Preconception homocysteine and B vitamin status and birth outcomes in Chinese women. Dietary and serum folate: their influence on the outcome of pregnancy. Maternal homocysteine before conception and throughout pregnancy predicts fetal homocysteine and birth weight. Second-trimester plasma homocysteine levels and pregnancy-induced hypertension, preeclampsia, and intrauterine growth restriction. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction. Effect of homocysteine concentration in early pregnancy on gestational hypertensive disorders and other pregnancy outcomes. Dietary folate intake during pregnancy and birth weight in Japan Maternal thrombophilia and the risk of recurrence of preeclampsia. Combining 2nd-Trimester Maternal Serum Homocysteine Levels and Uterine Artery Doppler for Prediction of Preeclampsia and Isolated Intrauterine Growth Restriction Plasma homocysteine in late pregnancies complicated with preeclampsia and in newborns. Diet and deprivation in pregnancy. Maternal homocysteine and related B vitamins as risk factors for low birthweight. Reduction of Incidence of Prematurity by Folic Acid Supplementation in Pregnancy
BACKGROUND The associations between homocysteine , B vitamin status , and pregnancy outcomes have not been examined prospect ively . OBJECTIVE We assessed the associations of preconception homocysteine and B vitamin status with  preterm birth and birth of low-birth-weight ( LBW ) and small-for-gestational-age ( SGA ) infants in Chinese women . DESIGN This was a case-control study of women aged 21 - 34 y. Preterm cases ( n = 29 ) delivered living infants at < 37 wk gestation ; term controls ( n = 405 ) delivered infants at > or = 37 wk . LBW cases ( n = 33 ) had infants weighing < 2500 g ; normal-birth-weight controls ( n = 390 ) had infants weighing > or = 2500 g. SGA cases ( n = 65 ) had infants below the 10th percentile of weight-for-gestational-age ; appropriate-for-gestational-age controls ( n = 358 ) had infants above this cutoff .  Nonfasting plasma concentrations of homocysteine , folate , and vitamins B-6 and B-12 were measured before conception . RESULTS Elevated homocysteine ( > or = 12.4 micro mol/L ) was associated with a nearly 4-fold higher risk of preterm birth ( OR : 3.6 ; 95 % CI : 1.3 , 10.0 ; P < 0.05 ) . The risk of preterm birth was 60 % lower among women with vitamin B-12 > or = 258 pmol/L than among vitamin B-12-deficient women ( OR : 0.4 ; 95 % CI : 0.2 , 0.9 ; P < 0.05 ) and was 50 % lower among women with vitamin B-6 > or = 30 nmol/L than among vitamin B-6-deficient women ( OR : 0.5 ; 95 % CI : 0.2 , 1.2 ; NS ) . Folate status was not associated with preterm birth , and homocysteine and B vitamin status were not associated with LBW or SGA status . CONCLUSIONS Elevated homocysteine and suboptimal vitamin B-12 and B-6 status may increase the risk of preterm birth . These results need to be confirmed in larger prospect i ve studies We examined the influence of folate intake from diet and supplements b y 28 wk of gestation and third trimester circulating concentrations of serum folate on the outcome of pregnancy in women from Camden , NJ . Mean daily folate intake by week 28 included both dietary and supplemental folate obtained prospect ively in 832 women . Circulating concentrations of serum folate as well as serum vitamin B-12 were assayed at 28 wk of gestation ( + /- 2 wk ) by radioimmunoassay . The outcomes of interest included preterm delivery ( < 37 wk ) and  infants with low birth weight ( < 2500 g ) . Mean folate intake was significantly correlated with circulating concentrations of serum folate ( r=0.17 , P<0.001 ) . Women with a low mean daily folate intake ( < /-240 microgram/d ) had an approximately twofold greater risk of preterm delivery and infant low birth weight after maternal characteristics , energy intake , and other correlated nutrients were controlled for . Lower concentrations of serum folate at week 28 were also associated with a greater risk of preterm delivery and low birth weight BACKGROUND Increased homocysteine has been associated with pregnancy complications . METHODS We investigated prospect ively the effect of maternal homocysteine on  normal pregnancy outcome .  The study included 93 women and their offspring ; 39 of the women took folic acid during the second and /or third trimesters of pregnancy . We measured homocysteine at preconception ; at weeks 8 , 20 , and 32 of pregnancy ; during labor ; and in the fetal cord ; we also recorded birth weight . RESULTS Geometric mean ( SE ) maternal total homocysteine ( tHcy ) increased between 32 weeks of pregnancy and labor [ 7.98 ( 1.05 ) micromol/L in unsupplemented women and 6.26 ( 1.07 ) micromol/L in supplemented women ; P < 0.0001 for both ] . Fetal tHcy was lower than maternal tHcy [ 6.39 ( 1.06 ) micromol/L in unsupplemented pregnancies ( P < 0.0001 ) , and 5.18 ( 1.06 ) micromol/L in supplemented pregnancies ( P < 0.05 ) ] . Maternal tHcy was correlated from preconception throughout pregnancy ( 8 weeks , r = 0.708 ; 20 weeks , r = 0.637 ; 32 weeks , r = 0.537 ; labor , r = 0.502 ; P < 0.0001 for all time points ) and with fetal tHcy [ preconception , r = 0.255 ( P < 0.05 ) ; 8 weeks , r = 0.321 ( P < 0.01 ) ; 20 weeks , r = 0.469 ; 32 weeks , r = 0.550 ; labor , r = 0.624 ( P < 0.0001 ) ] . Mothers in the highest tHcy tertile at 8 weeks of pregnancy were three times [ odds ratio , 3.26 ( 95 % confidence interval , 1.05 - 10.13 ) ; P < 0.05 ] and at labor were four times [ 3.65 ( 1.15 - 11.56 ) ; P < 0.05 ] more likely to give birth to a neonate in the lowest birth weight tertile . Neonates of mothers in the highest tHcy tertile at labor weighed , on average , 227.98 g less than those of mothers in the low and medium tertiles ( P = 0.014 ) . CONCLUSIONS Supplemented mothers had lower tHcy at labor than unsupplemented mothers , as did their neonates . Maternal and fetal tHcy was significantly correlated throughout the study . Neonates of mothers in the highest tertile of homocysteine weighed less OBJECTIVE The purpose of this study was to determine whether second-trimester plasma homocysteine levels are elevated among women whose pregnancies are subsequently complicated by pregnancy-induced hypertension , preeclampsia , or intrauterine growth restriction . STUDY DESIGN Women with normal but relatively low plasma zinc levels were r and omly assigned to receive zinc supplementation or placebo from 19 weeks ' gestation until delivery . Plasma homocysteine concentration and plasma and erythrocyte folate levels were determined for all available stored sample s ( zinc group , 231/294 ; placebo group , 206/286 ) at 26 and 37 weeks ' gestation . Among all women with available sample s , pregnancy-induced hypertension ( n = 12 ) or preeclampsia ( n = 4 ) developed in 16 women , and 22 pregnancies were complicated by intrauterine growth restriction . RESULTS Mean homocysteine levels in women with pregnancy-induced hypertension and preeclampsia  were similar to those of control subjects at 26 weeks ' gestation but were significantly higher at 37 weeks ' gestation . Homocysteine levels were similar between women with pregnancies complicated by intrauterine growth restriction and control subjects at both time points . CONCLUSION Second-trimester plasma homocysteine concentrations do not predict the subsequent development of pregnancy-induced hypertension , preeclampsia , and intrauterine growth restriction OBJECTIVE Our purpose was to assess the incidence of hyperhomocysteinemia in patients with a history of preeclampsia or fetal growth restriction , to evaluate the effects of vitamin supplementation on the methionine loading test , and to study the course of subsequent pregnancies in women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction . STUDY DESIGN A total of 207 consecutive patients with a history of preeclampsia or fetal growth restriction was tested for hyperhomocysteinemia . Thirty-seven were found to be positive and were treated with folic acid and vitamin B6 , and 27 had a second methionine loading test after vitamin supplementation . Fourteen patients became pregnant again while receiving vitamins and aspirin . RESULTS All patients who underwent a methionine loading test after vitamin supplementation had a completely normalized methionine loading test . Of the 14 pregnancies in women receiving vitamins and aspirin , 7 were complicated by preeclampsia . Birth weights were 2867 + /- 648 g compared with 1088 + /- 570 g in the previous pregnancies . CONCLUSIONS Vitamin B6 and folic acid correct the methionine loading test in patients with hyperhomocysteinemia . Perinatal outcome in patients with a history of preeclampsia or fetal growth restriction and hyperhomocysteinemia appears to be favorable BACKGROUND Increased total homocysteine ( tHcy ) may be associated with placental-mediated adverse pregnancy outcomes , but few prospect i ve studies have measured tHcy before pregnancy outcome . This study was undertaken to determine whether increased tHcy measured in early pregnancy is associated with  pregnancy loss , gestational hypertension ( GH ) , preeclampsia  , or small for gestational age ( SGA ) infants . METHODS We conducted a prospect i ve cohort study between 2002 and 2005 . We measured  tHcy and serum folate  in  blood sample s from pregnant women ( < 20 weeks ' gestation ) and collected detailed pregnancy information through a question naire and medical record review . RESULTS Of the 2119 women included in the study , 103 had a pregnancy loss , 115 had gestational hypertension , 65 had preeclampsia , and 129 had an SGA infant . Subjects with increased tHcy concentrations were at increased risk of pregnancy loss [ relative risk ( RR ) 2.1 , 95 % CI 1.2 - 3.6 ] or preeclampsia ( RR 2.7 , 95 % CI 1.4 - 5.0 ) than subjects with lower tHcy concentrations , but increased tHcy concentration was not associated with increased risk of developing GH or having an SGA infant . CONCLUSION The finding of high tHcy in early pregnancy as a risk factor for pregnancy loss and preeclampsia is consistent with a hypothesis that increased tHcy results in abnormalities of the placental vasculature Background Inadequate folate status has been associated with many negative reproductive outcomes , such as neural tube defects ( NTD ) , low birth weight and placental abruption . Aim of the study The objectives of this study were to evaluate the levels of dietary folate intake  during pregnancy in Japanese women and the subsequent birth weight of their babies . Methods A longitudinal prospect i ve study was conducted with 197 women with a singleton pregnancy in 2005 .  Dietary folate was investigated 3 times : in the first trimester at 12 weeks , in the second trimester at 20 weeks and in third trimester at 32 weeks using a diet history question naire ( DHQ ) . Non fasting blood sample s were collected from the women for measurement of homocysteine , hemoglobin , ferritin , unbound iron-binding capacity ( UIBC ) and total iron-binding capacity ( TIBC ) . Results Energy intake increased as pregnancy advanced , but not significantly . The daily intake of folate  increased from 248.5 ± 113.1 µg/d in the first trimester to 275.4 ± 100.2 µg/d in the third trimester ( P = 0.04 ) . This was well below the recommended level of 440 µg/d and only 10 % of mothers were above the levels . In the third trimester , plasma homocysteine concentration was significantly higher in the low folate group of less than 250 µg/d ( P = 0.02 ) , but not the first and second trimesters . Dietary folate intake and plasma homocysteine concentrations were not likely to be predictors of birth weight in our subjects . Conclusions Our study shows that Japanese women ’s energy and folate intakes do not meet their energy needs during pregnancy and are at an extremely low recommended dietary allowance level throughout pregnancy OBJECTIVE The aim of this prospect i ve study was to determine the impact of thrombophilia on the recurrence of preeclampsia . STUDY DESIGN In a multicenter , observational , cohort design , 172 white patients with a previous pregnancy complicated by preeclampsia were observed in the next pregnancy . They were evaluated for heritable thrombophilia ( factor V Leiden and factor II G20210A mutations , protein S , protein C , and antithrombin deficiency ) , hyperhomocystinemia , lupus anticoagulant , and anticardiolipin antibodies . Development of preeclampsia and maternal complications and both gestational age at delivery and birthweight were recorded . RESULTS Sixty women ( 34.9 % ) showed the presence of a thrombophilic defect . They had a higher risk for the recurrence of preeclampsia ( odds ratio [ OR ] , 2.5 ; 95 % confidence interval [ CI ] , 1.2 - 5.1 ) , compared to patients without thrombophilia . Similar findings were observed considering only heritable thrombophilia . Thrombophilic patients were at increased risk for the occurrence of very early preterm delivery ( < 32 weeks ; OR , 11.6 ; 95 % CI , 3.4 - 43.2 ) . CONCLUSION When counseling white women with a history of preeclampsia , screening for thrombophilia can be useful for preconceptional counseling and pregnancy management Aim : To evaluate the efficacy of a combined 2nd-trimester maternal serum homocysteine and uterine artery Doppler screening  at 20 weeks of gestation for complications of pregnancy : preeclampsia , isolated intrauterine growth restriction ( IUGR ) , placental abruption , and stillbirths .  Methods : Consecutive singleton pregnancies without previous risk factors who had homocysteine measured as part of a serum-screening program for trisomy 21 had uterine artery Doppler performed .  Sensitivity , specificity , positive and negative predictive values , odds ratio , and positive and negative likelihood ratios for the subsequent development of preeclampsia , isolated IUGR , placental abruption , stillbirth , and preterm delivery were calculated for the following methods ( 1 ) homocysteine cutoff level 6.3 µmol/l ( 95th centile ) ; ( 2 ) on Doppler ultrasound bilateral notches with a mean resistance index ( RI ) > 0.55 ( 50th centile ) , all unilateral notches with a mean RI > 0.65 ( 80th centile ) , and absence of notches with a mean RI > 0.7 ( 95th centile ) , and ( 3 ) Doppler ultrasound notch evaluation ( bilateral , unilateral , absence as in method 2 ) combined with the homocysteine cutof level of 6.3 µmol/l . Results : By using a logistic regression model , methods 1 and 2 predicted preeclampsia ( p < 0.001 ) , isolated IUGR ( p < 0.01 ) , and ‘ any complication ’ ( p < 0.01 ) . The sensitivity for prediction of preeclampsia using the combined method ( 3 ) was 61.3 % for a false-positive rate of 2 % , better than that for isolated IUGR ( 54 % ) below the 5th centile and ‘ any complication’(56 % ) . Conclusion : This prospect i ve study confirms the potential of a combined method of elevated homocysteine and uterine artery Doppler screening for preeclampsia , isolated IUGR , and any obstetric complication The aim of this study was to determine the relationship between maternal serum homocysteine levels in preeclampsia and the severity of the disease , neonatal serum homocysteine levels , maternal complications , and fetal outcome . Fifty pregnant women were included in this prospect i ve study , of which 25 were severe ( group I ) and 25 were non-severe preeclamptic ( group II ) .  Maternal and neonatal serum homocysteine levels were measured by the fluorescence polarization immunoassay ( FPIA ) method .  Maternal homocysteine levels in both groups were compared . The association of maternal and neonatal serum homocysteine levels with maternal complications and fetal outcome was investigated . When the maternal serum homocysteine cut-off value was accepted as 15 micromol/L , significant differences in relation to maternal ( eclampsia ; hemolysis , elevated liver enzymes , and low platelet count syndrome ) and fetal ( in utero mort fetalis , low birthweight ) complications were observed between the group with maternal serum homocysteine level > 15 micromol/L and the group with maternal serum homocysteine level < or = 15 micromol/L ( p < 0.05 ) . Hyperhomocysteinemia during pregnancy is a risk factor for both development of preeclampsia and its complications . Given that the diagnosis and treatment of hyperhomocysteinemia is possible , clinical trials to determine whether treatment to reduce homocysteine would be valuable in the prevention of both maternal and fetal complications in preeclampsia should be design ed Deprivation is associated with poor pregnancy outcome but the role of nutrition as a mediating factor is not well understood . We carried out a prospect i ve cohort study of 1461 singleton pregnancies in Aberdeen , UK during 2000 - 6 . We measured  nutrient intake and supplement use , B vitamin and homocysteine status , birth weight , gestational age , neonatal treatment and socio-economic deprivation status .  Women in the most deprived deciles were approximately 6 years younger and half as likely to take folic acid supplements periconceptually as the least deprived mothers . Deprivation was associated with low blood folate , high homocysteine and diets low in protein , fibre and many of the vitamins and minerals . The diets of the more deprived women were also characterised by low intakes of fruit , vegetables and oily fish and higher intakes of processed meat , fried potatoes , crisps and snacks . Deprivation was related to preterm birth ( OR 1.14 ( 95 % CI 1.03 , 1.25 ) ; P = 0.009 ) and whether the baby required neonatal treatment ( OR 1.07 ( 95 % CI 1.01 , 1.14 ) ; P = 0.028 ) . Low birth weight was more common in women consuming diets low in vitamin C ( OR 0.79 ( 95 % CI 0.64 , 0.97 ) ; P = 0.028 ) , riboflavin ( OR 0.77 ( 95 % CI 0.63 , 0.93 ) ; P = 0.008 ) , pantothenic acid ( OR 0.79 ( 95 % CI 0.65 , 0.97 ) ; P = 0.023 ) and sugars ( OR 0.78 ( 95 % CI 0.64 , 0.96 ) ; P = 0.017 ) even after adjustment for deprivation index , smoking , marital status and parity . Deprivation in pregnancy is associated with diets poor in specific nutrients and poor diet appears to contribute to inequalities in pregnancy outcome . Improving the nutrient intake of disadvantaged women of childbearing age may potentially improve pregnancy outcome OBJECTIVE We design ed a large prospect i ve study to explore the relationship between maternal homocysteine concentrations and related B vitamins and birthweight . STUDY DESIGN Blood was sample d from pregnant women at 30 - 34 weeks of gestation and their newborn infants ( n = 366 ) . RESULTS Concentrations of all analytes were higher in umbilical cord compared with maternal sample s. Birthweight was related negatively to maternal homocysteine ( r = -0.12 ) but not related to maternal cobalamin , methylmalonic acid , and folate ( r = 0.02 , r = 0.06 , and r = 0.04 , respectively ) . Regression analysis revealed smoking ( beta = -313 ; 95 % confidence interval [ CI ] , -479 to -149 ) , gestational age ( beta = 150 ; 95 % CI , 118 - 182 ) , female sex ( beta = -146 ; 95 % CI , -256 to -35 ) , and parity ( beta = 104 ; 95 % CI , 37 - 171 ) as strong determinants of birthweight . Maternal homocysteine , cobalamin , methylmalonic acid , and folate were not determinants of birthweight in multivariate analysis . CONCLUSION Maternal homocysteine and B vitamins are not related to birthweight in a multivariate model that was adjusted for potential confounders Folic acid administered to pregnant Bantu , whose diet is low in folate , was associated with a significant reduction in the incidence of prematurity . No such effect could be demonstrated in White patients subsisting on an average Western diet . This suggests that folate deficiency may contribute to the “ pregnancy wastage ” in population s whose dietary folate intake is low , and is a further indication for folic acid supplementation during pregnancy in these groups
BACKGROUND Growth retardation in utero leading to small-for-gestational-age ( SGA ) newborns is associated with increased neonatal morbidity and mortality and with lifelong consequences such as poor cognitive function and cardiovascular diseases .
Maternal total homocysteine ( tHcy ) concentrations have been linked to a wide range of adverse pregnancy outcomes and could possibly influence birth weight .
OBJECTIVE We performed a systematic review of and meta- analysis on the association of maternal tHcy and birth weight .