Homocysteinaemia - Its Impact in Gynaecology andObstetrics

Overview

Objective:
Metabolic study on plasmatic levels of homocysteine (Hcy) in healthy women duringnormal or pathological pregnancy accompanied with coresponding levels of Hcy in amniotic fluidand foetal sera. Increased levels of Hcy - hyperhomocysteinaemia is respected as an independentrisk factor accelerating the early development of vessel damage and causing the neural tubedefects (NTD).Design: Basic study to get our own data about Hcy in Czech healthy and population at risk ofpregnant and non-pregnant women.Setting: Department of Obstetrics and Gynaecology, 1st Faculty of Medicine, Charles University,Prague.Methods: Total homocysteine in plasma, amniotic fluid and foetal sera was estimated by chroma-tographic method with use of fluorescence detection.Results: Normal homocysteine in preclimacteric healthy nonpregnant women is: 9.7 ± 1.6 mmol/lwith evident age-dependence. In healthy climacteric women are higher levels of Hcy (correspon-ding to the men values): 11.8 ± 2,6 mmol/l. After use of hormonal contraceptives the plasmaticlevels of Hcy decrease: 7.2 ± 2.0 mmol/l. In physiological pregnancies Hcy reachs the lowest values:4.4 ± 1.7 mmol/l with any evident oscillations during pregnancy. In women in childbed period wasHcy 8.4 ± 2.1 mmol/l observed. In pathological pregnanciesare its levels slightly elevated: 6.3 ± 2.1mmol/l, most evident in placental abruptions: 7.5 ± 1.7 mmol/l. In pregnant women with susp.results of screening on M. Down only unsignificant increase of Hcy was observed: 6.12 ± 2.4 mmol/l.In amnial fluids of healthy pregnant women are levels of Hcy are quite low: 4.1 ± 1.2 mmol/l withany oscillations during pregnancy. In foetal sera of pregnancies at risk (NTD, susp., trisomy,inborn errors of metabolism): 3.6 ± 1.4 mmol/l of Hcy was detected. The foetoplacental quotient forHcy is 0.62.Conclusion: Average values for Hcy were established in physiological as well as in pathologicalpregnancies and till now only limited diagnostic significance has been observed. The hyperhomo-cysteinaemia mentioned in previous papers was not in NTD observed because our pregnantpatients were regularly supplemented with all critical vitamins (folate, B6 , B12 ).

Key words:
homocysteine, homocysteinaemia, hyperhomocysteinaemia, folate embryopathy, riskpregnancy, neural tube defects