title: Elevated homocysteine levels in mothers with neural tube defects: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To find the real relationship between maternal total homocysteine (tHcy) level and risk of neural tube defects (NTDs).
  
  
  METHODS
  A systematic review and meta-analysis were conducted. The literature search was conducted with the use of PubMed and EMBASE databases and weighted mean difference (WMD) with 95% confidence interval (CI) was applied to measure the difference in tHcy level between case and control group. Seventeen articles involving 3237 subjects were included according to the inclusion criteria.
  
  
  RESULTS
  Pooled result showed that mothers with NTDs offspring demonstrated significantly a higher mean log plasma tHcy level than mothers with normal offspring (log WMD: 0.06; 95%CI: 0.02-0.09, p = 0.001), corresponding to an increase of 6% (2-9%) in the geometric mean. Subgroup analyses also displayed this difference in subjects who were detected during pregnancy or without folate supplementation before sampling. However, in the mandatory folate fortification countries, we did not find this association.
  
  
  CONCLUSIONS
  A slightly higher tHcy level in mothers with NTDs was indicated, but potential confounders could not be ruled out completely. Further larger or cohort studies are needed to confirm this association.
authors.affiliation: a School of Public Health, Wuhan University of Science and Technology , Wuhan , China.
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.affiliation: b Department of Pharmacology and.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.affiliation: c Department of Maternal and Child Health , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Zhihua
authors.initials: Z
authors.lastname: Wan
authors.affiliation: c Department of Maternal and Child Health , Tongji Medical College, Huazhong University of Science and Technology , Wuhan , China.
authors.forename: Yukai
authors.initials: Y
authors.lastname: Du
mesh_terms: D016022:Case-Control Studies; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D009436:Neural Tube Defects / Q000097:blood* / Q000209:etiology* / Q000517:prevention & control; D011247:Pregnancy
chemical_list: D006397:Hematinics; D006710:Homocysteine; D005492:Folic Acid
keywords: Neural tube defects; folate supplementation; homocysteine; meta; prenatal care