Pregnancy and polymorphisms in folate-cycle genes: what dose and formulation of folates to choose?

Н. А. Курмачёва, Е. В. Верижникова, О. М. Харитонова

Abstract


Study objectives: To compare the course of pregnancy and perinatal outcomes of term delivery in women with polymorphisms in the folatecycle genes and a history of miscarriage, depending on what strategy was chosen to correct folate deficiency.

Study design: This was a retrospective, comparative study.

Materials and methods: We analyzed medical records of 114 patients (Medical Forms No. 025/у, 111/у and 113/у) with polymorphisms in the folate-cycle genes and a history of miscarriage. In Group I, 54 women received conventional treatment with folic acid (5.8 mg/day) before conception and until week 28 of pregnancy as a combination of a single supplement or a vitamin B complex with vitamin-mineral combination supplements. In Group II, 60 patients received a vitamin-mineralcombination supplement, containing 208 mg of metafolin and 200 mg of folic acid, and other B vitamins (В1, В2, В5, В6 and В12) before conception and throughout pregnancy. Also, we compared the levels of homocysteine, blood-coagulation parameters, the course of pregnancy and delivery, and the health state of newborns.

Study results: Compared to patients in Group I, patients in Group II had significantly lower levels of homocysteine, fibrinogen and the markers of abnormally increased blood levels of thrombin. In the second group, the rates of some obstetrical and perinatal complications were also lower (1.5–3.9-fold, p < 0.05) than in the first group.

Conclusion: In women with polymorphisms in the folate-cycle genes and a history of miscarriage, the use of vitamin-mineral-combination supplements, containing an active form of folates (metafolin), improves the course of pregnancy and perinatal outcomes of term delivery.


Keywords


pregnancy; miscarriage; polymorphisms in the folate-cycle genes; hyperhomocysteinemia; metafolin; folic acid

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GOST Style Citations


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21. Prinz-Langenohl, R., Brämswig, S., Tobolski, O., et al. “(6S)-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wildtype 677C>T polymorphism of methylenetetrahydrofolate reductase.” Br J Pharmacol 158.8 (2009): 2014–21.

22. Puri, M., Kaur, L., Walia, G.K., et al. “MTHFR C677T polymorphism, folate, vitamin B12 and homocysteine in recurrent pregnancy losses: a case control study among North Indian women.” J Perinat Med 41.5 (2013): 549–54.

23. Timmermans, S., Jaddoe, V.W., Hofman, A., et al. “Periconception folic acid supplementation, fetal growth and the risks of low birth weight and preterm birth: the Generation R Study.” Br J Nutr 102.5 (2009): 777–85.

24. Vollset, S.E., Refsum, H., Irgens, L.M., et al. “Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine study.” Am J Clin Nutr 71.4 (2000): 962–8.

25. Wilson, R.D., Audibert, F., Brock, J.A., et al. “Pre-conception folic acid and multivitamin supplementation for the primary and secondary prevention of neural tube defect and other folic acidsensitive congenital anomalies.” J Obstet Gynaecol Can 37.6 (2015): 534–52.





DOI: https://doi.org/10.18370/2309-4117.2017.36.96-102

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