), Milano 20142, Italy.
| | - Giuseppe Canzone
- Obstetrics and Gynecology Unit, S. Cimino Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Termini Imerese, Palermo 90018, Italy.
| | - Marcello Giovannini
- Department of Pediatrics, San Paolo Hospital, Department of Health Science, University of Milan-Italian Society of Pediatric Nutrition (SINUPE), Milano 20142, Italy.
| | - Paolo Scollo
- Division of Gynecology and Obstetrics, Maternal and Child Department, Cannizzaro Hospital-Italian Society of Gynecology and Obstetrics (SIGO), Catania 95126, Italy.
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo-Italian Society of Pediatrics (SIP), Palermo 90127, Italy.
| | - Andrea Poli
- NFI-Nutrition Foundation of Italy, Milano 20124, Italy.
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Ho CL, Quay TAW, Devlin AM, Lamers Y. Prevalence and Predictors of Low Vitamin B6 Status in Healthy Young Adult Women in Metro Vancouver. Nutrients 2016; 8:nu8090538. [PMID: 27598193 PMCID: PMC5037525 DOI: 10.3390/nu8090538] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/31/2022] Open
Abstract
Low periconceptional vitamin B6 (B6) status has been associated with an increased risk of preterm birth and early pregnancy loss. Given many pregnancies are unplanned; it is important for women to maintain an adequate B6 status throughout reproductive years. There is limited data on B6 status in Canadian women. This study aimed to assess the prevalence of B6 deficiency and predictors of B6 status in young adult women in Metro Vancouver. We included a convenience sample of young adult non-pregnant women (19–35 years; n = 202). Vitamin B6 status was determined using fasting plasma concentrations of pyridoxal 5’-phosphate (PLP). Mean (95% confidence interval) plasma PLP concentration was 61.0 (55.2, 67.3) nmol/L. The prevalence of B6 deficiency (plasma PLP < 20 nmol/L) was 1.5% and that of suboptimal B6 status (plasma PLP = 20–30 nmol/L) was 10.9%. Body mass index, South Asian ethnicity, relative dietary B6 intake, and the use of supplemental B6 were significant predictors of plasma PLP. The combined 12.4% prevalence of B6 deficiency and suboptimal status was lower than data reported in US populations and might be due to the high socioeconomic status of our sample. More research is warranted to determine B6 status in the general Canadian population.
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Affiliation(s)
- Chia-Ling Ho
- Food Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.
- Research Institute, British Columbia Children's Hospital, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.
| | - Teo A W Quay
- Food Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.
- Research Institute, British Columbia Children's Hospital, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.
| | - Angela M Devlin
- Research Institute, British Columbia Children's Hospital, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.
- Department of Pediatrics, The University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada.
| | - Yvonne Lamers
- Food Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, 2205 East Mall, Vancouver, BC V6T 1Z4, Canada.
- Research Institute, British Columbia Children's Hospital, 950 West 28th Ave, Vancouver, BC V5Z 4H4, Canada.
- Fraser Health Authority, 10334 152A St, Surrey, BC V3R 7P8, Canada.
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7
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Hekmatdoost A, Vahid F, Yari Z, Sadeghi M, Eini-Zinab H, Lakpour N, Arefi S. Methyltetrahydrofolate vs Folic Acid Supplementation in Idiopathic Recurrent Miscarriage with Respect to Methylenetetrahydrofolate Reductase C677T and A1298C Polymorphisms: A Randomized Controlled Trial. PLoS One 2015; 10:e0143569. [PMID: 26630680 PMCID: PMC4668025 DOI: 10.1371/journal.pone.0143569] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/07/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine whether 5-methylenetetrahydrofolate (MTHF) is more effective than folic acid supplementation in treatment of recurrent abortion in different MTHFR gene C677T and A1298C polymorphisms. Methods A randomized, double blind, placebo-controlled trial conducted April 2011-September 2014 in recurrent abortion clinics in Tehran, Iran. The participants were women with three or more idiopathic recurrent abortion, aged 20 to 45 years. Two hundred and twenty eligible women who consented to participate were randomly assigned to receive either folic acid or 5-MTHF according to the stratified blocked randomization by age and the number of previous abortions. Participants took daily 1 mg 5-methylentetrahydrofolate or 1 mg folic acid from at least 8 weeks before conception to the 20th week of the pregnancy. The primary outcome was ongoing pregnancy rate at 20th week of pregnancy, and the secondary outcomes were serum folate and homocysteine at the baseline, after 8 weeks, and at the gestational age of 4, 8, 12, and 20 weeks, MTHFR gene C677T and A1298C polymorphisms. Results There was no significant difference in abortion rate between two groups. Serum folate increased significantly in both groups over time; these changes were significantly higher in the group receiving 5-MTHF than the group receiving folic acid (value = 2.39, p<00.1) and the result was the same by considering the time (value = 1.24, p<0.01). Plasma tHcys decreased significantly in both groups over time; however these changes were not significantly different between the groups (value = 0.01, p = 0.47). Conclusion The results do not support any beneficial effect of 5-MTHF vs. folate supplementation in women with recurrent abortion with any MTHFR C677T and/or A1298C polymorphism. Trial Registration ClinicalTrials.gov NCT01976676
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Affiliation(s)
- Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farhad Vahid
- National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Students' Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Yari
- National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Students' Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Sadeghi
- Department of Andrology and Embryology, Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Hassan Eini-Zinab
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niknam Lakpour
- Department of Andrology and Embryology, Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Soheila Arefi
- Department of Endocrinology, Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
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8
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Fayyaz F, Wang F, Jacobs RL, O’Connor DL, Bell RC, Field CJ. Folate, vitamin B12, and vitamin B6status of a group of high socioeconomic status women in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort. Appl Physiol Nutr Metab 2014; 39:1402-8. [DOI: 10.1139/apnm-2014-0181] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Folic acid supplementation and food fortification policies have improved folate status in North American women of child bearing age. Recent studies have reported the possible inadequacy of vitamin B12and B6in the etiology of neural tube defects in folate-fortified populations. The aims of this study were to describe folate status and its relationship to supplementation and to assess vitamin B12and B6status in a cohort of pregnant women. Supplement intake data were collected in each trimester from the first cohort (n = 599) of the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Red blood cell folate (RBCF) and plasma folate, holotranscobalamin, and pyridoxal 5-phosphate were measured. Overt folate deficiency was rare (3%) but 24% of women in their first trimester had suboptimal RBCF concentration (<906 nmol·L−1). The proportion of the cohort in this category declined substantially in second (9%) and third (7%) trimesters. High RBCF (>1360 nmol·L−1) was observed in approximately half of the women during each pregnancy trimester. Vitamin B12and B6deficiencies were rare (<1% of the cohort). Women consuming folic acid supplements above the upper level had significantly higher RBCF and plasma folate concentrations. In conclusion, the prevalence of vitamin B12and B6deficiency was very low. A quarter of the women had suboptimal folate status in the first trimester of pregnancy and over half the women had abnormally high RBCF, suggesting that supplementation during pregnancy is not appropriate in a cohort of women considered to be healthy and a low risk for nutritional deficiencies.
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Affiliation(s)
- Faiqa Fayyaz
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Flora Wang
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - René L. Jacobs
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Deborah L. O’Connor
- Department of Nutritional Sciences, University of Toronto and the Physiology and Experimental Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada
| | - Rhonda C. Bell
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Catherine J. Field
- Department of Agricultural, Food and Nutritional Sciences, 4-126A Li Ka Shing Health Research Innovation Centre, University of Alberta, Edmonton, AB T6G 2P5, Canada
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9
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Hoyo C, Daltveit AK, Iversen E, Benjamin-Neelon SE, Fuemmeler B, Schildkraut J, Murtha AP, Overcash F, Vidal AC, Wang F, Huang Z, Kurtzberg J, Seewaldt V, Forman M, Jirtle RL, Murphy SK. Erythrocyte folate concentrations, CpG methylation at genomically imprinted domains, and birth weight in a multiethnic newborn cohort. Epigenetics 2014; 9:1120-30. [PMID: 24874916 DOI: 10.4161/epi.29332] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Epigenetic mechanisms are proposed to link maternal concentrations of methyl group donor nutrients with the risk of low birth weight. However, empirical data are lacking. We have examined the association between maternal folate and birth weight and assessed the mediating role of DNA methylation at nine differentially methylated regions (DMRs) of genomically imprinted genes in these associations. Compared with newborns of women with folate levels in the lowest quartile, birth weight was higher in newborns of mothers in the second (β = 143.2, se = 63.2, P = 0.02), third (β = 117.3, se = 64.0, P = 0.07), and fourth (β = 133.9, se = 65.2, P = 0.04) quartiles, consistent with a threshold effect. This pattern of association did not vary by race/ethnicity but was more apparent in newborns of non-obese women. DNA methylation at the PLAGL1, SGCE, DLK1/MEG3 and IGF2/H19 DMRs was associated with maternal folate levels and also birth weight, suggestive of threshold effects. MEG3 DMR methylation mediated the association between maternal folate levels and birth weight (P =0.06). While the small sample size and partial scope of examined DMRs limit our conclusions, our data suggest that, with respect to birth weight, no additional benefits may be derived from increased maternal folate concentrations, especially in non-obese women. These data also support epigenetic plasticity as a key mechanistic response to folate availability during early fetal development.
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Affiliation(s)
- Cathrine Hoyo
- Department of Biological Sciences; North Carolina State University; Raleigh, NC USA; Department of Obstetrics and Gynecology; Division of Clinical Epidemiology; School of Medicine; Duke University; Durham, NC USA
| | - Anne Kjersti Daltveit
- Department of Global Public Health and Primary Care; University of Bergen; Bergen, Norway
| | - Edwin Iversen
- Department of Statistics; Duke University; Durham, NC USA
| | - Sara E Benjamin-Neelon
- Department of Community and Family Medicine; Duke University School of Medicine and Duke Global Health Institute; Durham, NC USA
| | - Bernard Fuemmeler
- Department of Community and Family Medicine; Duke University; Durham, NC USA
| | - Joellen Schildkraut
- Department of Community and Family Medicine; Duke Cancer Institute; Duke University; Durham, NC USA
| | - Amy P Murtha
- Department of Obstetrics and Gynecology; Division of Maternal-Fetal Medicine; School of Medicine; Duke University; Durham, NC USA
| | - Francine Overcash
- Department of Obstetrics and Gynecology; Division of Clinical Epidemiology; School of Medicine; Duke University; Durham, NC USA
| | - Adriana C Vidal
- Department of Obstetrics and Gynecology; Division of Clinical Epidemiology; School of Medicine; Duke University; Durham, NC USA
| | - Frances Wang
- Department of Community and Family Medicine; Duke Cancer Institute; Duke University; Durham, NC USA
| | - Zhiqing Huang
- Department of Obstetrics and Gynecology; Division of Gynecologic Oncology; School of Medicine; Duke University; Durham, NC USA
| | - Joanne Kurtzberg
- Duke University Department of Pediatrics; Duke Cancer Institute; School of Medicine; Duke University; Durham, NC USA
| | - Victoria Seewaldt
- Department of Medicine; Division of Oncology; School of Medicine; Duke University; Durham, NC USA
| | - Michele Forman
- Department of Nutritional Sciences; University of Texas; Austin, TX USA
| | - Randy L Jirtle
- Department of Oncology; McArdle Laboratory for Cancer Research; University of Wisconsin-Madison; Madison, WI USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology; Division of Gynecologic Oncology; School of Medicine; Duke University; Durham, NC USA
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10
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Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
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Sundrani DP, Chavan Gautam PM, Mehendale SS, Joshi SR. Altered metabolism of maternal micronutrients and omega 3 fatty acids epigenetically regulate matrix metalloproteinases in preterm pregnancy: A novel hypothesis. Med Hypotheses 2011; 77:878-83. [DOI: 10.1016/j.mehy.2011.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/23/2011] [Accepted: 08/02/2011] [Indexed: 02/06/2023]
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Wilson SMC, Bivins BN, Russell KA, Bailey LB. Oral contraceptive use: impact on folate, vitamin B6, and vitamin B12 status. Nutr Rev 2011; 69:572-83. [DOI: 10.1111/j.1753-4887.2011.00419.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yin Y, Zhang T, Dai Y, Zheng X, Pei L, Lu X. Pilot study of association of anembryonic pregnancy with 55 elements in the urine, and serum level of folate, homocysteine and S-adenosylhomocysteine in Shanxi Province, China. J Am Coll Nutr 2009; 28:50-5. [PMID: 19571160 DOI: 10.1080/07315724.2009.10719761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To estimate the association of anembryonic pregnancy with 55 elements, homocysteine, folate and S-adenosylhomocysteine in pregnant women. METHODS Thirty cases of anembryonic pregnancy were diagnosed using ultrasound scanning that showed an empty gestation sac with no embryo pole in the uterus. Additionally, thirty women with normal pregnancy were followed through the delivery a live and normal baby. The cases and controls were matched by age and week of gestation. Levels of 55 elements, homocysteine, folate and S-adenosylhomocysteine in women with anembryonic pregnancies were compared with those of the women experiencing normal pregnancies. RESULTS Women with anembryonic pregnancies had statistically significantly lower levels of folate and 10 elements including V, Ti, Li, Cd, Sr, Rb, P, Na, K, and B than did women experiencing normal pregnancies. However, they had higher homocysteine and Ge levels than did the controls. CONCLUSIONS The levels of multiple nutrients including folate, 11 elements and homocysteine may be associated with the risk of anembryonic pregnancy.
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Affiliation(s)
- Yan Yin
- Peking Union Medical College, Capital Institute of Pediatric, Peking University, Beijing, China
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15
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Hasan R, Olshan AF, Herring AH, Savitz DA, Siega-Riz AM, Hartmann KE. Self-reported vitamin supplementation in early pregnancy and risk of miscarriage. Am J Epidemiol 2009; 169:1312-8. [PMID: 19372214 DOI: 10.1093/aje/kwp050] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Miscarriage is a common and poorly understood adverse pregnancy outcome. In this study, the authors sought to evaluate the relation between self-reported use of prenatal vitamins in early pregnancy and the risk of miscarriage. Between 2000 and 2008, 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy. Approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage (odds ratio = 0.43, 95% confidence interval: 0.30, 0.60) in comparison with no exposure. These results should be viewed in the context of a potentially preventive biologic mechanism mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy.
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Affiliation(s)
- Reem Hasan
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA.
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Rodríguez-Guillén MDR, Torres-Sánchez L, Chen J, Galván-Portillo M, Blanco-Muñoz J, Anaya MA, Silva-Zolezzi I, Hernández-Valero MA, López-Carrillo L. Maternal MTHFR polymorphisms and risk of spontaneous abortion. SALUD PUBLICA DE MEXICO 2009; 51:19-25. [PMID: 19180309 DOI: 10.1590/s0036-36342009000100006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 08/13/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). MATERIAL AND METHODS We conducted a nested case-control study within a perinatal cohort of women recruited in the state of Morelos, Mexico. Twenty-three women with SA were compared to 74 women whose pregnancy survived beyond week 20th. Intake of folate and B vitamins respectively, was estimated using a validated food frequency questionnaire. Maternal MTHFR polymorphisms were determined by PCR-RFLP and serum homocysteine levels by HPLC. RESULTS Carriers of MTHFR 677TT and 1298AC genotypes respectively showed an increased risk of SA (OR 677TT vs. CC/CT=5.0; 95% CI: 1.2, 20.9 and OR 1298 AC vs. AA=5.5; 95% CI: 1.1, 26.6). CONCLUSIONS Our results support the role of MTHFR polymorphisms as a risk factor for SA, regardless of dietary intake of B vitamins.
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Di Santolo M, Banfi G, Stel G, Cauci S. Association of recreational physical activity with homocysteine, folate and lipid markers in young women. Eur J Appl Physiol 2008; 105:111-8. [PMID: 18853178 DOI: 10.1007/s00421-008-0880-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2008] [Indexed: 11/29/2022]
Abstract
We assessed the influence of recreational physical activity in young healthy women on homocysteine, a potential risk factor for cardiovascular disease (CVD). Participants were 124 23-year-old normal-weight Italian recreational athletes (performing 8.7 +/- 2.46 h week(-1) exercise) and 116 controls. Median blood homocysteine, folate and lipid markers did not differ between athletes and controls. Elevated homocysteine levels at CVD risk > or =12.0 and > or =15.0 micromol l(-1) were not different between groups. Continuous homocysteine was inversely related to folate (P < 0.001), positively associated with age (P = 0.009) and creatinine (P = 0.033), but not associated with hours of exercise, body mass index, and lipid markers. Women with folate depletion (<3.0 microg l(-1)) were 4.5-fold more likely to have homocysteine > or =15.0 micromol l(-1). Recreational physical exercise does not adversely impact homocysteine levels among young women. Only low folate significantly increases the risk for hyperhomocysteinemia in young women.
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Affiliation(s)
- Manuela Di Santolo
- Department of Biomedical Sciences and Technologies, School of Medicine, University of Udine, 33100, Udine, Italy
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Mehta S, Manji KP, Young AM, Brown ER, Chasela C, Taha TE, Read JS, Goldenberg RL, Fawzi WW. Nutritional indicators of adverse pregnancy outcomes and mother-to-child transmission of HIV among HIV-infected women. Am J Clin Nutr 2008; 87:1639-49. [PMID: 18541551 PMCID: PMC2474657 DOI: 10.1093/ajcn/87.6.1639] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Poor nutrition may be associated with mother-to-child transmission (MTCT) of HIV and other adverse pregnancy outcomes. OBJECTIVE The objective was to examine the relation of nutritional indicators with adverse pregnancy outcomes among HIV-infected women in Tanzania, Zambia, and Malawi. DESIGN Body mass index (BMI; in kg/m(2)) and hemoglobin concentrations at enrollment and weight change during pregnancy were prospectively related to fetal loss, neonatal death, low birth weight, preterm birth, and MTCT of HIV. RESULTS In a multivariate analysis, having a BMI < 21.8 was significantly associated with preterm birth [odds ratio (OR): 1.82; 95% CI: 1.34, 2.46] and low birth weight (OR: 2.09; 95% CI: 1.41, 3.08). A U-shaped relation between weight change during pregnancy and preterm birth was observed. Severe anemia was significantly associated with fetal loss or stillbirth (OR: 3.67; 95% CI: 1.16, 11.66), preterm birth (OR: 2.08; 95% CI: 1.39, 3.10), low birth weight (OR: 1.76; 95% CI: 1.07, 2.90), and MTCT of HIV by the time of birth (OR: 2.26; 95% CI: 1.18, 4.34) and by 4-6 wk among those negative at birth (OR: 2.33; 95% CI: 1.15, 4.73). CONCLUSIONS Anemia, poor weight gain during pregnancy, and low BMI in HIV-infected pregnant women are associated with increased risks of adverse infant outcomes and MTCT of HIV. Interventions that reduce the risk of wasting or anemia during pregnancy should be evaluated to determine their possible effect on the incidence of adverse pregnancy outcomes and MTCT of HIV.
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Affiliation(s)
- Saurabh Mehta
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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Abstract
Women with a history of reproductive loss may be at an increased risk of having an unfavourable outcome in subsequent pregnancies. Using data from a matched case-control study based on the record of the Epidemiological Surveillance System of Neural Tube Defects, we evaluated the association between history of maternal reproductive loss and the risk of anencephaly in three Mexican states. Mothers of 157 cases of anencephaly and 151 controls born during the period March 2000 to February 2001, were interviewed about their reproductive history and other additional factors, including socio-economic characteristics, prenatal care, use of tobacco and alcohol, presence of chronic diseases, acute illnesses and fever during the periconceptional period, and consumption of multivitamins and medicines during this period; mothers who reported no prior pregnancies were excluded from the analysis; 58 matched case-control pairs were used for the analysis. After adjusting for potential confounders, women with a history of miscarriage in previous pregnancies had 4.58 times more risk of having a child with anencephaly, than those who did not have this history; OR = 4.58, [95% CI 1.22, 17.23]. Our results suggest that a history of previous miscarriages is a risk indicator for anencephaly in future gestations. This does not necessarily mean that the miscarriage itself is the cause, but that common mechanisms could be involved in the aetiology of both events. Thus, women who have had histories of reproductive losses, especially miscarriages, should be a priority group for the primary and secondary prevention of neural tube defects.
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