Plasma Homocysteine in Late Pregnancies Complicated with Preeclampsia and in Newborns

ABSTRACT

The aim of this study was to determine the relationship between maternal serum homocysteine levels in preeclampsia and the severity of the disease, neonatal serum homocysteine levels, maternal complications, and fetal outcome. Fifty pregnant women were included in this prospective study, of which 25 were severe (group I) and 25 were nonsevere preeclamptic (group II). Maternal and neonatal serum homocysteine levels were measured by the fluorescence polarization immunoassay (FPIA) method. Maternal homocysteine levels in both groups were compared. The association of maternal and neonatal serum homocysteine levels with maternal complications and fetal outcome was investigated. When the maternal serum homocysteine cut-off value was accepted as 15 μmol/L, significant differences in relation to maternal (eclampsia; hemolysis, elevated liver enzymes, and low platelet count syndrome) and fetal (in utero mort fetalis, low birthweight) complications were observed between the group with maternal serum homocysteine level > 15 μmol/L and the group with maternal serum homocysteine level ≤ 15 μmol/L (p < 0.05). Hyperhomocysteinemia during pregnancy is a risk factor for both development of preeclampsia and its complications. Given that the diagnosis and treatment of hyperhomocysteinemia is possible, clinical trials to determine whether treatment to reduce homocysteine would be valuable in the prevention of both maternal and fetal complications in preeclampsia should be designed.

KEYWORDS

Homocysteine - preeclampsia - maternal complications

REFERENCES

• 1 Hague W M. Homocysteine and pregnancy.  Best Pract Res Clin Obstet Gynaecol. 2003;  17 459-469
• 2 Aubard Y, Dorades N, Cantaloube M. Hyperhomocysteinemia and pregnancy: review of our present understanding and therapeutic implications.  Eur J Obstet Gynecol Reprod Biol. 2000;  93 157-165
• 3 Weir D G, Scott J M. Homocysteine as a risk factor for cardiovascular and related disease: nutritional implications.  Nutr Res Rev. 1998;  11 311-338
• 4 Andersson A, Hultberg B, Brattstrom L, Isaksson A. Decreased serum homocysteine in pregnancy.  Eur J Clin Chem Clin Biochem. 1992;  30 377-379
• 5 Malinow M R, Rajkovic A, Druell P B, Hess D L, Upson B M. The relationship between maternal and neonatal umbilical cord plasma homocysteine suggests a potential role for maternal homocysteine in fetal metabolism.  Am J Obstet Gynecol. 1998;  178 228-233
• 6 Patrick T E, Powers R W, Daftary A R, Ness R B, Roberts J M. Homocysteine and folic acid are inversely related in black women with preeclampsia.  Hypertension. 2004;  43 1279-1282
• 7 D'anna R, Baviera G, Corrado F, Ientile R, Granese D, Stella N C. Plasma homocysteine in early and late pregnancies complicated with preeclampsia and isolated intrauterine growth restriction.  Acta Obstet Gynecol Scand. 2004;  83 155-158
• 8 Vanderjagt D J, Patel R J, el-Nafaty A U, Melah G S, Crossey M J, Glew R H. High density lipoprotein and homocysteine levels correlate in preeclamptic women in northern Nigeria.  Acta Obstet Gynecol Scand. 2004;  83 536-542
• 9 Var A, Yildirim Y, Onur E et al.. Endothelial disfunction in preeclampsia.  Gynecol Obstet Invest. 2003;  56 221-224
• 10 Egerman R S. HELLP syndrome and imitators of preeclampsia and eclampsia. In: Buttino L, Elkayom U, Evans MI, Galbraith RM, Gall SA, Sibai BM Principles and Practice of Medical Therapy in Pregnancy. Stamford, CT; Appleton & Lange 1998: 1028-1035
• 11 Quere I, Bellet H, Hoffet M, Janbon C, Mares P, Gris J C. A woman with five consecutive fetal deaths: case report and retrospective analysis of hyperhomocysteinemia prevalence in 100 consecutive women with recurrent miscarriages.  Fertil Steril. 1998;  69 152-154
• 12 Goddijn-Wessel T A, Wouters M G, van de Molen E F et al.. Hyperhomocysteinaemia: a risk factor for placental abruption or infarction.  Eur J Obstet Gynecol Reprod Biol. 1996;  66 23-29
• 13 Walker M C, Smith G N, Perkins S L, Keely E J, Garner P R. Changes in homocysteine levels during normal pregnancy.  Am J Obstet Gynecol. 1999;  180 660-664
• 14 Powers R W, Majors A K, Kerchner L J, Conrad K P. Renal handling of homocysteine during normal pregnancy and preeclampsia.  J Soc Gynecol Investig. 2004;  11 45-50
• 15 Wouters M G, Boers G H, Blom H J et al.. Hyperhomocysteinemia: a risk factor in women with unexpected recurrent early pregnancy loss.  Fertil Steril. 1993;  60 820-825
• 16 Rosenquist T H, Ratashak S A, Selhub J. Homocysteine induces congenital defects of the heart and neural tube: effect of folic acid.  Proc Natl Acad Sci USA. 1996;  93 15227-15232
• 17 de Vries J I, Dekker G A, Huijgens P C, Jakobs C, Blomberg P M, van Geijn H P. Hyperhomocysteinaemia and protein S deficiency in complicated pregnancies.  Br J Obstet Gynaecol. 1997;  104 1248-1254
• 18 Leeda M, Riyazi N, de Vries J I, Jakobs C, van Geijn H P, Dekker G A. Effects of folic acid and vitamin B6 supplementation on women with hyperhomocysteinemia and a history of preeclampsia or fetal growth restriction.  Am J Obstet Gynecol. 1998;  179 135-139
• 19 Burke G, Robinson K, Refsum H, Drumm J, Graham I. Intrauterine growth retardation, perinatal death, and maternal homocysteine levels.  N Engl J Med. 1992;  326 69-70
• 20 Roberts J M, Hubel C A. Is oxidative stress the link in the two-stage model of pre-eclampsia?.  Lancet. 1999;  354 788-789
• 21 Dekker G A, de Vries J I, Doelitzsch P M et al.. Underlying disorders associated with severe early onset preeclampsia.  Am J Obstet Gynecol. 1995;  173 1042-1048
• 22 Rajkovic A, Catalano P M, Malinow M R. Elevated homocysteine levels with preeclampsia.  Obstet Gynecol. 1997;  90 168-171
• 23 Powers R W, Evans R W, Majors A K et al.. Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation.  Am J Obstet Gynecol. 1998;  179 1605-1611
• 24 Cotter A M, Molloy A M, Scott J M, Daly S F. Elevated plasma homocysteine in early pregnancy: a risk factor for the development of severe preeclampsia.  Am J Obstet Gynecol. 2001;  185 781-785
• 25 Cotter A M, Molloy A M, Scott J M, Daly S F. Elevated plasma homocysteine in early pregnancy: A risk factor for the development of nonsevere preeclampsia.  Am J Obstet Gynecol. 2003;  189 391-396
• 26 Guerra-Shinohara E M, Paiva A A, Rondo P H, Yamasaki K, Terzi C A, D'Almeida V. Relationship between total homocysteine and folate levels in pregnant women and their newborn babies according to maternal serum levels of vitamin B12.  BJOG. 2002;  109 784-791
• 27 Vilaseca M A, Moyano D, Ferrer I, Artuch R. Total homocysteine in pediatric patients.  Clin Chem. 1997;  43 690-692
• 28 De Laet C, Wautrecht J C, Brasseur D et al.. Plasma homocysteine concentration in a Belgian school-age population.  Am J Clin Nutr. 1999;  69 968-972