Abstract
This study aimed to investigate serum methylmalonic acid (MMA) and homocysteine levels and to assess their effects on pregnancy and neonatal outcomes. Serum MMA and homocysteine levels in 278 pregnant Korean women, determined by liquid chromatography–tandem mass spectrometry in each trimester, were compared with those of previous studies in other ethnic groups. We investigated the association between MMA and homocysteine status with pregnancy and neonatal events: gestational diabetes, preeclampsia, gestational age at delivery, preterm birth, small for gestational age, neonatal birth weight, and congenital abnormalities. The median (range) MMA level was 0.142 (0.063–0.446) µmol/L and homocysteine level was 10.6 (4.4–38.0) µmol/L in pregnant women. MMA levels were significantly higher in the third trimester than during other trimesters (p < 0.05), while homocysteine levels were not. No significant association was observed between MMA or homocysteine levels and any of the maternal or neonatal outcomes examined. Future studies are needed to assess the associations among maternal serum concentrations of MMA and homocysteine, and maternal and neonatal outcomes.
Highlights
Vitamin B12, a water-soluble micronutrient which is essential for hematologic and neurologic processes, serves as a cofactor in the remethylation of homocysteine to methionine and in the conversion of L-methylmalonyl-CoA to succinyl-CoA [1]
We investigated the association between maternal serum methylmalonic acid (MMA) and homocysteine levels and negative pregnancy and neonatal outcomes
Before assessing the association between serum MMA and homocysteine levels and pregnancy and neonatal outcomes, we examined the association between demographic factors and maternal and neonatal outcomes to identify potential confounding variables, as shown in Supplementary Materials
Summary
Vitamin B12, a water-soluble micronutrient which is essential for hematologic and neurologic processes, serves as a cofactor in the remethylation of homocysteine to methionine and in the conversion of L-methylmalonyl-CoA to succinyl-CoA [1]. Maternal serum vitamin B12 concentration has been reported to gradually decline throughout normal pregnancy with the lowest concentration reached in late gestation, and maternal vitamin B12 deficiency has been associated with an increased risk of adverse pregnancy outcomes (e.g., neural tube defects, preterm delivery, and intrauterine growth retardation) indicating the importance of sufficient vitamin B12 intake/status during pregnancy for optimal fetal development and growth [4,5,6,7]. An elevated level of MMA is more sensitive and specific for diagnosis, since homocysteine level increases in clinical folate deficiency [3]. The levels of both MMA and total homocysteine are markedly elevated in the vast majority (>98%) of patients with clinical B12 deficiency including those who have only neurologic manifestations of deficiency (i.e., who are not anemic) [3]
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