Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

Abstract

Objective: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women. Design: Cross-sectional study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n ¼ 382) of all pregnant women (n ¼ 2856) coming for their first antenatal visit in a 12 month period, 1994 -1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n ¼ 54) were excluded. The remaining women (n ¼ 328) were included in the statistical analysis. Results: Overall mean values ( AE s.d.) of s-tHcy and s-MMA were 9.5 ( AE 4.2) mmol=l and 0.39 ( AE 0.32) mmol=l, respectively. Elevated s-tHcy (>7.5 mmol=l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 mmol=l). Low s-cobalamin values (<150 pmol=l) were observed in 49% of the women, while only 7% had low s-folate values ( 4.5 nmol=l). s-tHcy was significantly correlated with s-MMA (r ¼ 0.28, P<0.001), s-cobalamin (r ¼ 70.30, P<0.001) and s-folate (r ¼ 70.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r ¼ 70.40, P<0.001), but not with s-folate. Conclusions: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women. Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

Maternal serum vitamin B12, folate and homocysteine and the risk of neural tube defects in the offspring in a high-risk area of China

“…Because a variety of dietary foods are rich in vitamin B 12 and folate, such as fresh fruits and vegetables, which are rich sources of folate (24) , and a nutritional characteristic of ruminant meat, which has high content of vitamin B 12 (25) , (25,26) . Differences of dietary pattern on varieties of area were exemplified, which showed that both folate and vitamin B 12 deficiency were equally prominent in pregnancy (27)(28)(29) . The present study was in accordance with the quite early work by Grainger et al that related vitamin B 12 -deficient diet in pregnant animals to hydrocephalus and other birth defects (30) .…”

Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal

“…Additionally, vitamin B 12 deficiency is quite common and is mainly explained by a diet low in animal products (37) . Two previous studies of pregnant women in Nepal documented that vitamin B 12 deficiency (serum level < 150 pmol/l) was common; 49 % in Kathmandu (38) and 28 % in the Sarlahi District (9) . In our study, the main sources of vitamin B 12 were meat, dairy products and eggs, which were consumed in small amounts by 62 %, 68 % and 25 % of the women, respectively.…”

“…Two prior studies of pregnant Nepali women each found a low prevalence of folate deficiency: 7 % < 4·5 nmol/l (38) and 11 % < 6·7 nmol/l (9) . A study on folate status in Nepali infants found that folate deficiency was nonexistent (39) .…”

Plasma zinc, vitamin B12 and α-tocopherol are positively and plasma γ-tocopherol is negatively associated with Hb concentration in early pregnancy in north-west Bangladesh

“…Anaemia was defined by Hb concentration as: mild, ,110 g/l or ,105 g/l for gestational age ,12 weeks or $12 weeks, respectively (20) ; moderate, ,90 to 70 g/l; and severe, ,70 g/l. Micronutrient deficiency was defined with the following cut-offs: Fe deficiency, ferritin ,12 mg/l or TfR .8?5 mg/l; retinol, ,0?70 mmol/l (18) ; a-tocopherol, ,9?3 mmol/l (21) ; vitamin B 12 , ,150 pmol/l (22) ; folate, ,6?7 nmol/l (23) ; and Zn, ,8?6 mmol/l (24) . An additional less conservative cut-off of ,12 mmol/l was also used to define a-tocopherol deficiency (25) .…”