DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201212

Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

Shaina Chamotra, Kushla Pathania, S. K. Verma, Ankit Chaudhary

Abstract


Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.

Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.

Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.

Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.


Keywords


Abnormal homocysteine, Cohort study, Foeto-maternal outcomes, Pregnancy

Full Text:

PDF

References


Mignini LE, Latthe PM, Villar J, Kilby MD, Carroli G, Khan KS. Mapping the theories of preeclampsia: the role of homocysteine. Obstet Gynecol. 2005;105:411-25.

Hoque MM, Bulbul T, Mahal M, Islam NA, Ferdausi M. Serum homocysteine in preeclampsia and eclampsia. Bangladesh Med Res Counc Bull. 2008;34:16-20.

Vollset SE, Refsum H, Irgens LM, Emblem BM, Tverdal A, Gjessing HK, et al. Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study. Am J Clin Nutr. 2000;71:962-8.

Nelen WL, Blom HJ, Steegers EA, den Heijer M, Thomas CM, Eskes TK. Homocysteine and folate levels as risk factors for recurrent early pregnancy loss. Obstet Gynecol. 2000;95:519-24.

Dutta DC. Textbook of Obstetrics. 9th Ed. Jaypee Brothers Medical Publishers; 2015:217-220.

Arun M, Gopinath M, Nirmala C. Prevalence of hyperhomocysteinemia among preeclampsia patients. J Med Sci Clin Res. 2017;05(04):21063-9.

Pathania K, Verma SK, 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 Obstet Gynecol. 2019;8:3117-22.

Jaiswal N, Agrawal A, Agrawal S, Das V, Pandey A, Singh R. Correlation of serum homocysteine levels and pregnancy outcome: the dilemma continues. Int J Reprod Contracept Obstet Gynecol. 2016;5:391-5.

Mascarenhas M, Habeebullah S, Sridhar MG, Revisiting the role of first trimester homocysteine as an index of maternal and fetal outcome. J Preg. 2014:2014.

Gaiday AN, Tussupkaliyev AB, Bermagambetova SK, Zhumagulova SS, Sarsembayeva LK, Dossimbetova MB, et al. Effect of homocysteine on pregnancy: a systematic review. Chemico-Biological Interact. 2018;293:70-6.

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 Ottawa and Kingston birth cohort. BMC Preg Childbirth. 2019;19:75.