Nutrient Deficiency And Related Factors In Patients With Recurrent Miscarriage

ObjectiveThe study starts multi-center cohorts of unexplained recurrent,recording the related medical history and detecting their concentration of vitamin B1,vitamin B2,vitamin B3,folic acid and their metabolites in red blood cells or plasma.The study aims to investigate whether recurrent miscarriage is related to the level of these vitamins in vivo.MethodThe study involved Peking Union Medical College Hospital(PUMCH)and seventeen gynecology and obstetrics departments in Beijing.Patients fulfilled the criteria of unexplained recurrent pregnancy loss(RPL)were enrolled in our study.The control group consisted of women participating in pre-marital health check-ups.Baseline data was collected as well as their fasting venous blood samples.The samples were dispensed into cooperating units at a uniform location for testing the concentration of thiamine,riboflavin,folic acid,niacin and its metabolites in red cells and plasma.We analyzed the variance of detected results between the RPL group and control group by T test and analysis of variance.Besides,the variance of vitamins among subgroups in the study group were also analyzed and discussed.Result675 people were recruited,including 226 in the RPL group and 449 in the controls.In the study group,221 women never received detection of somatic cell’s chromosome abnormalities as well as their couples,3 women reported with abnormal chromosomes carried by themselves or by their husbands,1 reported with uterine septum,6 were non-fasting when their blood samples were drawn.In the end,the samples of 219 enrolled patients were selected and detected.Among them,the number of women who did not take folic acid or multivitamins in the past 3 months was 93,while 104 women took regular folic acid in the past 3 months,and 98 women took regular multivitamin supplements in the past 3 months.70 women took both of them.The average age of the study group was 31.90-32.89 years old,and the average pregnancy losses were 2.6.For the control group,the average age was 27.54-27.74 years old.According to the detection results,the NMN concentrations in red cells were higher than those in plasma.On the contrast,RBC 2-PY levels in recurrent miscarriage women was those in control specimens,especially in specimens dispensed the next day they were collected.After adjusting the age,from the average point of view,the lower concentration of RBC NMN and higher plasma 2-PY level compared to the controls still existed.Although the probability test showed no significantly difference,the small sample size and large standard errors in our data indicated it’s worth more exploration.Plasma NAD,2-PY levels of RPL women are significantly higher than those of controls.In analysis between controls adjusted for ages and non-vitamins-taken RPL women group,the RBC NMN levels don’ s show any significant difference.However,plasma 2-PY and plasma 4-PY of RPL women are still higher than those of controls.The multivariate analysis for uterine surgery,BMI,and number of repeated miscarriages showed they had no significant influence on the concentration of these vitamins and their metabolites.SummaryMultiple subgroup analyses have shown that the content of 2-PY in red blood cells of RPL women were higher than those of controls,while the content of 2-PY and 4-PY in plasma exceeds the upper limit in repeated abortions,and the effect of intrauterine surgery,BMI,and number of repeated abortions could be ignored.The concentration of TPP,FAD and 5MTHF in red blood cells did not show significant difference between the recurrent abortion group and the control group.Corollary:There may be a certain degree of NAMPT(Nicotinamide Phosphoribosyltransferase)deficiency in the repeated abortion group,which leads to the continued reduction of the content of NMN in the repeated abortion group,and the rise of the metabolites 2-PY,4-PY in the NAD consumption pathway.