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Original Research Communication |
1 From the Departments of Environmental Health (AGR), Maternal and Child Health (IWA), Epidemiology (MBG), and Nutrition (WCW), Harvard School of Public Health, Boston; Beijing Medical University Center for Ecogenetics and Reproductive Health, Beijing (DC); Anhui Medical University, Anqing Biomedical Institute, Anhui, China (DC); the Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston (JS); and the Department of Environmental Health and Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston (XX).
Background: The associations between homocysteine, B vitamin status, and pregnancy outcomes have not been examined prospectively.
Objective: We assessed the associations of preconception homocysteine and B vitamin status with preterm birth and birth of low-birth-weight (LBW) and small-for-gestational-age (SGA) infants in Chinese women.
Design: This was a case-control study of women aged 21–34 y. Preterm cases (n = 29) delivered living infants at <37 wk gestation; term controls (n = 405) delivered infants at 
37 wk. LBW cases (n = 33) had infants weighing <2500 g; normal-birth-weight controls (n = 390) had infants weighing 2500 g. SGA cases (n = 65) had infants below the 10th percentile of weight-for-gestational-age; appropriate-for-gestational-age controls (n = 358) had infants above this cutoff. Nonfasting plasma concentrations of homocysteine, folate, and vitamins B-6 and B-12 were measured before conception.
Results: Elevated homocysteine (12.4 µmol/L) was associated with a nearly 4-fold higher risk of preterm birth (OR: 3.6; 95% CI: 1.3, 10.0; P < 0.05). The risk of preterm birth was 60% lower among women with vitamin B-12 258 pmol/L than among vitamin B-12–deficient women (OR: 0.4; 95% CI: 0.2, 0.9; P < 0.05) and was 50% lower among women with vitamin B-6 30 nmol/L than among vitamin B-6–deficient women (OR: 0.5; 95% CI: 0.2, 1.2; NS). Folate status was not associated with preterm birth, and homocysteine and B vitamin status were not associated with LBW or SGA status.
Conclusions: Elevated homocysteine and suboptimal vitamin B-12 and B-6 status may increase the risk of preterm birth. These results need to be confirmed in larger prospective studies.
Key Words: WORDSHomocysteine • vitamin B-12 • vitamin B-6 • preterm birth • low birth weight • pregnancy • pregnancy outcome • China
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