Let’s talk about….. Miscarriage

About 10% of known pregnancies end in miscarriage and that increases to 20% if you include unknown pregnancies.

Most early miscarriages occur because of chromosomal abnormalities in either the egg or sperm.  Yes, sperm aneuploidy exists, which is evidence that it is not only the health of the mother and her eggs that affects whether a pregnancy is viable or not, but also the health of the father and his sperm.

Your eggs and sperm are at a higher risk of chromosomal damage if they are exposed to radiation, think pelvic x-rays, laptops on laps, mobile phones in pockets.  Also, nutrient deficiencies play a role with zinc and selenium deficiency a cause of chromosome changes due to the fact they are an essential component of genetic material.  Therefore, zinc and selenium deficiencies (amongst other nutrients) are a direct cause of miscarriage.

A recent study showed that low total antioxidant status is associated with miscarriage [1]   CoQ10 is an excellent antioxidant, often used by women who are trying to conceive.  In naturopathic medicine, it is especially recommended for older mothers aged 35+.

Are you taking the right type of folate?

Most people confuse the word folate with folic acid and assume that folic acid comes from food but it does not.  There are 3 types of folate:

Folic acid is the cheap, synthetic form found in supplements.

Folinic acid is an active form found in supplements and food.

5-methyltetrahydrofolate (5-MTHF) is the most active form of folate found in supplements and food like green, leafy vegetables.

You may have heard of the acronym MTHFR.  This is an enzyme which is ultimately responsible for remethylating homocysteine into methionine which probably sounds all a bit scientific and boring so let me explain how this relates to pregnancy and your risk of miscarriage and neural tube defects. 

When you go for an MTHFR blood test they will generally be checking for 2 genetic polymorphisms – C677T and A1298C.   You can be either homozygous (inherited from both parents) or heterozygous (inherited from one parent).  

Taking a preconception vitamin that contains active folate, zinc, selenium and CoQ10 amongst other essential nutrients is a good idea for at least 3-4 months prior to conception.

Neural tube defects

C677T is the one we are most interested in when it comes to folic acid metabolism because if you are homozygous you have a 70% reduction in your ability to metabolise folic acid into the active form of folate (this is why those women will be prescribed 5mg of folic acid by their obstetrician) and if you are heterozygous you have a 40% reduction in your ability to metabolise folic acid into the active form (5-MTHF).

So basically what this means is, if you are homozygous, then you will still have a high risk of a neural tube defect if you are taking a standard prenatal multivitamin that contains 500mcg of folic acid.  However, if you take a supplement containing 500mcg of 5-MTHF, your risk is reduced (although you will still need to seek professional advice as 500mcg of 5-MTHF is unlikely to be enough for you).  NaturoBest prenatal vitamins are the only prenatal supplements on the Australian and New Zealand markets that contain 500mcg of 5-MTHF as Quatrefolic®.

Miscarriage

Let’s get on to this homocysteine methylation.   Homocysteine is an amino acid that naturally occurs in the body and high levels lead to thrombophilia, i.e. an increased risk of blood clotting which is a cause of miscarriage.   High homocysteine later on in life leads to an increased risk of heart attacks and stroke so it’s important at all stages of life to keep this under control. Amongst other nutrients, we need adequate levels of vitamins B6, B12 and folate to ensure homocysteine levels stay in the normal range. 

It has been found that those people who are homozygous for C677T or heterozygous for both C677T and A1298C are at an increased risk of high homocysteine levels and the risks associated with that.

If you are homozygous for MTHFR C677T, you may be interested in a study that showed 800mcg of Quatrefolic® was better than 5mg of folic acid in reducing the risk of miscarriage.

I hope it is starting to become clear to you that there is a lot to take into consideration when preparing to have a baby.  A preconception care plan for both partners is vital when planning a baby and should be commenced 4 months prior to conception for the best chance of a successful pregnancy and a healthy baby.

Reference

1. Omeljaniuk, W.J., et al., Antioxidant status in women who have had a miscarriage. Adv Med Sci, 2015. 60(2): p. 329-34.