title: Increased MMA concentration and body mass index are associated with spontaneous abortion in Brazilian women: a pilot study.
abstract: BACKGROUND
  The pathophysiology of spontaneous abortion is complex and may involve the interaction of genetic and environmental factors. We evaluated the predictors of spontaneous abortion in Brazilian pregnant women. The effects of age, gestational age, body mass index (BMI), cigarette smoking, alcohol ingestion, use of multivitamins and concentrations of vitamins (folate, cobalamin and vitamin B6) and vitamin-dependent metabolites were analyzed.
  
  
  METHODS
  Study population included 100 healthy women that attended pre-natal care in 2 health centers of Sao Paulo, Brazil, and in whom pregnancy outcome was known. Folate and cobalamin status was measured in blood specimens collected between 4 and 16 weeks. The genotypes for 8 gene polymorphisms were evaluated by PCR-RFLP.
  
  
  RESULTS
  Eighty-eight women had normal pregnancy outcome (Group 1), while 12 experienced a miscarriage after blood collection (Group 2). Increased methylmalonic acid (MMA) concentrations were found in Group 2 (median [25th-75th percentile]=274 [149-425] nmol/l) relative to Group 1 (138 [98-185]) (P<0.01). No differences between the groups were observed for serum cobalamin, serum or red cell folate, and serum total homocysteine or allele frequencies for 8 polymorphisms. In a conditional logistic regression analysis including age, gestational age, serum creatinine, MMA, cystathionine, body mass index (BMI), cigarette smoking, alcohol ingestion and use of multivitamins the risk of abortion was significantly associated with MMA (OR [95% CI]=3.80 [1.36, 10.62] per quartile increase in MMA), BMI (OR [95% CI]=5.49 [1.29, 23.39] per quartile) and gestational age (OR [95% CI]=0.10 [0.01, 0.77] per increase of interval in gestational age).
  
  
  CONCLUSIONS
  Increased serum MMA and BMI concentrations are associated with spontaneous abortion in Brazilian women.
authors.affiliation: Department of Clinical Chemistry and Toxicology, Faculty of Pharmaceutical Science, University of Sao Paulo, Brazil. emguerra@usp.br
authors.forename: Elvira M
authors.initials: EM
authors.lastname: Guerra-Shinohara
authors.forename: Perla M
authors.initials: PM
authors.lastname: Pereira
authors.forename: Ananka M
authors.initials: AM
authors.lastname: Kubota
authors.forename: Thaiomara A
authors.initials: TA
authors.lastname: Silva
authors.forename: Jucilene L
authors.initials: JL
authors.lastname: Reis
authors.forename: Gerson S
authors.initials: GS
authors.lastname: Miyashita
authors.forename: Vânia
authors.initials: V
authors.lastname: D'Almeida
authors.forename: Robert H
authors.initials: RH
authors.lastname: Allen
authors.forename: Sally P
authors.initials: SP
authors.lastname: Stabler
mesh_terms: D000022:Abortion, Spontaneous / Q000097:blood*; D000328:Adult; D000483:Alleles; D015992:Body Mass Index; D001938:Brazil; D004252:DNA Mutational Analysis; D005260:Female; D005838:Genotype; D006801:Humans; D008764:Methylmalonic Acid / Q000097:blood*; D010865:Pilot Projects; D016133:Polymerase Chain Reaction; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D011247:Pregnancy; D012680:Sensitivity and Specificity
chemical_list: D008764:Methylmalonic Acid