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Preconception Folate and Vitamin B₆ Status and Clinical Spontaneous Abortion in Chinese Women

From the Department of Environmental Health, Program for Population Genetics, Department of Maternal and Child Health, and Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts; Department of Environmental Health and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts; Vitamin Bioavailability Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts; New England Research Institutes, Watertown, Massachusetts; Beijing Medical University Center for Ecogenetics and Reproductive Health, Beijing, China; and Anhui Medical University, Anqing Biomedical Institute, Anhui, China.

Address reprint requests to: Alayne G. Ronnenberg, ScD, Harvard School of Public Health, Department of Environmental Health, FXB101, 665 Huntington Avenue, Boston, MA 02115; E-mail: ronnenberg{at}attbi.com.

OBJECTIVE: To assess the association between preconception homocysteine and B vitamin status and risk of clinical spontaneous abortion in women from Anqing, China.

METHODS: All women were aged 21–34 years, had never smoked, and were primigravid. Patients (n = 49) were women with a clinically recognized pregnancy who experienced a fetal death before 100 days’ gestation. Controls (n = 409) were women who maintained a pregnancy that ended in a live birth. Homocysteine, folate, and vitamins B₆ and B₁₂ concentrations were measured in plasma obtained before conception.

RESULTS: Mean vitamin B₆ concentration was lower in patients than in controls (34.0 versus 37.9 nmol/L, P = .04). In addition, the risk of spontaneous abortion tended to increase with decreasing plasma vitamin B₆ and folate concentration (P for trend = .06 and .07, respectively), although the significance of these trends was further reduced in logistic models that included age, body mass index, and both vitamins. The risk of spontaneous abortion was four-fold higher among women with suboptimal plasma concentrations of both folate and vitamin B₆ (folate less than or equal to 8.4 nmol/L and vitamin B₆ less than or equal to 49 nmol/L) than in those with higher plasma concentrations of both vitamins (odds ratio 4.1, 95% confidence interval 1.2, 14.4). Homocysteine and vitamin B₁₂ status were not associated with spontaneous abortion risk.

CONCLUSION: Suboptimal preconception folate and vitamin B₆ status, especially when they occur together, may increase the risk of clinical spontaneous abortion. Additional prospective studies are needed to confirm these findings and to determine whether antenatal B vitamin supplementation reduces spontaneous abortion risk.

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