Folate, Vitamin B12, and Homocysteine Levels in Women With Neural Tube Defect-Affected Pregnancy in Addis Ababa, Ethiopia

Winner Kucha; Daniel Seifu; Abenezer Tirsit; Mahlet Yigeremu; Markos Abebe; Dawit Hailu; Dareskedar Tsehay; Solomon Genet

doi:10.3389/fnut.2022.873900

Folate, Vitamin B12, and Homocysteine Levels in Women With Neural Tube Defect-Affected Pregnancy in Addis Ababa, Ethiopia

Front Nutr. 2022 Apr 8:9:873900. doi: 10.3389/fnut.2022.873900. eCollection 2022.

Authors

Winner Kucha¹, Daniel Seifu², Abenezer Tirsit³, Mahlet Yigeremu⁴, Markos Abebe⁵, Dawit Hailu⁵, Dareskedar Tsehay⁵, Solomon Genet¹

Affiliations

¹ Department of Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
² Biochemistry Division of Basic Sciences, University of Global Health Equity, Kigali, Rwanda.
³ Neurosurgery Unit, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ Armauer Hansen Research Institute, Addis Ababa, Ethiopia.

Abstract

Background: Neural tube defects (NTDs) are prevalent congenital defects associated with pre-pregnancy diet with low levels of maternal folate. They are linked to severe morbidity, disability, and mortality, as well as psychological and economic burdens.

Objective: The goal of this study was to determine the levels of folate, vitamin B12, and homocysteine in the blood of women who had a pregnancy impacted by NTDs.

Subjects and methods: A hospital-based case-control study was undertaken between September 2019 and August 2020. The study comprised a total of 100 cases and 167 controls. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of folate, vitamin B12, and homocysteine in the serum.

Results: Only 39% of the cases and 54.5% of control mothers reported periconceptional use of folic acid/multivitamin, which indicated a statistically significant difference (p = 0.014). Logistic regression indicated that periconceptional use of folic acid/multivitamin was associated with NTDs (p = 0.015, OR = 1.873, 95% CI: 1.131-3.101). We found that 57% of the cases and 33.5% of controls, as well as 43% of cases and 20.4% of controls had serum folate and vitamin B12 levels below the cut-off value, respectively. Twenty-seven percent of the cases and 6.6% of controls had hyperhomocysteinemia (HHcy). The median concentrations of folate, vitamin B12, and homocysteine in cases and controls were 4.78 and 8.86 ng/ml; 266.23 and 455 pg/ml; 13.43 and 9.7 μmol/l, respectively. The median concentration of folate (p < 0.001) and vitamin B12 (p < 0.001) were significantly lower in the cases than controls, while the homocysteine concentration (p < 0.001) was significantly lower in the controls than cases. Folate [OR (95% CI) = 1.652 (1.226-2.225; p = 0.001)], vitamin B12 [OR (95% CI) = 1.890 (1.393-2.565; p < 0.001], and homocysteine [OR (95% CI) = 0.191 (0.09-0.405; p < 0.001)] levels were associated with NTDs.

Conclusion: Folate and vitamin B12 are deficient in both cases and control mothers. The lower levels of folate and vitamin B12 with an elevated homocysteine level in NTD-affected pregnancy may be an indication that these biochemical variables were risk factors for NTDs. Folate/multivitamin supplementation and/or food fortification should be promoted.

Keywords: ELISA; NTDs; folate; homocysteine; vitamin B12.