5-methyltetrahydrofolate: A mandatory support for T677T MTHFR SNP women suffering from premature ovarian insufficiency, endometriosis and/or multiple ART failures

A patients, age 39 in 2019, suffering hypermenorrhea, secondary dysmenorrhea and endometriosis with pelvic adhesions, Normal physical examination with an AMH value of 0.877 ng/L . At this time the couple had been trying to conceive for over 2 years while taking nature made prenatal vitamins and the wife was given 9 rounds of clomid treatments (6–50 mg, 3- 100 mg). She was advised to take DHEA and then started IUI and IVF with no success. On August, 2020, it was elected to check the couple for MTHFR mutation. The woman was found to be homozygous for T677T MTHFR mutation and her spouse homozygous for the C1298C MTHFR mutation but with a subnormal sperm. The patient and her spouse were both advised to discontinue any vitamins containing folic acid and start vitamins with a daily dose of 1,000 mcg of 5-MTHF (folate) with chelated zinc and a vitamin B complex. On December, 2020 spontaneous conception occurred. On July 27, 2021, a healthy 48.26 cm (19 inches), 3 kg (6 pounds 9 ounces) girl was delivered by c-section. Keywords: MTHFR 677TT SNP; endometriosis; ART failures; premature ovarian insufficiency; 5MTHF.

Anemia Prevalence and Iron Supplementation Practices Among Pregnant Women in Vancouver, Canada

Objectives Health Canada recommends supplementation with 16–20 mg iron during pregnancy to maintain adequate iron stores and reduce the prevalence of iron deficiency. Most prenatal vitamins contain 27 mg iron (the recommended dietary allowance). In the case of diagnosed iron deficiency (typically defined as a ferritin concentration < 15–50 µg/L), some pregnant women may be recommended to take additional iron. Iron is an essential nutrient and adequate intake is needed for a healthy pregnancy; however, excess iron can also be harmful. We aimed to evaluate the hematological profile, prevalence of anemia, and iron supplementation practices of healthy pregnant women in Vancouver, Canada. Methods As part of an ongoing clinical trial, 40 healthy pregnant women (aged 19–42 years) received prenatal vitamins containing 27 mg iron over 16 weeks of pregnancy, starting at 9–21 weeks gestation. A complete blood count was measured at baseline and endline. Anemia was defined as hemoglobin < 110 g/L in the first/third trimesters and < 105 g/L in the second trimester. Microcytic anemia (most commonly caused by iron deficiency) was defined as having both anemia and a MCV concentration < 80 fL. Participants reported other supplement use throughout the study, including additional iron prescribed for treatment of iron deficiency and/or anemia. Results At baseline and endline, the mean ± SD of hemoglobin was 124 ± 9 g/L and 127 ± 11 g/L; and for MCV was 89 ± 3 fL and 91 ± 3 fL, respectively. Based on hemoglobin (trimester-specific) and MCV thresholds, no participants were classified as having anemia or microcytic anemia at either timepoint, respectively. At endline, a total of n = 8 women (20%) reported that following their baseline visit (during the intervention period) they were informed by their health care provider to increase their supplemental dose of iron up to 300 mg, in addition to the 27 mg in the study prenatal vitamin. Conclusions Whether recommendation for additional iron was warranted in 20% of women is unclear, as none had microcytic anemia based on hemoglobin and MCV values. Measurement of ferritin is warranted for the definitive diagnosis of iron deficiency, and to elucidate if there is a need for improved clinical practices for recommending additional iron supplementation. Funding Sources Healthy Starts Catalyst Grant (BC Children's Hospital Research Institute, Vancouver, Canada).

Diet in Early Pregnancy: Focus on Folate, Vitamin B12, Vitamin D, and Choline

Purpose: Prenatal multivitamins are recommended in pregnancy. This study assessed food and supplement intakes of folate, vitamin B12 (B12), vitamin D, and choline in pregnant women living in Southern Ontario in comparison with current recommendations. Methods: Women recruited to the Be Healthy in Pregnancy RCT (NCT01693510) completed 3-day diet/supplement records at 12–17 weeks gestation. Intakes of folate, B12, vitamin D, and choline were quantified and compared with recommendations for pregnant women. Results: Folate intake (median (min, max)) was 1963 μg/day dietary folate equivalents (153, 10 846); 90% of women met the Estimated Average Requirement (EAR) but 77% exceeded the Tolerable Upper Intake Level (UL) (n = 232). B12 intake was 12.1 μg/day (0.3, 2336); 96% of women met the EAR with 7% exceeding the EAR 100-fold (n = 232). Vitamin D intake was 564 IU/day (0.0, 11 062); 83% met the EAR, whereas 1.7% exceeded the UL (n = 232). Choline intake was 338 mg/day (120, 1016); only 18% met the Adequate Intake and none exceeded the UL (n = 158). Conclusion: To meet the nutrient requirements of pregnancy many women rely on prenatal vitamins. Reformulating prenatal multivitamin supplements to provide doses of vitamins within recommendations to complement a balanced healthy diet would ensure appropriate micronutrient intakes for pregnant women.

Prenatal Vitamin Use in Rhode Island According to Women, Infants, and Children (WIC) Participation

Objectives To examine prenatal vitamin (PNV) use between Women, Infants, and Children (WIC) and non-WIC pregnant women and explore food security and sociodemographic characteristics associated with each group. Methods A cross-sectional study was conducted among a convenience sample of Rhode Island pregnant women 18 years of age or older. Women were recruited from WIC offices, OB-GYN offices, and pregnant women known to the research team. All women that participated in the study completed an anonymous 21-question survey in-person or online that asked about PNV use, sociodemographic characteristics, and food security. We conducted t -testsand chi-square tests in this data analysis using SPSS. T-tests were used for continuous variables and chi-square was used for categorical variables. Results Out of 96 pregnant women, 61% were WIC participants. WIC participants were more likely to be Hispanic (47% vs 16%, P = 0.00), identify as a race other than white (35% vs 8%, P = 0.02), and were less likely to have a bachelor's degree (7% vs 59%, P < 0.001). WIC participants had a higher prevalence of food security than non-WIC participants (56% vs 27%, P = 0.01). There was no significant difference in PNV use between WIC and non-WIC participants (P = 0.91), with 92% of women from both groups consuming PNVs during pregnancy. However, WIC participants were more likely to obtain PNVs through a prescription than non-WIC participants (53% vs 24%, P = 0.003). Conclusions This study indicates that there is high use of prenatal vitamins in both WIC and non-WIC participants, which is contrary to previous published studies on prenatal vitamin use among low-income women. In addition, we found that WIC participants are obtaining prescription prenatal vitamins more than non-WIC women. This is worth further attention as the composition of prescription and non-prescription prenatal vitamins differ. Funding Sources University of Rhode Island startup grant.

Male fetus susceptibility to maternal inflammation: C-reactive protein and brain development

Background Maternal inflammation in early pregnancy has been identified epidemiologically as a prenatal pathogenic factor for the offspring's later mental illness. Early newborn manifestations of the effects of maternal inflammation on human fetal brain development are largely unknown. Methods Maternal infection, depression, obesity, and other factors associated with inflammation were assessed at 16 weeks gestation, along with maternal C-reactive protein (CRP), cytokines, and serum choline. Cerebral inhibition was assessed by inhibitory P50 sensory gating at 1 month of age, and infant behavior was assessed by maternal ratings at 3 months of age. Results Maternal CRP diminished the development of cerebral inhibition in newborn males but paradoxically increased inhibition in females. Similar sex-dependent effects were seen in mothers' assessment of their infant's self-regulatory behaviors at 3 months of age. Higher maternal choline levels partly mitigated the effect of CRP in male offspring. Conclusions The male fetal-placental unit appears to be more sensitive to maternal inflammation than females. Effects are particularly marked on cerebral inhibition. Deficits in cerebral inhibition 1 month after birth, similar to those observed in several mental illnesses, including schizophrenia, indicate fetal developmental pathways that may lead to later mental illness. Deficits in early infant behavior follow. Early intervention before birth, including prenatal vitamins, folate, and choline supplements, may help prevent fetal development of pathophysiological deficits that can have life-long consequences for mental health.