Hyperhomocysteinemia in pre-eclampsia: is routine screening rational?
Keywords:Homocysteine, Pre-eclampsia, Pregnancy
Background: Hypertensive disorders complicate upto 5 to 10% of all pregnancies. Though the exact cause of pre-eclampsia is still undecided, maternal hyperhomocysteinemia has been implicated as a risk factor for pre eclampsia, placental abruption and other vascular diseases. The objectives of present study were to estimate the levels of serum homocysteine in antenatal patients and to study the above parameters in patients of pre-eclampsia.
Methods: A prospective observational study was performed with 30 pre eclamptic patients and an equal number taken as control having comparable demographic characteristics. Level of homocysteine was measured by an enzymatic method, using Diazyme homocysteine 2 reagent enzymatic assay kit on Beckman coulter analyzer in all the patients. Obstetrics and neonatal outcomes were observed in all the patients. The statistical analysis was done using unpaired T test for determining level of significance.
Results: Mean Serum homocysteine in the study group was 13.99±5.46 µmol/l and was 6.03±2.58 µmol/l in control group. This was statistically significant (p value 0.002). However the mean values of serum homocysteine did not correlate with severity of pre-eclampsia 14.32±6.72 µmol/l in mild pre-eclampsia and 13.60±3.77μmol/l in severe pre-eclampsia respectively (p value - 0.727).
Conclusions: It appears that maternal serum homocysteine has a causal role in pathogenesis of pre eclampsia, however to recommend it as a routine test, larger studies are required.
Cunningham FG. Pregnancy hypertension. Willams Obstetrics. 23rd Edition. Mc Graw Hill: London; 2011:706.
Pregnancy Mortality Surveillance System. Available from:http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html.
Qureshi SB, Ahmad M, Qureshi PM, Memon A, Qazi RA. Hyperhomocysteinaemia, vascular related pregnancy complications and to response to vitamin supplementation in pregnant women of Pakistan. J Pak Med Assoc. 2010;60(9):741-5
Mital P, Mital P, Hooja N, Sangita H, Gupta D. Association between Serum Homocysteine Concentration in Pregnant Women and Neonatal Birth Weight. Sch. Acad. J. Biosci. 2015; 3(2A):161-5.
Hoque MM, Bulbul T, Mahal M, Islam N, Ferdausi M. Serum homocysteine in pre-eclampsia and eclampsia. Bangladesh Med Res Counc Bull. 2008;34:16-20.
Khosrowbeygi A, Ahmadvand H. Circulating levels of homocysteine in preeclamptic women. Bangladesh Med Res Counc Bull. 2011;37:106-9.
Patel AP, Chakrabarti C, Singh A, Patel JD, Mewada HA, Sharma SL. Effect of Homocysteine, Vitamin B12, Folic acid during pregnancy. NHL J Medic Sci. 2012;1:1-27.
Mujawar SA, Patil VW, Daver RG. Study of serum homocysteine, folic acid and vitamin B12 in patients with preeclampsia. Indian J Clin Biochem. 2011;26(3):257-60.
Braekke K, Ueland PM, Harsem NK, Karlsen A, Blomhoff R, Staff AC. Homocysteine, cysteine, and related metabolites in maternal and fetal plasma in preeclampsia. Pediatric Research. 2007;62:319-24.
Makedos G, Papanicolaou A, Hitoglou A, Kalogiannidis I, Makedos A, Vrazioti V et al. Homocysteine, folic acid and B12 serum levels in pregnancy complicated with preeclampsia. Arch Gynecol Obstet. 2007;275(2):121-4.
Zeeman GG, Alexander JM, McIntire DD, Devaraj S, Leveno KJ. Homocysteine plasma concentration levels for the prediction of preeclampsia in women with chronic hypertension. Am J Obstet Gynecol. 2003;189(2):574-6.
Hietala R, Turpeinen U, Laatikainen T. Serum homocysteine at 16 weeks and subsequent pre-eclampsia. Obstet Gynacol. 2001;97:527-29.
Şanlıkan F, Tufan F, Göçmen A, Kabadayı C, Şengül E. The evaluation of homocysteine level in patients with preeclampsia. Ginekol Pol. 2015;86(4):287-91.
Qureshi SB, Ahmad M, Qureshi PM, Memon A, Qazi RA. Hyperhomocysteinaemia, vascular related pregnancy complications and to response to vitamin supplementation in pregnant women of Pakistan. J Pak Med Assoc. 2010;60(9):741-5.