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What Causes High Folic Acid And High Homocystine Levels?

Posted on Thu, 20 Feb 2014

Question: I have MTHFR c677t hetrozygout mutation I had 2 misscarriage before , Now I am taking Folic acid 5 mg Vit B complex Baby asperin My last blood work shows Very high folic acid and high homocystine , What should i take ? Is this danger if i got pregnant

Answered by Dr. Dattaprasad (44 minutes later)

Brief Answer: No danger for baby if homocystine controlled. Detailed Answer: Hi, Welcome back. Normally MTHFR c677t heterozygous mutation alone should not cause high homocystine levels. She might be having compound heterozygous mutation (that is some other heterozygous mutation along with c677t). High homocystine levels do increase risk of cardiovascular events & risk of abortion. If folic acid & B complex (which should contain Vit B6 & B12) are not able to control homocystine levels, she needs folinic acid (5-methyltetrahydrofolate) supplement. With this, her homocystine level should come down & once it comes down, risks associated with it will be reduced (Including risk of abortion). She needs to continue Baby aspirin, as it will also reduce risk of thrombosis & abortions. Regarding high folic acid levels in blood, its because she is taking folic acid in therapeutic dose & body is not able to efficiently convert it to folinic acid (methyltetrahydrofolate). You can reduce the dose of folic acid to 400/500mcg (0.4/0.5mg) & start methyltetrahydrofolate supplement which should do both jobs (reducing blood folic acid & homocyctine levels). Regarding transmission to baby of the same genes, there is a small chance that both defective genes (if there is a mutation other than c677t) be transmitted, but still baby can lead a normal life. Summarizing plan, you can: 1. Start methyltetrahydrofolate supplement in consultation with your doctor 2. Reduce dose of folic acid to 0.4/0.5mg in consultation with your doctor 3. Continue other medicines (Baby aspirin) Hope this helps you. Let me know if you have other concerns. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dattaprasad (18 minutes later)

Thanks 1/ i did all genetic tests i have only c677t heteozygout 2/ my homocystine was normal 6 months ago when i was taking only 800 mcg folic acid 3/ if homocystine normal and folic acid high is this danger for baby ? 4/ here in my country there is no methyltetrahydrofolate at all 5/ one dr told me that if i got pregnant naturally my baby will be defects , Orher dr said this us not true ! Thanks

Answered by Dr. Dattaprasad (41 minutes later)

Brief Answer: All genetic tests?? Detailed Answer: Welcome back. Whether you have been checked for other MTHFR mutations? Normally these tests are not done for recurrent pregnancy loss. Simple karyotype (which shows chromosomal makeup of an individual) doesn't detect other MTHFR mutations. If methyltetrahydrofolate is not available in your country, you can order it online (It should be available online: checked just now, available on amezon). High homocystine levels can cause placental thrombosis increasing risk of abortion (No risk to baby as such, if effectively countered by baby aspirin & heparin if necessary). If you take methyltetrahydrofolate supplement & are able to control homocystine levels, there should be no risk to baby. What gestational age previous abortions occurred? Whether baby's cardiac activity was documented? Whether you have done other tests for recurrent pregnancy loss? Normally we do following tests in such circumstances: Lupus anticoagulant, Anticardiolipin antibody (IgG & IgM), Anti beta2 glycoprotein, karyotype (Husband & wife, depending on gestational age of abortion, though not absolutely must), VDRL (husband & wife) & Sugar (wife). Kindly let me know details. Awaiting reply. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dattaprasad (13 minutes later)

Thanks dr I did all tests you mention above including karyotype , but only me did them not my husband , The abortions occour at 6-7 weeks , after we heard heartbeats , It starts with bleeding and after days complete abortions , Note : we heard heartbeats by vaginal ultrasound only , Another question My hormones report this month Day 13 E2- 278 ng/ml Progesterone 0.68 pg/ml Day 16 E2 - 58 ng/ml Progesterone 4.6 pg/ml Day 19 Progesterone 25.98 pg/ml My dr said this may be a pregnancy ? Is that true ?

Answered by Dr. Dattaprasad (7 minutes later)

Brief Answer: Hormones indicate ovulation only. Detailed Answer: Welcome back. Your hormone tests indicate good ovulation (they can't predict pregnancy). If you have tried naturally this cycle, there is good chance of pregnancy. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dattaprasad (11 minutes later)

Ok thanks Regarding The abortions occour at 6-7 weeks , after we heard heartbeats , It starts with bleeding and after days complete abortions , Note : we heard heartbeats by vaginal ultrasound only , As all tests normal except MTHFR c677t hetro

Answered by Dr. Dattaprasad (18 minutes later)

Brief Answer: Ok. Detailed Answer: It should be OK. Just take methyltetrahydrofolate supplement if possible. Continue Baby aspirin & pregnancy should continue naturally. You may need little progesterone supplement (vaginal natural micronised progesterone 200-400mg twice daily), to support pregnancy. It is not absolutely must, but in the absence of any other factors explaining pregnancy loss (except MTHFR mutation, which should not cause loss at this early stage), you can take it empirically in consultation with your doctor. Regarding vaginal ultrasound, its most accurate method to assess baby in first 12 weeks of pregnancy. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar