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.