From the Research
Women with a heterozygous MTHFR mutation should take a standard prenatal vitamin containing 400-800 mcg of folic acid during pregnancy, and may also benefit from low-dose aspirin and low-molecular-weight heparin to reduce the risk of preeclampsia and other placenta-mediated complications, as suggested by the most recent study 1. The MTHFR mutation affects folate metabolism, which is crucial for DNA synthesis and repair, methylation processes, and neurotransmitter production, explaining why severe deficiencies can impact pregnancy outcomes and maternal health. Some key points to consider:
- The MTHFR mutation reduces the efficiency of the MTHFR enzyme, which can mildly affect folate metabolism and homocysteine levels 2.
- Heterozygous carriers generally don't need additional supplementation unless they have elevated homocysteine levels or previous pregnancy complications 3.
- Low-molecular-weight heparin use was associated with a significant reduction in the risk of preeclampsia and other placenta-mediated complications in high-risk women, particularly when treatment was started before 16 weeks' gestation 1.
- The combination of low-dose aspirin and low-molecular-weight heparin was associated with a significant reduction in the risk of preeclampsia compared with low-dose aspirin alone 1.
- Methylfolate (400-800 mcg daily) may be recommended instead of folic acid as it bypasses the partially impaired enzymatic pathway 4. During the postpartum period, heterozygous MTHFR mutation carriers have a slightly increased risk of thrombosis, but this alone rarely warrants anticoagulation therapy. Most women with heterozygous MTHFR mutations have normal pregnancies and postpartum periods without complications. However, in cases of recurrent miscarriages, treatment with low-dose aspirin, enoxaparin, and folic acid may be effective in improving pregnancy outcomes 3. It's essential to note that the quality of evidence for these recommendations ranges from very low to moderate, and therefore, these results merit confirmation in large well-designed clinical trials 1.