title: Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?
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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Patan Hospital, Kathmandu, Nepal.
  
  
  METHODS
  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) micromol/l and 0.39 (+/-0.32) micromol/l, respectively. Elevated s-tHcy (>7.5 micromol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 micromol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (< or =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.
  
  
  BACKGROUND
  The Norwegian Research Council and the Norwegian Universities Committee for Development, Research and Education.
authors.affiliation: Centre for International Health, University of Bergen, Bergen, Norway. gunnar.bondevik@cih.uib.no
authors.forename: G T
authors.initials: GT
authors.lastname: Bondevik
authors.forename: J
authors.initials: J
authors.lastname: Schneede
authors.forename: H
authors.initials: H
authors.lastname: Refsum
authors.forename: R T
authors.initials: RT
authors.lastname: Lie
authors.forename: M
authors.initials: M
authors.lastname: Ulstein
authors.forename: G
authors.initials: G
authors.lastname: Kvåle
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D003430:Cross-Sectional Studies; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008764:Methylmalonic Acid / Q000097:blood*; D009390:Nepal / Q000453:epidemiology; D009752:Nutritional Status; D011247:Pregnancy / Q000097:blood*; D014805:Vitamin B 12 / Q000008:administration & dosage; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12