Maternal folate, one-carbon metabolism and pregnancy outcomes

Single nucleotide polymorphisms and pre- and peri-conception folic acid (FA) supplementation and dietary data were used to identify one-carbon metabolic factors associated with pregnancy outcomes in 3196 nulliparous women. In 325 participants, we also measured circulating folate, vitamin B12 and homocysteine. Pregnancy outcomes included preeclampsia (PE), gestational hypertension (GHT), small for gestational age (SGA), spontaneous preterm birth (sPTB) and gestational diabetes mellitus (GDM). Study findings show that maternal genotypeMTHFR A1298C(CC) was associated with increased risk for PE, whereasTCN2 C766G(GG) had a reduced risk for sPTB. PaternalMTHFR A1298C(CC) andMTHFD1 G1958A(AA) genotypes were associated with reduced risk for sPTB, whereasMTHFR C677T(CT) genotype had an increased risk for GHT. FA supplementation was associated with higher serum folate and vitamin B12 concentrations, reduced uterine artery resistance index and increased birth weight. Women who supplemented with <800 mu g daily FA at 15-week gestation had a higher incidence of PE (10.3%) compared with women who did not supplement (6.1%) or who supplemented with >= 800 mu g (5.4%) (P< .0001). Higher serum folate levels were found in women who later developed GDM compared with women with uncomplicated pregnancies (Mean +/- SD: 37.6 +/- 8 nmol L(-1)vs. 31.9 +/- 11.2,P= .007). Fast food consumption was associated with increased risk for developing GDM, whereas low consumption of green leafy vegetables and fruit were independent risk factors for SGA and GDM and sPTB and SGA, respectively. In conclusion, maternal and paternal genotypes, together with maternal circulating folate and homocysteine concentrations, and pre- and early-pregnancy dietary factors, are independent risk factors for pregnancy complications.

Automated summary

The study identified maternal genotype MTHFR A1298C (CC) associated with increased risk for gestational hypertension, while folic acid supplementation was related to higher serum folate levels and increased birth weight. Paternal genotypes MTHFR A1298C (CC) and MTHFD1 G1958A (AA) were associated with reduced risk for preterm birth, while MTHFR C677T (CT) was associated with increased risk for gestational hypertension.