ASSESSMENTS OF VITAMIN B12 AND FOLIC ACID STATUS AMONG DISPLACED PREGNANT WOMEN ATTENDING ANTENATAL CARE CLINIC IN DOMIZ CAMP OF A SYRIAN REFUGEES /KURDISTAN REGION, IRAQ

Background: Vitamin B12, folic acid and their relevant biomarkers are essential micronutrients for healthy fetal growth and development. Thus, deficiency in the levels of these vitamins and relevant biomarkers during pregnancy leads to many adverse outcomes such as neural tube and neurological problems for both mother and fetus. Objective: The current research project was undertaken to detect the status of vitamin B12, Folic acid and relevant biomarkers such as Homocysteine, Methylmalonic acid and Holotranscobalamin among displaced pregnant women attending antenatal care in Domiz Camps Clinic of Syrian refugees. Methods and Subjects: This cross-sectional research was performed at Syrian refugee’s camps in DomizDuhok City, Kurdistan Region, Iraq, from February 2019 until June 2019. This study included 540 pregnant women whose ages ranged between 15-44 years. Participants were subdivided into three groups based on their trimesters. Each group included 180 pregnant women. Vitamin B12 and folic acid were measured by Automatic Clinical Chemistry Analyzer COBAS 6000 while Methylmalonic acid (MMA), Homocysteine (Hcy), and Holotranscobalamin (HoloTc) were measured by ELISA. Results: The results of the current study revealed that the prevalence of vitamin B12 insufficiency (<200 pg/mL) was high across all three trimesters, which constitutes 73% in the total cohort. The mean vitamin B12 (pg/mL) during 1st semester was within the normal range (226.5± 6.95), whereas during the 2nd and 3rd semesters it was highly significantly (P<0.0001) low (179.25± 4.52 and 151.60±4.32, respectively). Prevalence of folic acid (ng/ml) insufficiency (<3.8 ng/mL) was 11.5% in total studied subjects and means of folic acid during the 3 semesters were 11.2± 0.41, 11.0± 0.41 and 9.2±0.41), respectively. Methylmalonic acid levels (umol/L) also showed a highly significant (P < 0.001) differences between the three semesters. The mean MMA levels during the three semesters were 0.130±0.003, 0.142±0.002, and 0.154± 0.003, respectively. Whereas homocysteine (umol/L) showed non-significant (P=0.2085) differences between all trimesters; and their levels were 7.6± 0.45, 8.0± 0.39, and 8.6± 0.42. respectively. Furthermore, Holotranscobalamin also showed a non-significant (P=0.883) difference between studied trimesters; and its level during the three trimesters was 137.4± 2.86, 135.1± 3.25 and 137.16± 4.20 pmol/l, respectively. From the total sum, 22.2% of the total pregnant women showed an increased MMA level (more than 0.280 umol/l), and 18.5% of the total participant showed an elevated level of Hcy (more than 15 umol/l). Whereas only 7.9% of 540 pregnant women showed low level of HoloTc less than 40 pmol/l. From the total cohort, only 7.03% showed combining lowered HoloTc level plus elevated MMA and Hcy level which indicates the manifestation of vitamin B12 deficiency during pregnancy. Conclusion: From the results of the current study, it can be concluded that the levels of maternal Vit B12 and folic acid significantly decrease at the last trimesters. Vitamin B12 deficiency was prevalent in the studied subjects, while folic acid insufficiency was relatively uncommon. Furthermore, levels of HoloTc plus MMA and Hcy can be considered as an accurate diagnostic indicator during pregnancy.