Afaq Erum, Ali Anwar, Jamil Rabia, Waseem Hira Fatima
Erum Afaq, M.Phil. Department of Physiology, Dow University of Health Sciences, Karachi, Pakistan, University of Karachi, Pakistan.
Anwar Ali, Ph.D. Department of Physiology, University of Karachi, Pakistan. University of Karachi, Pakistan.
Pak J Med Sci. 2023 Sep-Oct;39(5):1280-1285. doi: 10.12669/pjms.39.5.7432.
To investigate the relationship of serum homocysteine, folic acid, and vitamin-B12 levels with recurrent pregnancy loss (RPL).
A case-control study was conducted in the Department of Gynecology and Obstetrics, Dr. Ruth Pfau Civil Hospital, Karachi from July 2021 to June 2022. Total 124 participants were recruited from gynecology outpatient department after taking informed consent. The participants included 62 non-pregnant females with two or more consecutive unexplained RPLs and 62 healthy women having at least two successful deliveries without any pregnancy loss. Serum folic acid and vitamin-B12 levels were measured by chemiluminescent method and serum homocysteine was measured by enzyme-linked immunosorbent assay (ELISA). Comparison of quantitative variables with RPL cases and control was done by Mann-Whitney U-test (for non-normally distributed data) and independent sample t-test (for normally distributed data), while Pearson's chi-square test was used for the association of qualitative variables with RPL cases and control. Correlation of homocysteine with vitamin-B12 and folic acid was assessed in RPL cases.
The median age of the study population was 27 (IQR 25-32) years. The median body mass index (BMI) was 26.25 (IQR 22-29) kg/m. Cases had significantly lower serum folic acid (p-value=0.022), while vitamin-B12 was decreased in cases as compared to controls (p-value=0.295). Mean concentration of serum homocysteine was higher in RPL cases as compared to controls (p-value=0.094). There was significant association of serum vitamin B12 (p-value=0.001) and folic acid levels (p-value=0.004) with RPL. The homocysteine was not significantly correlated with vitamin-B12 (r=0.124, p=0.338) and folic acid (r=0.067, p=0.606) in the RPL group.
Reduced level of serum folic acid and vitamin B12 was significantly associated with RPL cases, while homocysteine was marginally raised however the difference was not significant. Folic acid and vitamin B12 supplementation before next pregnancy in RPL patients is likely to be beneficial in improving pregnancy outcomes.
探讨血清同型半胱氨酸、叶酸和维生素B12水平与复发性流产（RPL）的关系。
2021年7月至2022年6月在卡拉奇鲁思·普法伊夫民医院妇产科进行了一项病例对照研究。在获得知情同意后，从妇科门诊招募了124名参与者。参与者包括62名有两次或更多次连续不明原因复发性流产的未孕女性和62名至少有两次成功分娩且无任何流产史的健康女性。采用化学发光法测定血清叶酸和维生素B12水平，采用酶联免疫吸附测定（ELISA）法测定血清同型半胱氨酸。采用曼-惠特尼U检验（用于非正态分布数据）和独立样本t检验（用于正态分布数据）对复发性流产病例组和对照组的定量变量进行比较，采用Pearson卡方检验对定性变量与复发性流产病例组和对照组的相关性进行分析。评估复发性流产病例组中同型半胱氨酸与维生素B12和叶酸的相关性。
研究人群的中位年龄为27岁（四分位间距25 - 32岁）。中位体重指数（BMI）为26.25（四分位间距22 - 29）kg/m²。病例组血清叶酸水平显著降低（p值 = 0.022），而与对照组相比，病例组维生素B12水平降低（p值 = 0.295）。与对照组相比，复发性流产病例组血清同型半胱氨酸的平均浓度更高（p值 = 0.094）。血清维生素B12（p值 = 0.001）和叶酸水平（p值 = 0.004）与复发性流产存在显著相关性。在复发性流产组中，同型半胱氨酸与维生素B12（r = 0.124，p = 0.338）和叶酸（r = 0.067，p = 0.606）无显著相关性。
血清叶酸和维生素B12水平降低与复发性流产病例显著相关，而同型半胱氨酸略有升高，但差异不显著。复发性流产患者下次怀孕前补充叶酸和维生素B12可能有利于改善妊娠结局。
