Uterine Fibroids and Low Folate Linked to Higher Risk of Hypertensive Disorders of Pregnancy
Hypertensive disorders of pregnancy co-occur with uterine fibroids and low maternal folate levels, according to a cross-sectional secondary analysis published in Placenta on October 22, 2026. Researchers Ananya S. Dewan, Mengmeng Li, Xiaobin Wang, and Katherine Cameron evaluated data from the Boston Birth Cohort to determine whether micronutrient biomarkers modify the association between benign pelvic tumors and hypertensive disorders of pregnancy.
- The study analyzed 722 participants from the Boston Birth Cohort, identifying uterine fibroids in 12 percent of patients and hypertensive disorders of pregnancy in 10 percent.
- Patients in the lowest folate quartile faced a significantly higher odds ratio of 2.35 for hypertensive disorders of pregnancy compared to those in the highest quartile.
- Women presenting with both uterine fibroids and low folate showed higher odds of hypertensive disorders of pregnancy at an odds ratio of 1.84 compared to participants without fibroids and with adequate folate.
Boston Birth Cohort Findings on Biomarkers and Pregnancy Blood Pressure
The investigation examined maternal plasma folate, vitamin B12, homocysteine, and cord blood vitamin D to clarify why benign pelvic tumors confer a two-to three-fold higher risk for hypertensive disorders of pregnancy. Hypertensive disorders of pregnancy affect approximately one in seven delivery hospitalizations in the United States, and constitute a leading cause of maternal and fetal morbidity and mortality globally. While previous clinical observations established that uterine fibroids correlate with these vascular complications, the precise biological pathways involving circulating micronutrients remained poorly understood.
Evaluating continuous biomarker measurements and quartile distributions across 722 diverse participants revealed distinct nutritional gradients. Out of the total cohort, 87 individuals lived with uterine fibroids, while 72 experienced hypertensive disorders of pregnancy. While individual nutritional biomarkers did not differ significantly by baseline fibroid status alone, systemic metabolic indicators showed clear divergence regarding blood pressure outcomes.
Low Folate and High Homocysteine Increase Pregnancy Hypertension Risk
Patients in the lowest quartile of plasma folate faced an odds ratio of 2.35 for developing hypertensive disorders of pregnancy, matching a similar elevation seen among individuals in the highest homocysteine quartile, where the odds ratio reached 2.36. Folate and vitamin B12 act as cofactors in homocysteine metabolism, meaning that deficiencies in these nutrients can lead to elevated homocysteine concentrations and subsequent endothelial injury. Because endothelial dysfunction and inadequate uteroplacental perfusion are likely multifactorial components of the pathophysiology of hypertensive disorders of pregnancy, researchers investigated whether nutritional status directly modified the fibroid-associated vascular risk.
Joint-effects analyses demonstrated that women with both uterine fibroids and low folate levels experienced heightened odds of hypertensive disorders of pregnancy at an odds ratio of 1.84. However, formal interaction tests between individual nutritional biomarkers and uterine fibroids yielded no statistically significant effect modification. This indicates that while both conditions independently compound vascular vulnerability, low folate does not mathematically alter the biological mechanism linking fibroids to hypertensive disorders of pregnancy.
Postpartum Blood Samples Prevent Establishing Temporality of Results
Summaries emphasize that because the study relied on a cross-sectional secondary analysis with maternal blood samples collected postpartum, investigators could not establish temporality. The collection window prevents determining whether changes in folate levels preceded the onset of clinical hypertension during gestation. While the Boston Birth Cohort provides a racially and ethnically diverse population—addressing historical gaps in nutritional research regarding minority women disproportionately affected by hypertensive disorders of pregnancy—the results require validation in other populations.
Prospective clinical studies in early pregnancy must now evaluate whether tracking uterine fibroid presence alongside maternal folate status can effectively inform risk assessment.
Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.