Pregnancy and polymorphisms in folate-cycle genes: what dose and formulation of folates to choose?
DOI:
https://doi.org/10.18370/2309-4117.2017.36.96-102Keywords:
pregnancy, miscarriage, polymorphisms in the folate-cycle genes, hyperhomocysteinemia, metafolin, folic acidAbstract
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.
References
- Galina, T.V., Dobretsova, T.A. Pregnant of XXI century: it’s harder than ever. Why is it necessary to take care of the optimal folate status of a pregnant woman? Newsletter. Ed. by V.E. Radzinsky. Moscow. Publishing house of the magazine StatusPraesens (2015): 20 p.
- Gromova, O.A., Torshin, I.Y. The use of folic acid in obstetric-gynecological practice: a methodical guide for physicians. Moscow: RCC of the UNESCO Institute for Microelements (2009): 60 p.
- Gromova, O.A., Torshin, I.Y., Limanova, O.A. “Omega-3 polyunsaturated fatty acids and active folates: perspectives of complex application for nutritional support of pregnancy and prophylaxis of developmental defects (literary review).” Gynecology 15.2 (2013): 71–7.
- Kurtser, M.A., Grodnitskaya, E.E., Shamanova, M.B., Lobova, A.V. “Folacin in complex pregravid preparation and therapy of habitual miscarriage in women with hyperhomocysteinemia.” Problems of Reproductions 2 (2010): 87–91.
- Malanina, E.N., Davidyan, L.Y., Kasymova, D.R. “Evaluation of complex therapy, including Femibion 2, in the prevention and correction of primary placental insufficiency.” Archive of Internal Medicine 1 (2011): 60–3.
- Norms of physiological needs in energy and nutrients for different groups of the population of the Russian Federation, MP 2.3.1.2432-08. Available from: [http://rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=4583], last accessed Jul 10, 2017.
- Ozolinya, L.A., Kashezheva, O.Z. “Pregravidary preparation of women with hyperhomocysteinemia.” Gynecology 15.2 (2013): 67–70.
- Radzinsky, V.E. Obstetric aggression. Moscow. Publishing house of the magazine StatusPraesens (2011): 688 p.
- Sandakova, E.A., Gosteva, E.O. “The effectiveness of folic acid preparations in pregnancy in women with congenital malformations of the fetus in the anamnesis.” Treatment and prevention 6.2 (2013): 20–5.
- Tapilskaya, N.I., Gaidukov, S.N. “Assessment of the importance of replenishment of folate deficiency and polyunsaturated fatty acids during pregnancy and lactation: data from evidence-based medicine.” Effective Pharmacotherapy 36.4 (2013): 12–22.
- Tseitsel, E. “Primary prevention of birth defects: multivitamins or folic acid?” Gynecology 14.5 (2012): 38–46.
- Bailey, L.B., Berry, R. “Folic acid supplementation and the occurrence of congenital heart defects, orofacial clefts, multiple births, and miscarriage.” Am J Clin Nutr 81.5 (2005): S1213–1217.
- Bodnar, L.M., Himes, K.P., Venkataramanan, R., et al. “Maternal serum folate species in early pregnancy and risk of preterm birth.” Am J Clin Nutr 92.4 (2010): 864–71.
- Bukowski, R., Malone, F.D., Porter, F.T., et al. “Preconceptional folate supplementation and the risk of spontaneous preterm birth: a cohort study.” PLoS Med 6.5 (2009): e1000061.
- Greenberg, J.A., Bell, S.J., Guan, Y., Yu, Y. “Folic acid supplementation and pregnancy: more than just neural tube defect prevention.” Rev Obstet Gynecol 4.2 (2011): 52–9.
- Hogeveen, M., Blom, H.J., den Heijer, M. “Maternal homocysteine and small-for-gestational-age offspring: systematic review and metaanalysis.” Am J Clin Nutr 95.1 (2012): 130–6.
- Kim, M.W., Hong, S.C., Choi, J.S., et al. “Homocysteine, folate and pregnancy outcomes.” J Obstet Gynaecol 32.6 (2012): 520–4.
- Lamers, Y., Prinz-Langenohl, R., Brämswig, S., Pietrzik, K. “Red blood cell folate concentrations increase more after supplementation with [6S]-5- methyltetrahydrofolate than with folic acid in women of childbearing age.” Am J Clin Nutr 84.1 (2006): 156–61.
- Lumley, J., Watson, L., Watson, M., Bower, C. “WITHDRAWN: Periconceptional supplementation with folate and/or multivitamins for preventing neural tube defects.” Cochrane Database Syst Rev 4 (2011): CD001056.
- Pietrzik, K., Bailey, L., Shane, B. “Folic acid and L-5-methyltetrahydrofolate: comparison of clinical pharmacokinetics and Pharmacodynamics.” Clin Pharmacokinet 49.8 (2010): 535–48.
- 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.
- 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.
- 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.
- 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.
- 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.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Н. А. Курмачёва, Е. В. Верижникова, О. М. Харитонова
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.