Abstract
BackgroundMaternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population.Materials and methodsDesign: A case-control study.Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012.Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls.Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy.Main Outcomes Measures: Odds ratio for pre-eclampsia.ResultsAfter adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy.ConclusionsMaternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.
Highlights
Pre-eclampsia is defined as the development of hypertension and proteinuria after the 20th week of gestation in normotensive women [1], and is considered one of the major causes of maternal and neonatal morbidity and mortality in low and middle-income countries [2,3]
After adjusting for potential confounders in logistic regression models, the odds ratios (OR) for preeclampsia was 0.80 for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12
Women who selfreported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy
Summary
Pre-eclampsia is defined as the development of hypertension and proteinuria after the 20th week of gestation in normotensive women [1], and is considered one of the major causes of maternal and neonatal morbidity and mortality in low and middle-income countries [2,3]. In the last two decades, a number of authors have investigated the effect that maternal concentrations of folate, homocysteine, and vitamin B12 may have on the development of preeclampsia [11,12]. Homocysteine is an intermediate amino acid that is metabolized into cysteine or methionine. In the latter, homocysteine requires folate as a co-substrate and vitamin B12 as a cofactor for the function of involved enzymes such as the methionine synthase enzyme [12]. Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population.
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