Can someone explain MTHFR to me? - Page 2

[MarineWife]

I did/do take a prenatal but mine has the regular 800 mcg. My OB did prescribe me one that had 1000 mcg but I couldn't take it. It made me too nauseous. In addition to the prenatal vitamin I took 3200 mcg of folic acid when I was pg with my 3rd child. I did not take the extra folic acid when I was pg with my 1st and 2nd children because I didn't know I had a RPL issue or a MTHFR mutation yet. With this pg I have been taking between 800 and 1600 mcg (depending of whether or not I remember) folic acid in addition to the 800 mcg in the prenatal.

FWIW, I saw my MFM doc today and asked if I should continue the extra folic acid. He said that the idea that a MTHFR mutation inhibits folic acid absorption has been recently disproven. In his opinion, the 800 mcg in any regular prenatal was and is enough for me. He did say I should continue with the aspirin for now and we'd re-evaluate when I got to the 3rd trimester.

[blueyezz4]

Originally Posted by MarineWife 

I did/do take a prenatal but mine has the regular 800 mcg. My OB did prescribe me one that had 1000 mcg but I couldn't take it. It made me too nauseous. In addition to the prenatal vitamin I took 3200 mcg of folic acid when I was pg with my 3rd child. I did not take the extra folic acid when I was pg with my 1st and 2nd children because I didn't know I had a RPL issue or a MTHFR mutation yet. With this pg I have been taking between 800 and 1600 mcg (depending of whether or not I remember) folic acid in addition to the 800 mcg in the prenatal.

FWIW, I saw my MFM doc today and asked if I should continue the extra folic acid. He said that the idea that a MTHFR mutation inhibits folic acid absorption has been recently disproven. In his opinion, the 800 mcg in any regular prenatal was and is enough for me. He did say I should continue with the aspirin for now and we'd re-evaluate when I got to the 3rd trimester.

Thanks, that helps!!  I'm so glad you shared the info  you learned just today.  I asked my RE's nurse today and she said that normally when you just have one mutation my RE doesn't normally recommend extra folic acid and as long as I'm getting it in my prenatal that is fine.  I figure I'll still take a little extra on my own which I figure can't hurt.    Once you get into your 3rd Tri. I'd be interested in hearing what they might do different.  Do you have any idea what could change with his re-evaluation at that point in time?

Originally Posted by mariacm 

Yes, I took a prenatal.  Prenate Elite was the brand, bc it has a different (patented) form of folic acid called metafolin in additional to reg folic acid, and the OB believed that bc of that, it was better absorbed and therefore helped maintain the right levels, in addition to the Folgard.

So my regimen during TTC and preg is: 1 Folgard daily, 1 Prenate Elite daily, 2 additional folic acid tablets.  That equals 4 mg of folic acid total, since I have 2 mutations.

The general rule anyway is to take the prenatal 3 months before the preg and then throughout the preg, so whether it's a normal one or a special one, if you're TTC, start taking one.

HTH!

Thanks for the info.  Yes, we've been trying for almost 5 yrs now and I started to take prenatals even a yr before we started trying, so i'm not too worried.  Thanks again!

[MarineWife]

Originally Posted by blueyezz4 

I figure I'll still take a little extra on my own which I figure can't hurt.

Yeah, that's what I think, too. It's a water-soluble vitamin so it's virtually impossible to OD on it. Everyone is always recommending that we take extra B vitamins for energy anyway so what the heck.

Originally Posted by blueyezz4

Once you get into your 3rd Tri. I'd be interested in hearing what they might do different. Do you have any idea what could change with his re-evaluation at that point in time?

I don't really know what the re-evaluation would be. I know it's customary to stop the aspirin once you get close to your EDD so no one has to worry about excessive bleeding during labor and birth. He said I should stay on it because it will help keep the placenta healthy. If I understood what he was inferring, he thinks that a lot of RPL happens because of disorders that cause the body to attack the placenta. He said that's why a woman might have several very early losses, maybe even where an embryo never forms, then have one pregnancy that gets to 15 or 18 weeks and everything looks good and then suddenly there's no heartbeat. When the baby is examined, s/he looks fine. They can't find anything with the baby to indicate why s/he didn't survive. Then it was probably a break down of the placenta. The reason it happened later with that pregnancy is just because sometimes it takes longer for those attacking chemicals to destroy the placenta. That's with auto-immune disorders like anticardiolipin, antiphospholipid something-or-other, lupus and disorders like that and blood-clotting disorders. I guess the aspirin, or sometimes heparin if the blood clotting disorder is serious, helps to combat that. Anyway, it will probably just be him telling when exactly he thinks I can stop taking the aspirin rather than just a vague 3rd trimester.

He also wants me to have extra growth scans and either biophysical profiles or non-stress tests during the 3rd trimester because of my age, my history of RPL and PCOS. He thinks I'm at a higher risk of IUGR (which I guess is related to my age, I'll be 41 when this baby is born) and early placental deterioration. I'm really not concerned about those things as they weren't issue with any of my other pregnancies, unless age is really a huge factor this time. No one else seems to really think it is. This doc is really nice, though. He doesn't pressure me or talk down to me or treat me like I'm doing something irresponsible if I don't submit to all of his tests and screening. He knows I'm reluctant to have all of that done so he said for now we'll just go with the Level II scan and rediscuss things then to see if I want to see him again or if he thinks something has come up that warrants me having to have more observation.

[Charlize]

From my understanding, one should generally take a single low dose aspirin when dealing with MTHFR due to an increased risk of blood clots. A close friend of mine was diagnosed with this and once she found out and took the aspirin daily, she went on to carry a healthy baby. I wish I knew how to contact her still so I could pass along more information to you. Also, someone with MTHFR may be more at risk for such things as a sub chorionic hematoma, which is simply a blood clot between the uterus and placenta. Also, not to scare you and please don't take this the wrong way, but MTHFR has been linked to an increased risk of pre-eclampsia. My current OB and MFM have me on Pre Que 10. It has certain ingredients in it that help prevent pre-eclampsia in those at risk and seems to also have a higher percentage concentration of what we need in general.

Have you had your progesterone tested? Some doctors don't agree on progesterone supplementation, but I suffered three miscarriages before being diagnosed with chronically low progesterone. Since that was discovered, I have carried two of my daughters to term and am on progesterone therapy for my current pregnancy. This pregnancy wasn't planned, so I didn't do the usual Clomid or injections and this pregnancy has been crazy. With the others I was able to stop taking Prometrium at 12 weeks, but my progesterone levels are still low even at 15 weeks so I'm still doing 200 mg daily of Prometrium and weekly progesterone injections.

Thinking of you!

[blueyezz4]

Charlize - Sorry it took me this long to get back to you!!  Anyways, I'm almost positive that I've had everything under the sun checked at this point in time.  When we actually got pregnant w/ a medicated IUI with our twin boys that we lost (@22.5wks)  they didn't have me on progesterone ever and checked it with my first 2 hcg levels and it was fine.  I didn't even need to supplement at all with that pregnancy.  With this last pregnancy via IVF they started me on progesterone right around the transfer time, but didn't ever check it after getting pregnant.  The next time we get pregnant I think I'll ask for it to be checked just to be sure.  Can you have too much progesterone in your system do you know?  Thanks again for the info and sharing your story.

[susanwhelan]

Hi, I work with Neevo. There is a great deal of information here, maybe I can provide some additional insight?

As you know, MTHFR is a genetic classification. In a practical sense, it refers to the amount of MTHFR enzyme in your body. Having MTHFR is an indication that you may be limited in the value you get from traditional folic acid. You should seek folate support through diet and/or a more modern source of supplementation such as L-methylfolate or metafolin. Modern prenatal vitamins have begun to include active L-methylfolate to help patients with MTHFR. 

There are two classifications of MTHFR, homozygous and heterozygous. Homozygous MTHFR is either CC or TT. Approximately 50% of the population is CC and considered "normal". This group has an ample amount of the MTHFR enzyme and can easily process folic acid into L-methylfolate. About 10% of the population is TT. This group has less than 30% of the normal amount of MTHFR enzyme and cannot process folic acid very effectively. These patients tens to be at risk for adequate folate status. The remaining 40% of the population is heterozygous or CT. This group has between 30-70% of normal MTHFR enzyme and their folate status falls somewhere between the two groups listed above.

This chart shows the methylation cycle and how & where the MTHFR enzyme limits processing of folic acid into active L-methylfolate: http://www.neevoprenatal.com/MethylationCycle

I hope this information helps!

[blueyezz4]

Originally Posted by susanwhelan 

Hi, I work with Neevo. There is a great deal of information here, maybe I can provide some additional insight?

As you know, MTHFR is a genetic classification. In a practical sense, it refers to the amount of MTHFR enzyme in your body. Having MTHFR is an indication that you may be limited in the value you get from traditional folic acid. You should seek folate support through diet and/or a more modern source of supplementation such as L-methylfolate or metafolin. Modern prenatal vitamins have begun to include active L-methylfolate to help patients with MTHFR. 

There are two classifications of MTHFR, homozygous and heterozygous. Homozygous MTHFR is either CC or TT. Approximately 50% of the population is CC and considered "normal". This group has an ample amount of the MTHFR enzyme and can easily process folic acid into L-methylfolate. About 10% of the population is TT. This group has less than 30% of the normal amount of MTHFR enzyme and cannot process folic acid very effectively. These patients tens to be at risk for adequate folate status. The remaining 40% of the population is heterozygous or CT. This group has between 30-70% of normal MTHFR enzyme and their folate status falls somewhere between the two groups listed above.

This chart shows the methylation cycle and how & where the MTHFR enzyme limits processing of folic acid into active L-methylfolate: http://www.neevoprenatal.com/MethylationCycle

I hope this information helps!

So can someone that is Herterozygous also benefit from something like L-methylfolate?  I'm assuming you have to have a script from your OBGYN for something like this and is it covered by insurance? Also, is this taken in addition to a prenatal vitamin or instead?

[swsmissus]

There are WAY more ramifications to all the MTHFR issues, and tons of information on the web on it. Depending on the type of genetic mutation you have, folic acid is NOT the treatment for it, and if your Dr. is prescribing this you may want to do some more research on your own. Methylated Folate or methylfolate (and there are some different brands) .  The body isn't converting things properly in the metabolic cycle, hence the reason for the methylated folate as treatment.

My 19 year old daughter has had what has looked like either chronic fatigue or fibromyalgia for years and years, getting worse all the time. We've tried a million different things, only to find out that she has MTHFR.  Clotting (and therefore pregnancy issues) and other vascular problems (stroke, arteriosclerosis) are only one tiny part of the many symptoms/problems when this genetic mutation exists.

:)
 

evy