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A Journal on Obstetrics and Gynecology
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Minerva Ginecologica 2004 October;56(5):379-84
Recurrent spontaneous miscarriages and hyperhomocysteinemia
Del Bianco A., Maruotti G., Fulgieri A. M., Celeste T., Lombardi L., Amato N. A., Pietropaolo F.
Aim. Recurrent fetal loss is defined as the number of consecutive miscarriages which is not less than 2 occurred within the 16th week of gestation and it is a very intersting pathology of pregnancy. Further to thrombophilia, very important causes have been identified, since the damage of the vascular system supporting the placenta may cause a deficiency of placenta functions and development, leading to a loss of the conception product, also in a condition of hyperhomocystinemia, causing a damage to the vascular endothelium . Hyperhomocystinemia seems to be a risk factor for artero-venous thrombotic diseases, even not in pregnancy.
Methods. We have examined 40 patients referred to our Institute for unexplained fetal loss (at least 2 consecutive miscarriages within the 16th week of gestation) and the same number of patients who had at least 1 spontaneous delivery with a healthy and alive newborn and none abortion nor fetal death nor abruptio placentae.
Results. The mean levels of homocystinemia observed were significantly different in the 2 groups (p¾0.05). In the control group the values of plasmatic homocysteine were 10±4 mmol/L, corresponding to normal range, while in the other group the values of plasmatic homocysteine were 21±6 mmol/L, values certainly elevated, also because during the 1st trimester of pregnancy the levels of homocysteine decrease, reaching the lowest value during the 2nd trimester of pregnancy. In particular, high levels of homocysteine have been found in 25% (10) of women with unexplained early fetal loss.
Conclusion. Hypercystinemia, as a consequence of an interaction between a primary genetic defect and a nutrition condition (folate deficiency), may be a cause of recurrent miscarriages. Therefore, in these cases, a possible hypercystinemia should be searched and an association of folic acid and vitamin B6, a non teratogenic treatment, should be useful to restore the metabolic picture and to favour the pregnancy outcome.