Maternal serum homocysteine and uterine artery Doppler as predictors of preeclampsia and poor placentation

Maged, Ahmed M.; Saad, Hany; Meshaal, Hadeer; Salah, Eman; Abdelaziz, Suzy; Omran, Eman; Deeb, Wesam S.; Katta, Maha

doi:10.1007/s00404-017-4457-y

Cited by 28 publications

(21 citation statements)

References 28 publications

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“…Higher maternal plasma homocysteine concentrations in preeclamptic pregnancies as compared to normotensive were widely reported [93,125,130,132,133,134,135,136,137]. Overall, these differences seem to be present at all of the investigated time points across the gestation, starting from early pregnancy before 20 weeks [138,139,140,141,142] and in both severe and non-severe forms of PE. Comprehensively, this finding led to a conclusion that high homocysteine in early pregnancy constitutes a risk factor for PE.…”

Section: No Adma and Homocysteine In Preeclampsiamentioning

confidence: 86%

“…Comprehensively, this finding led to a conclusion that high homocysteine in early pregnancy constitutes a risk factor for PE. Therefore, attempts to introduce Hcy measurement into a screening test for PE to improve the prediction model, for example, by combining it with uterine artery Doppler test in the second trimester, resulted in being valuable [140]. However, there are also studies that rejected an association between elevated Hcy in early second trimester and subsequent PE [143,144,145].…”

Section: No Adma and Homocysteine In Preeclampsiamentioning

confidence: 99%

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The Role of Nitric Oxide, ADMA, and Homocysteine in The Etiopathogenesis of Preeclampsia—Review

Dymara-Konopka¹,

Laskowska²

2019

IJMS

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Preeclampsia is a serious, pregnancy-specific, multi-organ disease process of compound aetiology. It affects 3–6% of expecting mothers worldwide and it persists as a leading cause of maternal and foetal morbidity and mortality. In fact, hallmark features of preeclampsia (PE) result from vessel involvement and demonstrate maternal endothelium as a target tissue. Growing evidence suggests that chronic placental hypoperfusion triggers the production and release of certain agents that are responsible for endothelial activation and injury. In this review, we will present the latest findings on the role of nitric oxide, asymmetric dimethylarginine (ADMA), and homocysteine in the etiopathogenesis of preeclampsia and their possible clinical implications.

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Section: No Adma and Homocysteine In Preeclampsiamentioning

confidence: 86%

Section: No Adma and Homocysteine In Preeclampsiamentioning

confidence: 99%

The Role of Nitric Oxide, ADMA, and Homocysteine in The Etiopathogenesis of Preeclampsia—Review

Dymara-Konopka¹,

Laskowska²

2019

IJMS

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“…Studies have reported inconsistent associations between maternal homocysteine, measured at different time points in pregnancy and placenta-mediated complications [10, 11]; even among larger cohort and case-control studies measuring homocysteine from early pregnancy, the associations are inconsistent [12–18]. The discrepancies could be due to moderating factors like high-risk pregnancy and differences in population frequencies of the MTHFR 677C>T polymorphism that can lead to moderately elevated homocysteine [19, 20].…”

Section: Introductionmentioning

confidence: 99%

The role of maternal homocysteine concentration in placenta-mediated complications: findings from the Ottawa and Kingston birth cohort

Chaudhry

Taljaard

MacFarlane

et al. 2019

BMC Pregnancy Childbirth

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Background Homocysteine is an intermediate metabolite implicated in the risk of placenta-mediated complications, including preeclampsia, placental abruption, fetal growth restriction, and pregnancy loss. Large cohort and case-control studies have reported inconsistent associations between homocysteine and these complications. The purpose of this study was to investigate whether elevated maternal plasma homocysteine concentration in the early to mid-second trimester is associated with an increased risk of placenta-mediated complications. We examined the following potential moderating factors that may explain discrepancies among previous studies: high-risk pregnancy and the MTHFR 677C>T polymorphism. Methods We analyzed data from participants recruited to the Ottawa and Kingston (OaK) Birth Cohort from 2002 to 2009 in Ottawa and Kingston, Canada. The primary outcome was a composite of any placenta-mediated complication, defined as a composite of small for gestational age (SGA) infant, preeclampsia, placental abruption, and pregnancy loss. Secondary outcomes were, individually: SGA infant, preeclampsia, placental abruption, and pregnancy loss. We conducted multivariable logistic regression analyses with homocysteine as the primary continuous exposure, adjusting for gestational age at the time of bloodwork and explanatory maternal characteristics. The functional form, i.e., the shape of the homocysteine association with the outcome was examined using restricted cubic splines and information criteria (Akaike’s/Bayesian Information Criterion statistics). Missing data were handled with multiple imputation. Results 7587 cohort participants were included in the study. Maternal plasma homocysteine concentration was significantly associated (linearly) with an increased risk of both the composite outcome of any placenta-mediated complication ( p = 0.0007), SGA ( p = 0.0010), severe SGA, and marginally with severe preeclampsia, but not preeclampsia, placental abruption and pregnancy loss. An increase in homocysteine concentration significantly increased the odds of any placenta-mediated complication (odds ratio (OR) for a 5 μmol/L increase: 1.63, 95% Confidence Interval (CI) 1.23–2.16) and SGA (OR 1.76, 95% CI 1.25–2.46). Subgroup analyses indicated some potential for modifying effects of the MTHFR 677C>T genotype and high-risk pregnancy, although the interaction was not statistically significant (high-risk subgroup OR 2.37, 95% CI 1.24–4.53, p -value for interaction =0.14). Conclusions Our results suggest an independent effect of early to mid-pregnancy elevated maternal homocysteine on placenta-mediated pregnancy complications. Electronic supplementary material The online version of this article (10.1186/s12884-019-2219-5) contains supplementary material, which is available to authorized users.

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“… 27 , 28 Among numerous pathological changes involved in preeclampsia, the most important are endothelial dysfunction, local inflammation, and oxidative stress. 29 – 31 Previous studies have shown that increased Hcy levels augment cellular oxidative stress and cause generalized endothelial dysfunction, 32 – 34 and increased plasma oxidative stress has been reported in mothers with preeclampsia. 35 In addition, elevated Hcy levels appear to impair endothelium and lead to ischemic hypoxia through impaired nitric oxide-dependent vasodilation, endothelial toxicity and injury, oxidative stress, and systemic inflammation.…”

Section: Discussionmentioning

confidence: 99%

<p>Reduced Intellectual Ability in Offspring Born from Preeclamptic Mothers: A Prospective Cohort Study</p>

Liu¹,

Zhou²,

Zheng³

et al. 2020

RMHP

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Background: Severe preeclampsia may affect placental development, and high homocysteine (Hcy) levels are linked to intellectual disability. However, the correlation between perinatal Hcy levels and intellectual ability remains unknown in severe preeclampsia-affected offspring. Objective: We aimed to investigate the intellectual ability in offspring born from preeclamptic mothers and examine the role of prenatal Hcy in the prediction of intellectual disability in preschool-aged offspring. Methods: The IQ scores were compared between 101 children born to mothers with severe preeclampsia and 202 offsprings born to normotensive mothers. Maternal Hcy levels within 7 days prior to delivery and postnatal cord blood Hcy were measured. The associations of Hcy with IQ scores were evaluated, and the optimal cutoff values for predicting intellectual disability in the offspring were estimated. Results: The children born to mothers with severe preeclampsia had a greater postnatal cord blood Hcy than those born from normotensive mothers (P < 0.001), and the mothers with severe preeclampsia presented a higher prenatal Hcy (P < 0.001). The children born to mothers with severe preeclampsia had significantly lower IQ scores than those born from normotensive mothers, and a higher Hcy was associated with a lower IQ in preeclampsiaaffected offspring. The prevalence of intellectual disability was 2.86 times higher in severe preeclampsia-affected offspring than in children born from normotensive mothers, and the prevalence of low IQ was greater in children born to mothers with severe preeclampsia than in those from normotensive mothers. ROC curve analysis showed that both maternal and cord blood Hcy were predictors of intellectual disability, and the optimal cutoff for predicting intellectual disability was 17.7 and 9.75 μmol/L for maternal and cord blood Hcy. Conclusion: Perinatal exposure to severe preeclampsia has an adverse effect on postnatal intellectual development, and high maternal and cord blood Hcy may contribute to this association.

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Maternal serum homocysteine and uterine artery Doppler as predictors of preeclampsia and poor placentation

Abstract: NCT02854501.

Cited by 28 publications

References 28 publications

The Role of Nitric Oxide, ADMA, and Homocysteine in The Etiopathogenesis of Preeclampsia—Review

The Role of Nitric Oxide, ADMA, and Homocysteine in The Etiopathogenesis of Preeclampsia—Review

The role of maternal homocysteine concentration in placenta-mediated complications: findings from the Ottawa and Kingston birth cohort

<p>Reduced Intellectual Ability in Offspring Born from Preeclamptic Mothers: A Prospective Cohort Study</p>

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