BackgroundMaternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population.Materials and methodsDesign: A case-control study.Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012.Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls.Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy.Main Outcomes Measures: Odds ratio for pre-eclampsia.ResultsAfter adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy.ConclusionsMaternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.

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<span>Cada una de las decisiones alrededor de pacientes obstétricas críticas requiere un equipo multidisciplinario de especialistas en cuidado crítico de adultos y en medicina materno-fetal para el difícil entendimiento y manejo de la historia natural de las enfermedades y sus complicaciones durante la gestación, el parto y el puerperio. No existen guías detalladas en Colombia que describan los planes de acción frente a una paciente embarazada en condiciones críticas; de ahí la importancia de un consenso que permita establecer el nivel de cuidado crítico requerido por este grupo poblacional especial, estandarizar las condiciones de atención de las gestantes críticas y generar planteamientos académicos y éticos frente a esta estrategia de alto impacto para la reducción de la mortalidad materna.</span>

Este artículo presenta los patrones que determinaron el ingreso de las gestantes críticamente enfermas a la Unidad de Cuidados Intensivos (UCI) o de Alta Dependencia Obstétrica (UAD), y las causas de complicaciones y muerte más frecuentes, al igual que los factores que afectan el pronóstico perinatal. Se plantea la implementación de las Unidades de Alta Dependencia Obstétrica para el manejo de las gestantes críticamente enfermas, y el entrenamiento del personal involucrado en el manejo obstétrico de estas pacientes.

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