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The determinants of maternal homocysteine in pregnancy: findings from the Ottawa and Kingston Birth Cohort

Published online by Cambridge University Press:  19 March 2020

Shazia H Chaudhry
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada OMNI Research Group, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Monica Taljaard
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Amanda J MacFarlane
Affiliation:
Nutrition Research Division, Health Canada, Ottawa, Ontario, Canada Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
Laura M Gaudet
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada OMNI Research Group, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Graeme N Smith
Affiliation:
Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Queen’s University, Kingston, Ontario, Canada Kingston General Hospital Research Institute, Kingston, Ontario, Canada
Marc Rodger
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Ruth Rennicks White
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada OMNI Research Group, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
Mark C Walker
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada OMNI Research Group, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Shi Wu Wen
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada OMNI Research Group, Department of Obstetrics, Gynecology, and Newborn Care, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
Corresponding
E-mail address:

Abstract

Objective:

Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population.

Design:

Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration.

Setting:

Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009.

Participants:

Women were recruited when presenting for prenatal care in the early second trimester.

Results:

In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration.

Conclusions:

We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.

Type
Research paper
Copyright
© The Authors 2020

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