Maternal Hyperhomocysteinemia as a Predictor of Placenta-Mediated Pregnancy Complications: A Two-Year Novel Study

Abstract

BackgroundPlacenta-mediated pregnancy complications (PMPCs) are a significant contributor to adverse maternal and fetal outcomes. Though the exact cause of the array of pregnancy-related vascular disorders is still unknown, increased maternal serum homocysteine (Hct) levels have been linked to the pathophysiology. Hyperhomocysteinemia (HHct) has been strongly linked with the risk of developing PMPCs such as preeclampsia (PE), fetal growth restriction (FGR), intrauterine fetal death (IUFD), preterm births and placental abruption. MethodologyThe present observational study was carried out on 810 low-risk antenatal women in their early second trimester (13-20 weeks gestation age) in the department of obstetrics and gynecology of a tertiary care rural hospital to identify the significance of abnormally raised maternal serum Hct level in developing PMPCs. ResultsOf the 810 participants studied, 224 (27.65%) had raised Hct levels whereas the rest of the 586 (72.35%) participants had normal Hct levels. The mean Hct level of raised homocysteine group (18.59 ± 2.46 micromol/L) was substantially raised than the normal Hct group (8.64 ± 3.1 micromol/L). It was observed that women with elevated serum Hct levels developed PMPCs significantly more than women with normal serum Hct levels (p-value <0.05). Among HHct subjects, 65.18% developed PE, 34.38% had FGR, 28.13% had a preterm delivery, 4.02% had abruptio placentae and 3.57% had IUFD. ConclusionsThe focus of the current study is on an easy and quick intervention such as assessing the often-ignored levels of Hct during pregnancy that can help predict and prevent PMPCs. It also highlights the necessity for well-thought-out large-scale studies and trials to further examine the phenomena, as pregnancy may be the only time when rural women will have the opportunity to receive advice and to be tested for HHct.

The Role of Helicobacter pylori and Metabolic Syndrome-Related Mast Cell Activation Pathologies and Their Potential Impact on Pregnancy and Neonatal Outcomes

“…As a proatherogenic factor, homocysteine independently elevates the risk of developing H. pylori/MetS-related C-CVD and additional systemic pathologies [54,56]. Hyperhomocysteinemia, hyperfibrinogenemia, and elevated levels of lipoprotein-a (a lowdensity lipoprotein-like particle that includes the plasminogen homologue apo (a) linked disulfide bound to apo B), are identified as "non-traditional" risk factors for CVD that might promote atherosclerosis and its related pathologies in the setting of H. pylori/MetS-related conditions [57].…”

“…Regarding pregnancy and neonatal outcomes related to hyperhomocysteinemia, recent evidence indicates that the prevalence of placenta-mediated pregnancy complications (PMPCs) is significantly high in women with hyperhomocysteinemia. Maternal hyperhomocysteinemia can be introduced as both a predictor of the development of PMPCs and a screening tool for low-risk antenatal patients in the early second trimester [57]. Hyperhomocysteinemia is closely connected with the risk of developing PMPCs such as preeclampsia, fetal growth restriction, intrauterine fetal death, preterm births, and placental abruption (Figure 1).…”