Protective effect of metafolin in pregnant patients with MTHFR polymorphism, under heparin and aspirin protect treatment

Abstract

Introduction: Thrombophilias during pregnancy are associated with maternal-fetal morbidity and mortality. In addition to this, the physiological changes that arise during pregnancy also generate a state of hypercoagulability, which can lead to complications during pregnancy such as Fetal Growth Restriction (FGR), Preeclampsia and Gestational Loss (GL). The objective was to evaluate the efficacy of Metafolin (MF) against Folic Acid (FA), in pregnant women with MTHFR-C677T mutation. Material and method: Retrospective, observational and cross-sectional study, which included 73 pregnant women. Groups: 1) GAF-T: Treatment with Folic Acid (FA, 400 mcg/24h) and 2) GMf-T: Treatment with Metafolin (Mf, 0.71 g/24h). In all cases, the women had the MTHFR C677T mutation and were treated with Heparin (5000 IU/12h) and Aspirin Protect (100 mg/24h), from the first trimester of pregnancy. Anthropometric data collection (in mothers and their newborns), presence of complications during pregnancy, MTHFR-C677T single nucleotide polymorphism (SNP) study and placental pathology were evaluated. Results: The prevalence of Fetal Growth Restriction (FGR) (15.3 vs 11.1%), placental abruption (PA) (7.6 vs 5.5%), hypertension (7.6 vs 0%) and preeclampsia (7.6 vs 5.5%) in GAF-T and GMf-T was low. GMf-T presented fewer small villi (61.5 vs 22.2%), ischemic changes (76.9 vs 22.2%), erythrocyte extravasation (61.5 vs 22.2%) and hematomas (46.1 vs 11.1%). Conclusion: The application of Mf from the beginning of pregnancy decreases the probability of developing placental pathologies. In addition, the joint application of Heparin and Aspirin Protect reduces the risk of developing complications during pregnancy such as Fetal Growth Restriction (FGR), Placental Abruption (PA), Hypertension and Preeclampsia.