TITLE:
Comparative Study between the Use of Regular Folic Acid Supplement versus the Use of L-Methyl Folate in Patients with Methyl Tetrahydrofolate Reductase (MTHFR) Gene Mutation with Recurrent Pregnancy Loss
AUTHORS:
Ahmed Essmat
KEYWORDS:
MTHFR, Recurrent Pregnancy Loss, Folic Acid, L-Methylfolate
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.9,
September
3,
2021
ABSTRACT: Background: Methylfolate is the active metabolite of folate
that is important for DNA repair, synthetized under the effect of
MTHFR (methyl-tetrahydro-folatereductase) enzyme. Patients with MTHFR gene
mutation have low levels of biologically active methyfolate. Those patients
have high homocysteine levels causing vasculopathy and inadequate feto-maternal
circulation. Aim of the Work: To predict the potential benefit of use of
methylfolate instead of use of the regular folic acid in patients with MTHFR
gene mutation with history of RPL (recurrent
pregnancy loss). Subjects and Methods: Study was performed on 100 women.
All women had experienced at least two consecutive miscarriages first trimester
abortion. All patients were positive of having
MTHFR gene mutation. Patients were divided into two groups in terms of 1st
trimester drug intake. The 1st group recieved a regular folic acid supplement
in a dose of 5 mg per day starting from the day of positive pregnancy test till the end of the first trimester. The 2nd
group recieved L-methylfolate supplement in a dose of 1000 mcg per day starting
from the day of positive pregnancy test till the end of the first trimester.
Then both groups were compared in terms of abortion rates, pregnancy
continuation rates and the development of other major obstetric complications. Results: Patients in 1st group had no associated pregnancy related complications in 56%,
PE in 14%, PROM in 18% and PTL in 12% of cases. On the other hand, patients in
2nd group had no associated pregnancy related complications in 78%, PE in
6%, PROM in 8% and PTL in 8% of cases 54% of
patients on folate group ended in abortion, while only 16% of
patients on methylfolate group had abortion. 24% of patients on folate group
had PTL, compared to 8% of patient who had had PTL in methylfolate group. 22%
of patients in the 1st group continued pregnancy to full term, while 60% of 2nd
group continued pregnancy to full term. Conclusion and Recommendations: The
use of methyl-folate supplement during the first trimester of in patients with
history of RPL and positive MTHFR gene mutation should be a routine practice
instead of the regular folate supplement as it improves pregnancy continuation
rates and decreases occurrence of associated pregnancy co-morbidities as
preterm labor and preeclampsia.