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Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?

European Journal of Clinical Nutrition volume 55, pages 856–864 (2001)Cite this article

Abstract

Objective: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women.

Design: Cross-sectional study.

Setting: Patan Hospital, Kathmandu, Nepal.

Subjects: A sub-sample (n=382) of all pregnant women (n=2856) coming for their first antenatal visit in a 12 month period, 1994–1995. The selection of the sub-sample was based on maternal haematocrit values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n=54) were excluded. The remaining women (n=328) were included in the statistical analysis.

Results: Overall mean values (±s.d.) of s-tHcy and s-MMA were 9.5 (±4.2) µmol/l and 0.39 (±0.32) µmol/l, respectively. Elevated s-tHcy (>7.5 µmol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 µmol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (≤4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r=−0.30, P<0.001) and s-folate (r=−0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r=−0.40, P<0.001), but not with s-folate.

Conclusions: Functional cobalamin deficiency was very common in the study population, while functional folate deficiency was rather uncommon. We suggest considering cobalamin supplementation to pregnant Nepali women.

Sponsorship: The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.

European Journal of Clinical Nutrition (2001) 55, 856–864

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Acknowledgements

We wish to thank Mrs B Pakhrin for her help with interviewing the pregnant women. Mr RB Shrestha for co-ordinating the laboratory investigations in Patan Hospital, and Dr G Rana for her advice in connection with the data collection.

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Author notes

  1. GT Bondevik and G Kvåle: Guarantors: GT Bondevik and G Kvåle.

  2. GT Bondevik, J Schneede, H Refsum, RT Lie, M Ulstein and G Kvåle: Contributors: GTB initiated the study, and was the main person responsible for all stages of the study, including the study design, literature searches, data collection, data entry, statistical analysis, interpretation of results and writing the paper. JS assisted in the literature searches, co-ordinated the laboratory analyses of homocysteine and methylmalonic acid, was involved in interpretation of results and contributed to writing the paper. HR assisted in the literature searches, advised on the laboratory methods used, participated in data interpretation and assisted in writing the paper. RTL discussed core ideas, advised on the statistical methods used, participated in data analysis, interpretation of results, and in writing the paper. MU contributed to core ideas, was involved in the protocol formulation, study design, interpretation of results and writing the paper. GK supervised all aspects of the study, was involved in the study design, data interpretation and participated in writing the paper. All discussed and edited the final manuscript.

Authors and Affiliations

  1. Centre for International Health, University of Bergen, Bergen, Norway

    GT Bondevik & G Kvåle

  2. Department of Pharmacology, University of Bergen, Bergen, Norway

    J Schneede & H Refsum

  3. Section for Medical Statistics, University of Bergen, Bergen, Norway

    RT Lie

  4. Department of Obstetrics and Gynaecology, University of Bergen, Bergen, Norway

    M Ulstein

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  1. GT Bondevik
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  6. G Kvåle
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Correspondence to GT Bondevik.

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Bondevik, G., Schneede, J., Refsum, H. et al. Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?. Eur J Clin Nutr 55, 856–864 (2001). https://doi.org/10.1038/sj.ejcn.1601236

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