The role of maternal serum homocysteine level in early onset preeclampsia for prediction of severity of disease
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20242790Keywords:
Maternal serum, Homocysteine level, PreeclampsiaAbstract
Background: This study was conducted to observe the relationship between high serum homocysteine levels and preeclampsia with severe features among preeclamptic pregnant women of 20-34 weeks of gestation.
Method: This study was a hospital based a prospective cohort study and was conducted in Department of Obstetrics and Gynaecology in Dhaka Medical College. A total of 110 preeclamptic pregnant women of 20-34 weeks of gestational age were taken and data were collected after taking an informed written consent. After diagnosis of preeclampsia, I gave them some investigations like CBC, SGPT, S. Creatinine and S. Homocysteine. The patients were divided into two groups that is normal homocysteine level (Group-I) and elevated/high homocysteine level (Group-II) and then the patients were followed up by me at 2 to 4 weekly interval or more frequent if needed.
Result: Among 110 preeclamptic women, mean age of the them was 27.2±6.84 (SD) years and gestational age was 28.0±2.58 (SD) weeks when patients developed preeclampsia without severe features. Majority were nullipara (51.8%) and overweight (54.5%). The mean BMI of the preeclamptic women were 28.2±3.46 kg/m2. The median (IQR) Homocysteine level was 11.4 (6.7-16.8) μmol/l and Hyperhomocysteinemia was reported in 31.8% of pregnant women. A cut-off value of homocysteine level≥15.3 μmol/l showed sensitivity, specificity, NPV, PPV and accuracy 91.3%, 83.9%, 60%, 97.3% and 85.4%, respectively to correctly predict preeclampsia with severe features. Homocysteine level was significantly associated with preeclampsia with severe features (p<0.05) and was higher in severe preeclamptic women (91.3%). The homocysteine level was higher in patients with severe features, median-18.3 (17.6-19.4) than without severe features median 9.14 (6.68-13.5). Women with Hyperhomocysteinemia had also greater fetal complications, FGR 20%, oligohydramnios 22.9%). The relative risk ratio of development of preeclampsia with severe features was 22.5, among the preeclamptic women having S. homocysteine level ≥15.3 µmol/l.
Conclusion: The study shows that increased maternal serum homocysteine level at 20-34 weeks gestation in preeclampsia without severe features pregnant lady is a predictor of subsequent development of preeclampsia with severe features.
References
Maru L, Verma M, Jinsiwale N. Homocysteine as predictive marker for pregnancy-induced hypertension-a comparative study of homocysteine levels in normal versus patients of PIH and Its complications. J Obstet Gynecol India, 2016;66(1):167-71.
Cindrova, DT. Pre-eclampsia from placental oxidative stress to maternal endothelial dysfunction. Gabor Than Award Lecture 2009;30(3):55-65.
Von DP, Magee LA, Taylor EL, Muir JC, Stewart SD, Sherman P, et al. Maternal hypertension and neonatal outcome among small for gestational age infants. Obstet Gynecol. 2005;106(2):335-9.
World Health Organization. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNIFPA and the World Bank. Geneva; 2007.
World Health Organization. Fact Sheet. 2012. Available at: https://www.who.int/news-room/fact-sheets.
Kathleen A, Pennington Schlitt JM, Jackson DL, Schulz LC, Schust DJ. Preeclampsia: multiple approaches for a multifactorial disease, disease models and mechanisms. 2012;5(1):9-18.
Welch GN, Loscalzo J. Homocysteine and Atherothrombosis. N Engl J Med. 1998;9(4):1042–50.
Nygard O, Vollset SE, Refsum H, Brattstrom L, Ueland PM. Total homocysteine and cardiovascular disease. J Intern Med. 1999;246(5):425-54.
Miner SE, Evrovski J, Cole DE. Clinical chemistry and molecular biology of homocysteine metabolism: An update. Clin Biochem. 1997;30(3):189-201.
Chaudhry SH, Taljaard M, MacFarlane AJ, Gaudet LM, Smith GN, Rodger M, et al. The role of maternal homocysteine concentration in placenta-mediated complications: Findings from the Ottwawa and Kingston birth cohort. BMC Pregnancy Childbirth. 2019;19(7):1-10.
Pathania K, Verma, S.K., Chamotra, S., Chaudhary, A. Can serum homocysteine predict hypertensive disorders of pregnancy?: An evidence from a case control study in a North Indian tertiary health care institution. Int J Reprod Contracept Obs Gynecol, 2019, 8(1), 3117–22.
Yelikar, K., Deshpande, S., Kulkarni, M. Association of maternal serum homocysteine level with severity of preeclampsia: A case control study. Int J Reprod Contraception, Obstet Gynecol. 2016;5(8):2713-8.
Cotter AM, Molloy AM, Scott JM, Daly SF. Elevated plasma homocysteine in early pregnancy: A risk factor for the development of severe preeclampsia. Am J Obstet Gynecol. 2001;185(4):781-85.
Seid JEH, Ghorbali F, Sarookhani M, Javadi A, Mashrabi O. The relationship between the level of homocysteine in mother’s serum and the intensity of preeclampsia. Life Sci J. 2012;9(4):1247-9.
Thilaganathan B, Ralph E, Papageorghiou AT, Melchiorre K, Sheldon J. Raised maternal serum cystatin C: An early pregnancy marker for preeclampsia. Reprod Sci. 2009;16(8):788-93.
Osanyin GE, Okunade KS, Ayotunde OA. Association between serum CA125 levels in preeclampsia and its severity among women in Lagos, South-West Nigeria. Hypertens Pregnancy. 2018;37(2):93-7.
Oluwole AA, Nwogu CM, Sekumade A, Ajepe A, Okunade KS. Association between serum homocysteine levels in preeclampsia and its severity among women in Lagos, South- West Nigeria. West Afr J Med. 2020;37(1):246–52.
Bergen NE, Jaddoe VW, Timmermans S, Hofman A, Lindemans J, Russcher H, et al. Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: The generation R study. BJOG. An Int J Obstet Gynaecol. 2012;119(6):739-51.
Visternicean E. Homocysteine and Recurrent Miscarriage. Mold Med J. 2017;60(1):15-9.
Dekker GA, Vries JIP, Doelitzsch PM. Underlying disordres associated with severe early-onset preeclampsia. Am J Obstet Gynecol. 1995;172(1):281.
Mignini LE, Latthe PM, Villar J, Kilby MD, Carroli G, Khan KS. Mapping the theories of preeclampsia: The role of homocysteine. Obstet Gynecol. 2005;105(2):411-25.
Jahan SA, Reaz N, Khanam S, Asaduzzaman M, Parvin Z, Banu DS. Serum Homocystine level in women with severe preeclampsia. Ibrahim Card Med J. 2015;5(1):54-60.
Acilmis YG, Dikensoy E, Kutlar AI, Balat O, Cebesoy FB, Ozturk ZGG, et al. Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension. Am J Obstet Gynecol. 2003;189(2):574-6.
Ghike S, Jain S, Kumare B, Gupta M, Shembekar C, et al. A study of serum homocysteine levels during normal pregnancy and pre-eclampsia. J SAFOG. 2011;3(2):71-4.
Lindblad B, Zaman S, Malik A, Martin H, Ekstrom AM, Amu S, et al. Folate, vitamin B12, and homocysteine levels in South Asian women with growth- retarded fetuses. Acta Obstet Gynecol Scand. 2005;84(11):1055.
