Trends of folate, vitamin B₁₂, and homocysteine levels in different trimesters of pregnancy and pregnancy outcomes

Abstract

Objective: To evaluate the effect of folate and vitamin B 12 levels on pregnancy progression and outcomes. Methods: The present study is a prospective follow up study of 100 pregnant women. Biochemical investigations (plasma homocysteine, folate, and vitamin B 12 levels) were performed on all pregnant women in first, second, and third trimesters. Nonparametric tests were used to compare the differences in median levels and odds ratio analysis for the assessment of the risk between the selected biomarkers and adverse pregnancy progression and outcomes. Results: The pregnant women at their first antenatal care visit were found to be predominantly folate replete (97%) and vitamin B 12 deficient (60%). Hyperhomocysteinemia in first and second trimesters was found to pose more than 3-fold increased risk for adverse pregnancy outcomes (P = .006 and .0002, respectively). Low birth weight (LBW) was found to be the most common adverse pregnancy outcome (52%), and was significantly associated with vitamin B 12 deficiency in the first and second trimesters (82%, P < .0001; 71.4%, P = .04, respectively). Conclusion: The vitamin B 12 deficiency is more common among Indian pregnant women as compared to folate deficiency. Hyperhomocysteinemia is an independent risk factor for pregnancy complications. Vitamin B 12 deficiency in first and second trimesters is associated with LBW babies.

Maternal Vitamin B12 Status During Pregnancy and Its Association With Outcomes of Pregnancy and Health of the Offspring: A Systematic Review and Implications for Policy in India

“…Wadhwani et al (24) examined 106 pregnant women prospectively (serially in every trimester till delivery) and reported that lower birth weight was associated with lower maternal folate and B12 (r=0.2, p<0.05) in the third trimester and higher maternal homocysteine (r=-0.2, p<0.05) in the first trimester (24). Mishra et al (42) in a prospective follow up of 100 pregnancies in a tertiary care centre in North India (Delhi) observed vitamin B12 deficiency in the first trimester to be associated with low birth weight outcomes (OR = 8.1) (42).…”

Association of MTHFR 677C>T polymorphism with pregnancy outcomes in IVF/ICSI-ET recipients with adequate synthetic folic acid supplementation

“…Folate deficiency and its resulting HCY accumulation can impair female fertility; possible mechanisms for this include reduced cell division, increased apoptosis, overproduction of inflammatory cytokines, impaired nitric oxide (NO) metabolism, oxidative stress, and defective methylation reaction (34). Moreover, maternal demand for folate increases during pregnancy, and a maternal folate deficiency often leads to APOs (35). Previous in vivo experiments have found that in the absence of maternal folate, placental mTOR signaling and amino acid transporter activity are inhibited (36) as well as the uterine decidualization (37) and decidual angiogenesis in pregnant mice (38), subsequently causing placental dysplasia and dysfunction and ultimately resulting in fetal growth restriction.…”

Dietary Vitamin B Complex: Orchestration in Human Nutrition throughout Life with Sex Differences

“…It was evident that hyperhomocysteinemia could increase the risk of pregnancy complications ca. 18-fold in the second trimester [ 90 ].…”

“…Low cobalamin levels and increased risk of low birth weight (LBW) are differentially related to the trimester during which the mother encountered vitamin B12 deficiency, i.e., the first-trimester lack can increase the risk of LBW up to 8 times [ 90 ]. The deficiency of vitamin B12 has also been related to other pregnancy complications such as recurrent miscarriages, preterm delivery, and intrauterine growth restriction [ 85 ].…”