The impact of the homocysteine axis on first-trimester miscarriages

Abstract

Objective: To evaluate if there is indeed a relationship between the three major components of the homocysteine axis and spontaneous miscarriages during early pregnancy.Study design: Sixty women—only 6 of whom were taking prenatal vitamins (PNV) presenting at the emergency room or clinic during the first trimester with either a complete miscarriage or blighted ovum were compared with 29 first-trimester controls from a private practice known to be taking daily multivitamins and 37 controls at 15–20 weeks of gestation from a primarily indigent population with unknown PNV status. All had serum samples evaluated. Homocysteine, folate, B12, progesterone, and β-hCG were determined in all samples by various forms of immunoassay. Resultant data were compared by Student’s t-test and regression and correlation analysis.Results: Both human chorionic gonadotropin (hCG) and progesterone (P <0.0001) were significantly decreased in the patients with miscarriage, compared with controls. Folate (0.0004) and homocysteine (0.0001) also were decreased. Significant correlations were noted in the controls for hCG and both folate and homocysteine (positive). In the patients with miscarriages, a correlation was noted between hCG and both B12 and progesterone (positive), as well as between B12 and homocysteine (negative). Only one patient in the SAB group had elevated homocysteine.Conclusions: The data suggest that spontaneous miscarriages are not related to circulating homocysteine but to the relative levels of folate, progesterone, and chorionic gonadotropin. These results affirm the need for PNV during early gestation, even before the normal first prenatal visit.