Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study

Background: Total homocysteine (tHcy) measured in serum or plasma is a mark er of folate status and a risk factor for cardiovascular disease. Objective: Our objective was to investigate associations between tHcy and c omplications and adverse outcomes of pregnancy. Design: Plasma tHcy values measured in 1992-1993 in 5883 women aged 40-42 y were compared with outcomes and complications of 14492 pregnancies in the same women that were reported to the Medical Birth Registry of Norway from 1967 to 1996. Results: When we compared the upper with the lower quartile of plasma tHcy, the adjusted risk fur preeclampsia was 32% higher [odds ratio (OR): 1.32; 95% CI: 0.98, 1.77; P for trend = 0.02], that for prematurity was 38% highe r (OR: 1.38; 95% CI: 1.09, 1.75; P for trend = 0.005), and that for very lo w birth weight was 101% higher (OR: 2.01; 95% CI: 1.23, 3.27; P for trend = 0.003). These associations were stronger during the years closest to the t Hcy determination (1980-1996), when there was also a significant relation b etween tHcy concentration and stillbirth (OR: 2.03; 95%, CI: 0.98, 4.21; P for trend = 0.02). Neural tube defects and clubfoot had significant associa tions with plasma tHcy. Placental abruption had no relation with tHcy quart ile, but the adjusted OR when tHcy concentrations >15 mu mol/L were compare d with levier values was 3.13 (95% CI: 1.63, 6.03; P = 0.001). Conclusion: Elevated tHcy concentration is associated with common pregnancy complications and adverse pregnancy outcomes.