Relationship between the plasma total homocysteine levels and skipping breakfast during pregnancy

Abstract

Purpose
The frequency of skipping breakfast among reproductive-age women has been increasing in Japan. Skipping breakfast was reported to result in low intake of several nutrients including folate and vitamins required for fetal development and the prevention of pregnancy complications. A high total homocysteine (tHcy) level, which occurs in association with a folate and vitamin B₁₂ deficiency, can lead to adverse perinatal outcomes. The aim of this study was to examine whether skipping breakfast during pregnancy is associated with the folate and vitamin B₁₂ intake, circulating tHcy, folate and vitamin B₁₂ levels.
Methods
Two hundred and fifty-four healthy women with a singleton pregnancy (age: 30.4±4.7, gestational age: 27.5±9.6 weeks) were recruited from a prenatal clinic in metropolitan Tokyo, Japan. The plasma tHcy, serum folate and vitamin B₁₂ levels were measured. The nutrient intake was assessed using a self-administered diet history questionnaire. Information on lifestyle factors relevant to tHcy levels and skipping breakfast was obtained from the questionnaire. We defined skipping breakfast as forgoing breakfast including a staple food, such as rice or bread, more than twice a week during the preceding 1-month period. A multiple regression analysis was performed to determine whether skipping breakfast was associated with plasma tHcy levels, after adjusting for confounding variables.
Results
Thirty percent of the participants skipped breakfast more than twice a week. The rate of primipara was higher than multipara among breakfast skippers (p=0.005). Skipping breakfast was associated with high plasma tHcy levels among the pregnant women after adjusting for confounding factors, including serum folate and vitamin B₁₂ levels (p=0.024). Meanwhile, there were no significant differences in the energy-adjusted intake of folate and vitamin B₁₂ or in serum folate and vitamin B₁₂ levels between the breakfast skippers and the non-skippers.
Conclusion
The relationship between the plasma tHcy levels and skipping breakfast could not be explained by the low levels of serum folate and vitamin B₁₂ among the breakfast skippers, in contrast to our hypothesis. However, our results indicated that any factors relevant to skipping breakfast may affect the tHcy levels during pregnancy. Therefore, health care providers may need to pay closer attention to whether pregnant women have breakfast or not, in order to prevent increased tHcy levels.