Аңдатпа
Introduction.Preeclampsia remains one of the leading causes of maternal and perinatal morbidity worldwide. Accumulated evidence indicates that disturbances in folate metabolism and elevated homocysteine levels may contribute to the development of hypertensive disorders of pregnancy. This study evaluated the effectiveness of long-term folic acid supplementation for the prevention of preeclampsia in pregnant women with and without polymorphisms in folate cycle genes.Methods.A single-center randomized controlled study included 320 women in the control group (folic acid intake until 12 weeks of gestation) and 894 women in the main group (folic acid intake throughout pregnancy). The main group was stratified by dosage: 400 μg, 800 μg, and 1200 μg. Clinical, biochemical, and genetic assessments were performed, including measurement of homocysteine levels and genotyping of MTHFR, MTR, and MTRR polymorphisms. Pregnancy outcomes and the incidence of hypertensive complications were compared between groups.Results.Long-term folic acid supplementation was associated with a lower overall incidence of hypertensive disorders of pregnancy compared with the control group (RR 1.43; p = 0.038). The incidence of preeclampsia was 1.67 times lower in the main group, indicating a favorable trend. No significant differences in blood pressure dynamics or perinatal outcomes were found among groups receiving different folic acid doses. Homocysteine levels were significantly higher in all women who subsequently developed preeclampsia, regardless of folic acid dosage. Genotype distribution demonstrated population-specific frequencies of MTHFR and MTR polymorphisms; however, no clear dose–response relationship was observed.Conclusion.Long-term folic acid supplementation reduces the risk of hypertensive disorders of pregnancy, including a tendency toward a decreased incidence of preeclampsia, and is safe at all studied doses. The potential benefit is particularly relevant for populations with a high prevalence of genetic variants affecting folate metabolism. Further multicenter randomized studies are required to determine the optimal dosage and duration of supplementation.Keywords:preeclampsia, folate cycle, folic acid.