Supplementation of Folic Acid in Pregnancy - Medical Science Assignment Help

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Introduction

Gestational hypertension (GHTN), formerly known as pregnancy induced hypertension, is defined as a new rise in blood pressure (BP) ≥140/90mm Hg, presenting at or after 20 weeks gestation without significant proteinuria (≥ 300mg/24 hour urine collection of urine, or 2 specimens of urine collected ≥ 4 hours apart with ≥ 2+ on the protein reagent strip, or protein creatinine ratio (PCR) ? 30mg/mmol) or other features of preeclampsia which usually resolves within 6-12 weeks of delivery.(1,2) It is the most frequent cause of hypertension during pregnancy, constituting approximately 70%, and complicating about 6-17% pregnancies in healthy nulliparous women and 2- 4% in multiparous women.(3  )Its incidence varies with the age and parity of the pregnant woman, being higher in younger nulliparous than older multiparous pregnant women, . Gestational hypertension and preeclampsia are common hypertensive disorders during pregnancy [1, 2]. Preeclampsia is a devastating complication of pregnancy responsible for maternal mortality and morbidity [3, 4]. Mothers with preeclampsia during pregnancy may result in neurocognitive dysregulation and suboptimal infant development in offspring [5]. During pregnancy, hypertension is a risk factor for diabetes and cardiovascular disease in later life [6, 7]. Preeclampsia is always caused by impaired placental perfusion, nevertheless, but other risk factors for preeclampsia remain unclear [8]. hyperhomocysteinemia might damage the vascular endothelium of the developing placenta, increasing contractile response and production of procoagulants and vasoconstrictors.9

 In an analysis of the national data of the United States, Zhang et al found that women with PE and eclampsia had a 3- to 25-fold increased risk of abruptio placentae, thrombocytopenia, disseminated intravascular coagulation, pulmonary edema, and aspiration pneumonia, and more than half of women with PE and eclampsia had cesarean delivery [10]. Since delivery is the only known cure, PE is a leading cause of indicated preterm delivery [11]. Means of gestational age were 38.3 and 35.3 weeks (as compared with 39–40 weeks in the general population), and perinatal mortality rates were 2% and 4% (as compared with 5–6 per 1,000 in the general population), respectively, in the mild and severe PE groups [12]. PE accounts for 25% of very low birth weight infants [13] and as many as 60% of these infants suffer from learning disabilities and low IQ [14].

Accumulating evidences have suggested that elevated levels of blood homocysteine are a cause of gestational hypertension and preeclampsia [15, 16]. In addition, more and more studies confirm that folic acid supplementation can reduce blood homocysteine levels [17- 18]. Furthermore, the relationship between folic acid supplementation and preeclampsia risk has been investigated by several epidemiological studies, but their results are inconsistent. Some studies showed that the supplementation of folic acid is beneficial in decreasing the incidence of preeclampsia and gestational hypertension during pregnancy [19,20,21]. However, Li et al. demonstrated that there was no association between the occurrence of preeclampsia or gestational hypertension and the consumption of folic acid alone during early pregnancy [22]. Three studies from the United States and Canada demonstrated that folic acid-containing multivitamins may greatly reduce the risk of gestational hypertension or preeclampsia.^{23 –24} However, Ray et al²⁵ indicated that mandatory folic acid fortification in 1998 did not result in a significant decline in the rate of gestational hypertension and preeclampsia in Canada. Were folic acid supplementation to decrease the risk of gestational hypertension or preeclampsia, it would have important clinical significance in prevention of these disorders. We used the data from a large population-based cohort study to examine whether a woman’s use of folic acid supplements during early pregnancy is associated with a decreased risk of subsequent gestational hypertension and preeclampsia.

 Aim of study, to assess folic acid in pregnancy.

Objective of study, to identify the relationship between folic acid during pregnancy and preeclampsia and gestational hypertension

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