Year: 2026 | Month: July | Volume: 16 | Issue: 7 | Pages: 49-58
DOI: https://doi.org/10.52403/ijhsr.20260706
Serum Homocysteine Levels and Folate Levels as a Predictor of Materno-Fetal Outcome in Pre-Eclamptic Women
Bhavani1, Vidyashree2, Prathima3, Sumitra Sangavi4
1,4Assistant Professor, Department of Obstetrics and Gynecology, Mahaveer Institute of Medical Sciences, Vikarabad, Telangana.
2,3Private Practitioner, Kalaburagi, Karnataka.
Corresponding Author: Dr. Sumitra Sangavi
ABSTRACT
Background and Aims: Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality, characterized by endothelial dysfunction and abnormal placentation. Hyperhomocysteinemia has been implicated in its pathogenesis, whereas folate deficiency may contribute through impaired homocysteine metabolism. This study evaluated the association of maternal serum homocysteine and folate levels with adverse materno-fetal outcomes in women with pre-eclampsia.
Methods: A hospital-based descriptive observational study was conducted at the Department of Obstetrics and Gynecology, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, India, from November 2019 to May 2021. A total of 150 women with pre-eclampsia at >34 weeks' gestation was enrolled consecutively after informed consent. Serum homocysteine and folate levels were measured using chemiluminescence immunoassay. Maternal complications and fetal outcomes were recorded. Continuous variables were summarized as mean ± standard deviation (SD) or median (IQR), and categorical variables as frequencies and percentages. Associations between categorical variables were analyzed using the Chi-square test or Fisher's exact test, as appropriate. A two-sided p-value <0.05 was considered statistically significant.
Results: The mean maternal age was 24.59±4.90 years. Elevated serum homocysteine (>13.6 µmol/L) was observed in 54.67% of participants. Hyperhomocysteinemia was significantly associated with maternal complications including HELLP syndrome (p=0.006), postpartum hemorrhage, placental abruption, acute kidney injury, disseminated intravascular coagulation, multiple organ dysfunction syndrome, cerebrovascular accident, and maternal death (all p<0.05). Significant associations were also observed with preterm birth (p=0.004), low birth weight (p=0.007), stillbirth (p<0.001), and neonatal intensive care unit admission (p=0.042). Serum folate levels remained within the normal range in nearly all participants and showed no significant association with maternal or fetal outcomes.
Conclusion: Elevated maternal serum homocysteine is significantly associated with adverse maternal and neonatal outcomes in pre-eclampsia and may serve as a useful biomarker for risk stratification. Serum folate demonstrated no predictive value, possibly reflecting adequate antenatal folic acid supplementation. Larger multicenter prospective studies with serial biomarker assessment are warranted.
Key words: Pre-Eclampsia; Homocysteine; Folic Acid; Pregnancy Outcome; Maternal Health; Infant, Low Birth Weight.