Homocysteine, folate and vitamin B(12) in puerperal cerebral venous thrombosis.
OBJECTIVE
Hyperhomocysteinemia (hyper-Hcy) is a known risk factor for venous thrombosis, but few studies document the risk in puerperal cerebral venous thrombosis (CVT). Nutritional folate and vitamin B(12) deficiency can cause hyper-Hcy and pregnancy may contribute to this deficiency. We studied the association of plasma total homocysteine (tHcy), folate and vitamin B(12) levels with puerperal CVT through a case-control study.


METHODS
Sixty women with puerperal CVT and 64 healthy puerperal controls were recruited. Plasma fasting tHcy was estimated by high pressure liquid chromatography using coulometric electrochemical detection. Vitamin B(12) and folate were measured by radioimmunoassay. Risk of puerperal CVT was estimated for each of the three variables.


RESULTS
Adjusted odds ratio for the risk of puerperal CVT with hyper-Hcy (>90th percentile) was 10.8 (95% CI: 4.0-29.4; adjusted for vitamin B(12) and folate levels). Low folate and vitamin B(12) levels (<10th percentile) did not increase the risk for puerperal CVT. There was a significant inverse correlation between folate and tHcy levels (rho=-0.471, p<0.001).


CONCLUSIONS
Hyperhomocysteinemia is associated with an increased risk of puerperal CVT occurring in Indian women and low folate levels contribute significantly to hyper-Hcy. Regular antenatal folate and vitamin B(12) supplementation is likely to lower puerperal tHcy levels, but its clinical benefit needs to be tested by large therapeutic trials.
Nagaraja
Dindagur
D
Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore 560029, India. dnn@nimhans.kar.nic.in
Noone
Mohan Leslie
ML
Bharatkumar
Venkata Pinnelli
VP
Christopher
Rita
R
D000293:Adolescent; D000328:Adult; D016001:Confidence Intervals; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020767:Intracranial Thrombosis / Q000097:blood* / Q000150:complications / Q000235:genetics; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D009154:Mutation; D016017:Odds Ratio; D011516:Prothrombin / Q000235:genetics; D011644:Puerperal Disorders / Q000097:blood* / Q000235:genetics; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D013223:Statistics as Topic; D020246:Venous Thrombosis / Q000097:blood* / Q000150:complications / Q000235:genetics; D014805:Vitamin B 12 / Q000097:blood*
D006710:Homocysteine; D011516:Prothrombin; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D014805:Vitamin B 12