Publication:

The role of maternal serum homocysteine level in early onset preeclampsia for prediction of severity of disease

Background This study was conducted to observe the relationship between high serum homocysteine levels and preeclampsia with severe features among preeclamptic pregnant women of 20-34 weeks of gestation.

Method This study was a hospital based a prospective cohort study and was conducted in Department of Obstetrics and Gynaecology in Dhaka Medical College. A total of 110 preeclamptic pregnant women of 20-34 weeks of gestational age were taken and data were collected after taking an informed written consent. After diagnosis of preeclampsia, I gave them some investigations like CBC, SGPT, S. Creatinine and S. Homocysteine. The patients were divided into two groups that is normal homocysteine level (Group-I) and elevated/high homocysteine level (Group-II) and then the patients were followed up by me at 2 to 4 weekly interval or more frequent if needed.

Result Among 110 preeclamptic women, mean age of the them was 27.2±6.84 (SD) years and gestational age was 28.0±2.58 (SD) weeks when patients developed preeclampsia without severe features. Majority were nullipara (51.8%) and overweight (54.5%). The mean BMI of the preeclamptic women were 28.2±3.46 kg/m2. The median (IQR) Homocysteine level was 11.4 (6.7-16.8) μmol/l and Hyperhomocysteinemia was reported in 31.8% of pregnant women. A cut-off value of homocysteine level≥15.3 μmol/l showed sensitivity, specificity, NPV, PPV and accuracy 91.3%, 83.9%, 60%, 97.3% and 85.4%, respectively to correctly predict preeclampsia with severe features. Homocysteine level was significantly associated with preeclampsia with severe features (p<0.05) and was higher in severe preeclamptic women (91.3%). The homocysteine level was higher in patients with severe features, median-18.3 (17.6-19.4) than without severe features median 9.14 (6.68-13.5). Women with Hyperhomocysteinemia had also greater fetal complications, FGR 20%, oligohydramnios 22.9%). The relative risk ratio of development of preeclampsia with severe features was 22.5, among the preeclamptic women having S. homocysteine level ≥15.3 µmol/l.

Conclusion The study shows that increased maternal serum homocysteine level at 20-34 weeks gestation in preeclampsia without severe features pregnant lady is a predictor of subsequent development of preeclampsia with severe features.