Folate, Vitamin B12, Vitamin B6 and homocysteine: impact on pregnancy outcome

Authors

  • Denise Furness,

    Corresponding author
    1. Robinson Institute, Research Centre for Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
    Search for more papers by this author
  • Michael Fenech,

    1. Nutritional Genomics and Genome Health Laboratory, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Food and Nutritional Sciences, Adelaide, South Australia, Australia
    Search for more papers by this author
  • Gustaaf Dekker,

    1. Discipline of Obstetrics and Gynaecology, The University of Adelaide, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
    Search for more papers by this author
  • T Yee Khong,

    1. Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, North Adelaide, South Australia, Australia
    Search for more papers by this author
  • Claire Roberts,

    1. Robinson Institute, Research Centre for Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
    Search for more papers by this author
  • William Hague

    1. Robinson Institute, Research Centre for Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
    2. Discipline of Obstetrics and Gynaecology, The University of Adelaide, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
    Search for more papers by this author

Dr Denise Furness, Robinson Institute, Research Centre for Reproductive Health, University of Adelaide, Adelaide 5005, SA, Australia. E-mail: denise.furness@adelaide.edu.au

Abstract

Good clinical practice recommends folic acid supplementation 1 month prior to pregnancy and during the first trimester to prevent congenital malformations. However, high rates of fetal growth and development in later pregnancy may increase the demand for folate. Folate and vitamins B12 and B6 are required for DNA synthesis and cell growth, and are involved in homocysteine metabolism. The primary aim of this study was to determine if maternal folate, vitamin B12, vitamin B6 and homocysteine concentrations at 18–20 weeks gestation are associated with subsequent adverse pregnancy outcomes, including pre-eclampsia and intrauterine growth restriction (IUGR). The secondary aim was to investigate maternal B vitamin concentrations with DNA damage markers in maternal lymphocytes. A prospective observational study was conducted at the Women's and Children's Hospital, Adelaide, South Australia. One hundred and thirty-seven subjects were identified prior to 20 weeks gestation as at high or low risk for subsequent adverse pregnancy outcome by senior obstetricians. Clinical status, dietary information, circulating micronutrients and genome damage biomarkers were assessed at 18–20 weeks gestation. Women who developed IUGR had reduced red blood cell (RBC) folate (P < 0.001) and increased plasma homocysteine concentrations (P < 0.001) compared with controls. Maternal DNA damage, represented by micronucleus frequency and nucleoplasmic bridges in lymphocytes, was positively correlated with homocysteine (r = 0.179, P = 0.038 and r = 0.171, P = 0.047, respectively). Multivariate regression analysis revealed RBC folate was a strong predictor of IUGR (P = 0.006). This study suggests that low maternal RBC folate and high homocysteine values in mid pregnancy are associated with subsequent reduced fetal growth.

Ancillary