Maternal homocysteine and chorionic vascularization in recurrent early pregnancy loss

Defective chorionic villous vascularization has been suggested to be associ ated with embryonic death. There are no reports, however, describing chorio nic vascular profiles in spontaneous miscarriage tissue. Therefore, we inve stigated chorionic villous vascularization by both histopathology and an im age analysis system combined with CD34 immunohistochemistry in spontaneous miscarriage tissue of 19 women with recurrent early pregnancy loss (REPL), Subsequently, we studied the vascular profile parameters (median vascular a rea, perimeter, number of vascular elements per measured chorionic area, an d the median area, perimeter and diameter per vascular element) in relation to the maternal plasma total homocysteine concentrations (an independent r isk factor for REPL), The histopathological scores and the measured number of vascular elements per mm(2) chorionic tissue were not significantly diff erent between women with elevated and those with normal total homocysteine concentrations. However, women with elevated total homocysteine concentrati ons (fasting >18.3 mu mol/l and/or 6 h after methionine load >61.5 mu mol/l ) showed (per measured chorionic area) significant smaller median vascular areas and perimeters. The single chorionic vascular elements in these women had significant smaller median areas, perimeters and diameters, Furthermor e, the fasting total homocysteine was negatively correlated with the perime ter of the vascular element (r = -0.54: P <0.05). In conclusion, in REPL, e levated maternal total homocysteine concentrations are associated with defe ctive chorionic villous vascularization.