HEALTH OF WOMAN. 2019.3(139): 31–34; doi 10.15574/HW.2019.139.31

Rossokha Z.
SI «Reference center for molecular diagnostics of the Ministry of Health of Ukraine», Kyiv
Institute of Genetic and Regenerative Medicine of the National Academy of Sciences of Ukraine, Kyiv

The clinical recommendations for the preconceptional consumption of folic acid in married couples during pregnancy planning are analyzed and peculiarities of folic acid status in 206 couples with reproductive disorders are estimated in the article. Hyperhomocysteinemia, due folate related genes polymorphism, was detected in 28.64% patients from couples with reproductive disorders, and in 9.70% of cases – in both of the couples. Folate status of 11.65% patients with 677TT /1298AA genotype compared to other variants of MTHFR gene was significantly different with increasing homocysteine level in blood plasma and decreasing folic acid level in serum. Other cases of hyperhomocysteinemia were due to the heterozygous variants of MTHFR in combination with MTRR, MTR1 genes variants and the effects of additional risk factors.

It is necessary to implement a personalized strategy for preconception period planning in married couples with reproductive disorders based on the use of an optimal dose of folic acid of (at least 800 micrograms) in multivitamins (with other vitamins of group B).

Key words: reproductive disorder, folic acid, hyperhomocysteinemia, couples, genotype, pregnancy.

REFERENCES

1. Gorovenko NG, Rossoha ZI, Kiryachenko SP. 2013. Rol geneticheskogo testirovaniya v diagnostike i lechenii nasledstvennoy trombofilii v akushersko-ginekologicheskoy praktike (obzor klinicheskih protokolov i rekomendatsiy). Meditsinskie aspekty zdorovya zhenschiny 6(70): 5-9.

2. Horovenko NH,  Rossokha ZI, Kyriachenko SP, Sheiko LP, Brishevats LI. 2018. Osoblyvosti mizhhennoi ta hen-faktornoi vzaiemodii u cholovikiv iz podruzhnikh par z bezpliddiam ta reproduktyvnymy vtratamy. Ukrainskyi medychnyi chasopys 5 (127); 2 –IX/X:28-31. DOI 10.32471/umj.1680-3051.127.131826

3. Gromova OA, Serov VN, Torshin IYu, Kerimkulova NV, Limanova OA. 2015. Rol vitaminno-mineralnyih kompleksov s folievoy kislotoy v profilaktike vrozhdennyih porokov serdtsa i defektov nervnoy trubki. Effektivnaya farmakoterapiya. Akusherstvo i ginekologiya 4: 4-12. http://umedp.ru/magazines/effektivnaya_farmakoterapiya_akusherstvo_i_ginekologiya_4_2015.html.

4. Rossokha ZI, Kyriachenko SP, Horovenko NH. 2018. Porivnialna otsinka modelei henetychnoho ryzyku reproduktyvnykh rozladiv, zumovlenykh polimorfizmom MTHFR, MTRR, MTR1. Medychni perspektyvy 18 (2);XXIII:85-91. https://doi.org/10.26641/2307-0404.2018.2.133943

5. Rossokha ZI, Kyriachenko SP, Horovenko NH. 2018. Rol mizhhennoi vzaiemodii MTHFR, MTRR, MTR1 u rozvytku porushen folatnoho obminu u patsiientok iz reproduktyvnymy rozladamy. Ukrainskyi medychnyi chasopys 3(2) (125);XI/XII: 35-39. https://doi.org/10.32471/umj.1680-3051.125.126970

6. Cordero AM, Crider KS, Rogers LM, Cannon MJ, Berry RJ. 2015. Optimal Serum and Red Blood Cell Folate Concentrations in Women of Reproductive Age for Prevention of Neural Tube Defects: World Health Organization Guidelines. Morbidity and Mortality Weekly Report 64 (15):421-423. https://doi.org/10.1017/S1368980012003576

7. Castillo-Lancellotti C., Tur J.A., Uauy R. (2012). Impact of folic acid fortification of flour on neural tube defects: a systematic review. Public Health Nutrition: 16(5), 901–911. doi:10.1017/S1368980012003576 

8. Danielsson K. 2018. Homocysteine and Recurrent Miscarriage. Elevated Levels of Homocysteine and Pregnancy Complications. https://www.verywellfamily.com/homocysteine-and-miscarriage-what-you-should-know-2371792?print

9. D’Uva M, Di Micco P,  Strina I, Alviggi C, Iannuzzo M, Ranieri A, Mollo A, De Placido G. 2007. Hyperhomocysteinemia in women with unexplained sterility or recurrent early pregnancy loss from Southern Italy: a preliminary report. Thrombosis Journal 5:10 https://doi.org/10.1186/1477-9560-5-10

10. Folic Acid Supplementation for the Prevention of Neural Tube Defects US Preventive Services Task Force Recommendation Statement. JAMA 317(2):183-189. https://doi.org/10.1001/jama.2016.19438.

11. Mandava P, Lutsep HL. 2017. Homocystinuria/Homocysteinemia. Medscape. https://emedicine.medscape.com/article/1952251-print

12. Maron BA, Loscalzo J. 2009. The Treatment of Hyperhomocysteinemia. Annu Rev Med. 60: 39–54. https://doi.org/10.1146/annurev.med.60.041807.123308.

13. Mascarenhas M, Habeebullah S, Sridhar MG. 2014. Revisiting the Role of First Trimester Homocysteine as an Index of Maternal and Fetal Outcome. Journal of Pregnancy.  Article ID 123024, 6 pages, https://doi.org/10.1155/2014/123024

14. Mills JL. 2017. Strategies for Preventing Folate-Related Neural Tube Defects Supplements, Fortified Foods, or Both? JAMA 317(2): 144-145. https://doi.org/10.1001/jama.2016.19894

15. Moussa HN, Nasab SH, Haidar ZA, Blackwell SC, Sibai BM. 2016. Folic acid supplementation: what is new? Fetal, obstetric, long-term benefits and risks. Future Sci. OA 2(2): FSO116. www.future-science.com   https://doi.org/10.4155/fsoa-2015-0015

16. Mukhopadhyay I, Pruthviraj V, Rao PS, Biswas M. 2017, Jun.  Hyperhomocysteinemia in recurrent pregnancy loss and the effect of folic acid and vitamin B12 on homocysteine levels: a prospective analysis. Int J Reprod Contracept Obstet Gynecol. 6(6):2258-2261. https://doi.org/10.18203/2320-1770.ijrcog20172013

17. Neural tube defects. Practice Bulletin 187. American College of Obstetricians and Gynecologists. Obstet Gynecol 130:e279–90. 2017. https://doi.org/10.1097/AOG.0000000000002412

18. Rossokha Z, Gorovenko N. 2017.  Assessment of the individual folic acid doses requirement for patients with reproductive disorders. XII World Congress of Perinatal Medicine. Oral Presentation. Journal of Perinatal Medicine (45):349. https://www.degruyter.com/downloadpdf/j/jpme.2017.45.issue-s2/jpm-2017-2008/jpm-2017-2008.pdf.

19. Hickey SE, Curry CJ., Toriello HV. 2013. ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genet Med:15(2):153–156. https://doi.org/10.1038/gim.2012.165

20. Serum and red blood cell folate concentrations for assessing folate status in populations. Vitamin and Mineral Nutrition Information System. World Health Organization. 2012.

https://apps.who.int/iris/bitstream/handle/10665/75584/WHO_NMH_NHD_EPG_12.1_eng.pdf?sequence=1

21. Zhang R, Huo C, Wang X, Mu BJ, Wang J. 2018. MTHFR C677T and A1298C Polymorphisms and Fetal Congenital Heart Disease Risk. Cell Physiol Biochem 45:2483-2496. https://doi.org/10.1159/000488267.