The Role of High Concentrations of Homocysteine for the Development of Fetal Growth Restriction

Abstract

Objective To assess homocysteine (Hcy) levels in the three trimesters of pregnancy in women with fetal growth restriction (FGR) and to evaluate the role of Hcy as a possible predictor of FGR.

Methods A total of 315 singleton pregnant women were included in the present prospective cohort study and were monitored since the 1^st trimester of pregnancy before delivery. Newborns were monitored for the first 7 days of life. Patients who had risk factors for FGR were excluded. Fetal growth restriction was defined according to uterine fundal height (< 10 percentile), ultrasound fetometry (< 5 percentile), and anthropometry of newborns (< 5 percentile). The concentrations of Hcy were detected at between 10 and 14, between 20 and 24, and between 30 and 34 weeks of pregnancy by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristics (ROC) curve test and diagnostic odds ratio (DOR) were performed to evaluate the results of ELISA.

Results The concentration of Hcy in patients with FGR was 19.65 umol/L at between 10 and 14 weeks, compared with 9.28 umol/L in patients with normal fetal growth (p < 0.0001). The optimal cut-off level for Hcy in the 1^st trimester of pregnancy was > 13.9 umol/L with AUC 0.788, sensitivity of 75%, specificity of 83.6%, and DOR of 15.2.

Conclusion Assessment of serum Hcy concentration may be used as a predictor of FGR, with the highest diagnostic utility in the 1^st trimester of pregnancy.

Resumo

Objetivo Avaliar os níveis de homocisteína (Hcy) em três trimestres da gravidez em mulheres com restrição de crescimento fetal (FGR, na sigla em inglês) e avaliar o papel da Hcy como possível preditor de FGR.

Métodos Um total de 315 gestantes solteiras foram incluídas no presente estudo de coorte prospectivo e monitoradas desde o 1° trimestre de gravidez antes do parto. Os recém-nascidos foram acompanhados durante os primeiros 7 dias de vida. Pacientes que apresentam fatores de risco para FGR foram excluídos. A FGR foi definida de acordo com a altura do fundo do útero (< percentil 10), ultrassonografia fetometria (< percentil 5) e antropometria dos recém-nascidos (< percentil 5). As concentrações de Hcy foram detectadas entre 10 e 14, entre 20 e 24 e entre 30 e 34 semanas de gravidez por ensaio de imunoabsorção enzimática (ELISA, na sigla em inglês). O teste da curva das características de operação do receptor (ROC, na sigla em inglês) e a razão de chances de diagnóstico (DOR, na sigla em inglês) foram realizados para avaliar os resultados do ELISA.

Resultados A concentração de Hcy em pacientes com FGR foi de 19,65 umol/L entre 10 e 14 semanas, em comparação com 9,28 umol/L em pacientes com crescimento fetal normal (p < 0,0001). O nível de corte ideal para Hcy no 1° trimestre da gravidez foi > 13,9 umol/L com AUC 0,788, sensibilidade de 75%, especificidade de 83,6%, e DOR 15,2.

Conclusão A avaliação da concentração sérica de Hcy pode ser usada como um preditor de FGR, com maior utilidade diagnóstica no 1° trimestre de gravidez.

Keywords

fetal growth restriction - homocysteine - hyperhomocysteinemia - prediction of fetal growth restriction

Palavras-chave

restrição de crescimento fetal - homocisteína - hiperhomocisteinemia - predição de restrição de crescimento fetal

Contributions

All authors had full access to all of the data in the present study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Akylbek Tussupkaliyev, Andrey Gaiday, Lazzat Balash. Acquisition of data: Akylbek Tussupkaliyev, Andrey Gaiday. Statistical analyses and data interpretation: Akylbek Tussupkaliyev, Andrey Gaiday, Lazzat Balash. Drafting of the manuscript: Andrey Gaiday, Lazzat Balash. Obtained funding: Akylbek Tussupkaliyev. Study supervision: Akylbek Tussupkaliyev.

Publication History

Received: 24 March 2021

Accepted: 17 December 2021

Article published online:
17 February 2022

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