COMPARISON OF MATERNAL B12 AND FOLATE STATUS IN PRENATALLY DIAGNOSED NEURAL TUBE DEFECTS: A CASE-CONTROL STUDY

Yıl 2020, Cilt: 83 Sayı: 4, 325 - 329, 19.10.2020

Gürcan Türkyılmaz Gökçe Naz Küçükbaş Emircan Ertürk Şebnem Türkyılmaz Onur Karaaslan Hanım Güler Şahin

Öz

Objective: To evaluate folate and B12 levels in fetuses who had been diagnosed with neural tube defects (NTDs) and healthy fetuses in Van Yüzüncü Yıl University and Van State Education and Research hospitals between March-August 2019. Material and Method: 38 pregnant women who had been diagnosed with fetuses with NTDs prenatally, and 40 healthy controls were recruited. The chi-square test and Mann-Whitney U test were employed to compare variables. Results: None of the women had taken folic acid preconceptionally in the NTD group. However, 4 (10%) women had taken folic acid supplementation in the preconception period in the control group, and this was significantly different among the groups (p=0.04). The women who had taken folic acid in the first trimester of pregnancy were 9 (23.6%) and 32 (80%) in cases and controls, respectively, and it was significantly different (p=0.01). The mean B12 level was 248.7±65.4ng/ml in cases and 239.3±27.5 ng/ml in controls, and there was no significance between the groups (p=0.78). The mean folate level was 9.6±4.8 ng/ml in cases and 9.8±3.9 ng/ ml in controls, and it was similar between the groups (p=0.62). Conclusion: We did not show difference in folate and B12 levels. However, folic acid intake in preconception or in the first trimester of pregnancy was significantly higher in women who have healthy babies compared to the NTD group.

Anahtar Kelimeler

Folate, neural tube defect, prenatal, supplementation, vitamin B12

PRENATAL FETAL NÖRAL TÜP DEFEKTİ TANISI KONULAN ANNELERDE SERUM B12 VE FOLAT DÜZEYLERİNİN KARŞILAŞTIRILMASI: VAKA- KONTROL ÇALIŞMASI

Öz

Amaç: Van Yüzüncü Yıl Üniversitesi ve Van Eğitim ve Araştırma Hastanesi’nde NTD tanısı koyulan ve sağlıklı fetüsü olan gebelerin B12 ve folat düzeyini karşılaştırdık. Gereç ve Yöntem: NTD tanısı koyulan 38 hasta ve 40 kontrol grubu çalışmaya dahil edildi. İstatistiksel analizde ki-kare testi ve Mann-Whitney U testi kullanıldı. Bulgular: NTD grubunda hiçbir hastada prekonsepsiyonel dönemde folik asit kullanımı yoktu ancak kontrol grubunda 4 (%10) hastada prekonsepsiyonel folik asit kullanımı mevcuttu ve bu fark istatistiksel olarak anlamlıydı (p=0,04). NTD grubunda 9 (%23.6), kontrol grubunda 32 (%80) hastada ilk trimesterde folik asit desteği alınmıştı ve bu istatistiksel olarak anlamlıydı (p=0,01). Ortalama B12 seviyesi NTD grubunda 248.7±65.4ng/ml, kontrol grubunda 239.3±27.5 saptandı ve bu fark anlamlı değildi (p=0,78). Ortalama folat seviyesi NTD grubunda 9.6±4.8 ng/ml, kontrol grubunda 9.8±3.9 ng/ml saptandı ve bu fark anlamlı değildi (p=0,62). Sonuç: Her iki grup arasında B12 ve folat seviyeleri farklı değildi ancak, sağlıklı bebeği olan grupta prekonsepsiyonel dönemde ve ilk trimesterde folik asit kullanımı NTD grubuna göre anlamlı olarak daha fazlaydı.

Anahtar Kelimeler

Folat, nöral tüp defekti, prenatal, vitamin B12

Kaynakça

• 1. Botto LD, Moore CA, Khoury MJ, Erickson JD. Neural-tube defects. N Engl J Med 1999;341(20):1509-19.
• 2. Ray JG, Wyatt PR, Thompson MD, Vermeulen MJ, Meier C, Cole DE, et al. Vitamin B12 and the risk of neural tube defects in a folic acid fortfied population. Epidemiology 2007;18(3):362-6.
• 3. Greene ND, Stainer P, Copp AJ. Genetics of human neural tube defects. Hum Mol Genet 2009;18 (R2):R113-R129.
• 4. Czeizel AE, Dudas I. Prevention of the first occurance of neural-tube defects by periconceptional vitamin supplementation. N Engl J Med 1992;327(26):1832-5.
• 5. Au KS, Ashley-Koch A, Northrup H. Epidemiologic and genetic aspects of spina bifida and other neural tube defects. Dev Disabil Res Rev 2010;16(1):6-15.
• 6. Van Loon K, Besseghir K, Eshkol A. Neural tube defects after infertility treatment: a review. Fertil Steril 1992;58(5):875-84.
• 7. Wald NJ, Hackshaw AD, Stone R. Blood folic acid and vitamin B12 in relation to neural tube defects: a case control study. Biol Neonate 1995;67(3):154-9.
• 8. Weir DG, Scott JM. Cobalamins: Physiology, dietary sources and requirements. In: Sadler MJ, Strain JJ, Caballero B. eds. Encylopedia of Human Nutrition. San Diego, CA, Academic Press 1999:394-401.
• 9. Cech I, Burau KD. Serological differences in folate/vitamin B12 in pregnancies affected by neural tube defects. South Med J 2010;103(5):419-24.
• 10. Zhang T, Xin R, Gu X, Wang F, Pei L, Zheng Z, et al. Maternal serum vitamin B12, folate and homocysteine and the risk of neural tube defects in the offspirng in a high risk area of China. Public Health Nutr 2009;12(5):680-6.
• 11. Mobasheri E, Keshtkar A, Golalipour MJ. Maternal folate and vitamin B12 status and neural tube defects in northern Iran: a case control study. Iran J Pediatr 2010;20(2):167-73.
• 12. Aydın H, Arısoy R, Karaman A, Erdogdu E, Cetinkaya A, Demirci O, et al. Evaluation of maternal serum folate, vitamin B12, and homocysteine levels and factor V Leiden, factor 2 g.20212G>A, and MTHRF variations in prenatally diagnosed neural tube defects. Turk J Med Sci 2016;46(2):489-94.
• 13. MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council vitamin study. Lancet 1991;338(8760):131-7.
• 14. Tinker SC, Cogswell ME, Devine O, Berry RJ. Folic acid intake among U.S. women aged 15-44 years, National Health and Nutrition Examination Survey, 2003-2006. Am J Prev Med 2010;38(5):534-42.
• 15. Kirke PN, Molloy AM, Daly LE, Burke H, Weir DG, Scott JM. Maternal plasma folate and vitamin B12 are independent risk factors for neural tube defects. QJM 1993;86(11):703-8.
• 16. Molloy AM, Kirke PN, Troandle JF, Burke H, Sutton M, Mills JL, et al. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defects prevalance and no folic acid fortification. Pediatrics 2009;123(3):917-23.
• 17. Ceyhan ST, Beyan C, Atay V, Yaman H, Alanbay I, Başer I, et al. Serum vitamin B12 and homocysteine levels in pregnant women with neural tube defects. Gynecol Endocrinol 2010;26(8):578-81.
• 18. Mills JL, Scott JM, Kirke PN, McPartlin JM, Conley MR, Weir DG, Molloy AM, Lee YJ. Homocysteine and neural tube defects. J Nutr 1996;126(3):756-60.
• 19. Yang M, Li W, Wan Z, Du Y. Elevated homocysteine levels in mothers with neural tube defects: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2017;30(17):2051-57.
• 20. Van der Put NM, Steegers-eunissen RPM, Frosst P, Trijbels FJ, Eskes TK, et al. Mutated methylenetetrahydrofolate reductase as a risk factor for spina bifida. Lancet 1995;346(8982):1070-1.
• 21. Shields DC, Kirke PN, Mills JL, Ramsbottom D, Molloy AM, Whitehead AS. The ‘thermolabile’ variant of methylenetetrahydrofolate reductase and neural tube defects: an evaluation of genetic risk and the relative importance of the genotypes of the embryo and the mother. Am J Hum Genet 1999;64(4):1045-55.
• 22. Liu J, Qi J, Yu X, Zhu J, Zhang L, Luo X, et al. Investigations of single nucleotide polymorphisms in folate pathway genes in Chinese families with neural tube defect. J Neurol Sci 2014;337(1-2):61-6.