Association between hyperhomocysteinemia and adverse obstetric outcome in patients with bad obstetric history
Saswati Sanyal Choudhury, Lokeshwari K, Gokul Chandra Das
Background: 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. Objectives: The study was taken up with the objectives 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.