Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study

Vollset, Stein Emil; Refsum, Helga; Irgens, Lorentz M.; Emblem, Barbro Mork; Tverdal, Aage; Gjessing, Håkon K.; Monsen, Anne Lise Bjørke; Ueland, Per Magne

doi:10.1093/ajcn/71.4.962

Cited by 429 publications

(195 citation statements)

References 37 publications

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“…Homocysteine is metabolized with folate as a cosubstrate and vitamin B 12 as a cofactor, and low levels of these vitamins cause hyperhomocysteinemia [43]. Elevated homocysteine concentration is associated with common pregnancy complications and adverse pregnancy outcomes [44]. Dodds et al [45] have shown that increased homocysteine is associated with pregnancy loss, gestational hypertension, preeclampsia and small gestational age infants.…”

Section: Discussionmentioning

confidence: 99%

Reduced Folate, Increased Vitamin B<sub>12</sub> and Homocysteine Concentrations in Women Delivering Preterm

et al. 2012

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Background and Aim: Maternal nutrition is an important determinant of the duration of pregnancy and fetal growth, and thereby influences pregnancy outcome. Folic acid and vitamin B₁₂ are involved in one-carbon metabolism and are reported to underlie intrauterine programming of adult diseases. Methods: In the present study, the levels of folate, vitamin B₁₂ and homocysteine were measured in mothers delivering preterm (PT; gestation <37 weeks; n = 67), those delivering preterm due to preeclampsia (PT-PE; n = 49) and women delivering at term (control group; n = 76). Results: Increased vitamin B₁₂ and homocysteine levels (p < 0.05 for both) were seen in the PT-PE and PT groups as compared to the controls. In addition, reduced folate levels (p < 0.05) were observed in the PT group. A negative association of maternal plasma homocysteine with birth weight was seen in the idiopathic preterm group. Conclusions: Altered maternal micronutrients and resultant increased homocysteine concentrations exist in women delivering preterm. These alterations may also be partly associated with other factors such as undiagnosed inflammatory conditions or inadequate placentation in some women. Since these micronutrients play an important role in epigenetic regulation of vital genes involved in the fetal programming of adult diseases, further studies need to be undertaken to understand their role in preterm deliveries.

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Section: Discussionmentioning

confidence: 99%

Reduced Folate, Increased Vitamin B<sub>12</sub> and Homocysteine Concentrations in Women Delivering Preterm

et al. 2012

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“…The majority of the data on folate deficiencies are based on small, local surveys, but they suggest that folate deficiency may be a public health problem affecting millions of people globally [18]. Folate and vitamin B 12 deficiencies are associated with adverse pregnancy outcomes including LBW and preterm birth [20]. A substantial proportion of neural tube defects are related to inadequate consumption of folic acid around the time of conception and in some populations associated with genetic factors that increase the need for dietary folic acid.…”

Section: Maternal Micronutrient Deficiency: Burden Significance and mentioning

confidence: 99%

“…A study in India showed that women with higher autonomy (defined as a woman's personal power in the household and her ability to influence and change her environment) were significantly less likely to have a stunted child than their peers who had less autonomy [80]. An analysis of survey data from 17 developing countries confirms a positive association between maternal education and nutritional status in children 3-23 months of age [20]. Poverty and food security conditions in a geographical location have a significant impact on maternal and child undernutrition [81].…”

Section: Way Forwardmentioning

confidence: 99%

Multiple Micronutrient Supplementation during Pregnancy and Lactation in Low-to-Middle-Income Developing Country Settings: Impact on Pregnancy Outcomes

Salam¹,

Das²,

Bhutta³

2014

Ann Nutr Metab

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Background: Malnutrition, including micronutrient deficiencies, remains one of the major public health challenges, particularly in low-to-middle-income countries. Micronutrient deficiencies affect people of all ages, but its effects appear more devastating in pregnant women and children. Poor maternal nutrition contributes to at least 20% of maternal deaths and increases the probability of poor pregnancy outcomes including intrauterine growth restriction, resulting in low birth weight, stunting, wasting and mortality. Key Messages: Several strategies have been employed to provide pregnant women with micronutrients. These strategies include education, dietary modification, food provision, agricultural interventions, supplementation and fortification either alone or in combination. Micronutrient supplementation is the most widely practiced intervention to prevent and manage single or multiple micronutrient deficiencies. Micronutrient supplementation either alone or in combination has shown to be effective in improving maternal, birth and child outcomes. Conclusions: There is a need to focus on maternal micronutrient status as a continuum from the periconceptional period throughout pregnancy to lactation. Given the wide prevalence of multiple micronutrient deficiencies in low-to-middle-income countries, the challenge is to implement intervention strategies that combine appropriate maternal and child health interventions with micronutrient interventions.

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“…Folate status is the major determinant of plasma homocysteine level, and there is a strong inverse correlation between plasma homocysteine level and serum or erythrocyte folate levels [17]. Folate and B12 deficiencies have been found to be associated with adverse pregnancy outcomes including both LBW and preterm birth [18]. …”

Section: Undernutrition Epidemiologymentioning

confidence: 99%

Global Nutrition Epidemiology and Trends

Bhutta

Salam²

2012

Ann Nutr Metab

127

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In the year 2011, 6.9 million children under the age of 5 years died worldwide, one third of them related to increased susceptibility to illnesses due to undernutrition. An estimated 178 million children under 5 years are stunted, 55 million are wasted, and 19 million of these are severely affected and are at a higher risk of premature death, the vast majority being from sub-Saharan Africa and South-Central Asia. Globally, over 2 billion people are at risk for vitamin A, iodine, and/or iron deficiency. Other micronutrient deficiencies of public health concern include zinc, folate, and the B vitamins. The risk factors for undernutrition include low birth weight, inadequate breastfeeding, improper complementary feeding, and recurrent infections. Infectious diseases often coexist with micronutrient deficiencies and exhibit complex interactions leading to the vicious cycle of malnutrition and infections. Diarrhea along with the poor selection and intake of complementary food are the major contributors to undernutrition. Possible strategies to combat malnutrition include promotion of breastfeeding, dietary supplementation of micronutrients, prevention of protein-energy malnutrition, and improvement in the standard of preparation and hygiene of available weaning foods. The universal coverage with the full package of these proven interventions at observed levels of program effectiveness could prevent about one quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one third. The median coverage rate of interventions along the continuum of care for Countdown countries has however been ≥80% for vaccination and vitamin A supplementation. However, for several interventions, including early initiation and exclusive breastfeeding below 6 months of age and case management of childhood illnesses, the median coverage rate hovers at or below 50%. This suggests that interventions requiring strong health systems or behavior change appear to be stalled and need to be re-examined to find more effective ways of delivery.

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Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study

Abstract: Elevated tHcy concentration is associated with common pregnancy complications and adverse pregnancy outcomes.

Cited by 429 publications

References 37 publications

Reduced Folate, Increased Vitamin B<sub>12</sub> and Homocysteine Concentrations in Women Delivering Preterm

Reduced Folate, Increased Vitamin B<sub>12</sub> and Homocysteine Concentrations in Women Delivering Preterm

Multiple Micronutrient Supplementation during Pregnancy and Lactation in Low-to-Middle-Income Developing Country Settings: Impact on Pregnancy Outcomes

Global Nutrition Epidemiology and Trends

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