Association between hyperhomocysteinemia and adverse obstetric outcome in patients with bad obstetric history
Saswati Sanyal Choudhury, Lokeshwari K,Gokul Chandra Das
Background and objectives of the study: Hyperhomocysteinemia is a condition characterized by an abnormally high level of homocysteine in the blood conventionally described above 15μmol/l. Plasma homocysteine concentrations are frequently found to be elevated in cases of bad obstetric history but a causal relationship between these two has not been clearly demonstrated yet. Hence, the study was taken up with the aim of determining the correlation between plasma homocysteine level and bad obstetric history, and its relevance as a potential marker for predicting bad obstetric outcome. Method: A total sixty five cases were taken. Out of which 45 cases had bad obstetric history and 20 had normal pregnancy in a tertiary care hospital from August, 2012 to July, 2013. It was a prospective observational study. Serum homocysteine level was measured by enzyme cycling method. Statistical tests used are Fisher test, Chi square test, student T test and ANOVA test to determine meaningful statistical outcome. Results: Mean serum homocysteine level in control group was 9.23 ± 3.4μmol/l and that of in bad obstetrical history (BOH) was 26.6± 5.9 μmol/l (p< 0.001). BOH group with diagnosed preeclampsia had elevated homocysteine level. There was highly significant difference in mild and severe preeclampsia, 25.6 μmol/l vs. 29.9μmol/l (p<0.001) and patients without hypertension with mild and severe disease (p<0.001). There was a relationship between level of homocysteine with adverse perinatal outcome like preterm and stillbirth (ANOVA test P<0.05). Level of homocysteine was high in BOH with FGR (p<0.05). Conclusion: High level of serum homocysteine has a strong association with bad obstetric outcome.