Serum Homocysteine, Vitamin B12 and folate in Ghanaian women with hypertensive disorders of pregnancy.

Thumbnail Image
November, 2016.
Journal Title
Journal ISSN
Volume Title
Hypertensive disorders of pregnancy are common complication occurring during pregnancy, and are associated with maternal and fetal mortality and morbidity. Hyperhomocysteinaemia, a known risk factor for vascular disease, could play a significant role in the aetiopathogenesis of pregnancy-induced hypertension (PIH). This study, therefore, evaluated the maternal serum concentrations of homocysteine, vitamin B12 and folate in normal pregnancy (NP) and pregnant women presenting with preeclampsia (PE) and gestational hypertension (GH). This randomized case-control study involved 30 PE patients, 30 GH patients and 30 age-matched normotensive uncomplicated pregnant women (control group) in the third trimester of pregnancy. After obtaining an informed consent from each participant, information on socio-demographic characteristics, medical history and previous obstetric history was obtained. Blood pressure, anthropometric measurements and blood sample were taken for the estimation of homocysteine, vitamin B12, folate and lipid profile of each woman. Mean levels of maternal serum homocysteine was significantly higher in PIH, PE and GH patients when compared with NP women (p<0.05). Although mean vitamin B12 and folate were decreased in the PIH, PE and GH patients when compared with the normal pregnant women, it was only in the PIH and the PE patients that the differences were significant (p<0.05). In the PIH patients, there was a statistically significant negative correlation between homocysteine and folate (r=-0.283, p<0.05). While none of the normal pregnant women had intrauterine growth restriction (IUGR) or low birthweight (LBW), thirty-five percent (35%) and twenty-eight percent (28%) of the participants with PIH demonstrated IUGR and LBW respectively. Except for the GH patients where estimated foetal weight (EFW) was insignificantly lower, EFW and birthweight were significantly lower in the PIH (PE and GH) patients when compared with the NP women. The use of the contraceptive Depo-Provera prior to pregnancy was significantly associated with about thirty-fold (30) increase in the odds of developing preeclampsia (OR=29.71, p<0.001). There was a significant (p<0.01) positive correlation between homocysteine and blood pressure (systolic and diastolic blood pressure) in the PIH patients. Maternal serum concentration of homocysteine is altered in PIH (PE and GH) when compared with normal pregnancy, and this imbalance is depicted by an elevated serum concentration of homocysteine with a correspondingly decreased serum concentrations of vitamin B12 and folate. Hyperhomocysteinaemia in pregnancy could play a significant role in the aetiopathogenesis of pregnancy induced hypertension, intrauterine growth restriction and low birthweight. Furthermore, the use of the contraceptive Depo-Provera by women prior to pregnancy predisposes them to a high risk of developing preeclampsia.
A thesis submitted in fulfillment of the requirements for the degree of Master of Philosophy in the Department of Molecular Medicine, School of Medical Sciences