Homocysteine and methylmalonic acid levels in pregnant Nepali women.: Should cobalamin supplementation be considered?

Objective: The aim of this study was to investigate homocysteine and methylmalonic acid levels as markers of functional cobalamin and folate status in pregnant Nepali women, Design: Cross-sectional study. Setting: Patan Hospital, Kathmandu, Nepal. Subjects: A sub-sample (n = 382) of all pregnant women (n = 2856) coming for their first antenatal visit in a 12 month period, 1994-1995. The selection of the sub-sample was based on maternal haematocrit Values, categorised into three groups: severely, moderately and non-anaemic women. As serum levels of total homocysteine (s-tHcy) and methylmalonic acid (s-MMA) were similar in the three groups, pooled data are presented. Women who had already received micronutrient supplementation (n = 54) were excluded. The remaining women (n = 328) were included in the statistical analysis. Results: Overall mean values (+/- s.d.) of s-tHcy and s-MMA were 9.5 (+/- 4.2) mu mol/l and 0.39 (+/-0.32) mu mol/l, respectively. Elevated s-tHcy (>7.5 mu mol/l) was found in 68% of the women, while 61% had elevated s-MMA (>0.26 mu mol/l). Low s-cobalamin values (<150 pmol/l) were observed in 49% of the women, while only 7% had low s-folate values (<less than or equal to>4.5 nmol/l). s-tHcy was significantly correlated with s-MMA (r=0.28, P<0.001), s-cobalamin (r= -0.30, P<0.001) and s-folate (r= -0.24, P<0.001). s-MMA was significantly associated with s-cobalamin (r= -0.40, P<0.001), but not with s-folate. Conclusions: Functional cobalamin deficiency was very common in the study Population, while functional folate, deficiency was rather uncommon. We suggest considering cobalamin Supplementation to pregnant Nepali women.