Briefly about the important things. Homocysteine. Why is it important to know your homocysteine ​​level?

Atherosclerosis

Diabetes

31602 06 November

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. We remind you that independent interpretation of the results is unacceptable; the information below is for reference only.

: indications for use, rules for preparing for the test, interpretation of the results and normal indicators.

Indications for prescribing the study

Homocysteine ​​is an amino acid, an intermediate product of the metabolism (metabolism) of other amino acids - methionine and cysteine.
Homocysteine ​​does not come from food, but is formed only in the body. Normally, this amino acid “lives” in the body for a very short time, after which it is converted into other compounds. To carry out such transformations, vitamins B6, B12 and folic acid are needed. When homocysteine ​​metabolism is impaired due to a defect in enzyme systems or due to a lack of essential vitamins, it accumulates in large quantities inside the cells and then enters the blood. Excess homocysteine ​​can lead to the formation of blood clots, damage to the vascular wall, making it more loose, and the deposition of cholesterol and calcium in it with the formation of atherosclerotic plaques. Vessels narrowed by atherosclerotic plaques and the tendency to form blood clots significantly increase the likelihood of complete closure of the lumen of blood vessels, in particular the vessels of the heart and brain with the development of myocardial infarction and ischemic stroke, respectively. The likelihood of damage to the vascular wall increases significantly with diabetes.

Thus, one of the indications for prescribing a homocysteine ​​test is to determine the risk of cardiovascular diseases, including in patients with diabetes.

It has been noted that the risk of Alzheimer's disease and senile dementia (dementia) increases with increasing homocysteine ​​levels, so measuring homocysteine ​​levels may be useful if these diseases are suspected.

During a physiologically proceeding pregnancy, the blood homocysteine ​​level decreases almost by half, and in the first trimester by more than 30%, reaching its lowest value at the end of the second trimester. This decrease may be due to an increase in circulating blood volume and hormonal changes. If homocysteine ​​levels increase, pregnancy complications are likely to develop - miscarriages, eclampsia (convulsions with loss of consciousness, a sharp rise in blood pressure and even death), vein thrombosis, etc. In this regard, determination of homocysteine ​​levels is prescribed to pregnant women who experience increased blood pressure, edema, and protein in the urine - proteinuria.

Increased homocysteine ​​occurs in some genetic diseases, such as homocystinuria.

Causes of increased homocysteine ​​levels

Excess amounts of this amino acid in the blood may be associated with a mutation (most often C677T) in the MTHFR gene. It encodes a protein of the same name, which plays the role of an enzyme in the process of biosynthesis of homocysteine ​​from methionine.

The cause of hyperhomocysteinemia is also considered to be a lack of folic acid in the body. However, in people who have a mutation in the MTHFR gene, supplemental intake does not normalize homocysteine ​​levels.

In order to find out the exact reason for the increased concentration of this amino acid, it is necessary to conduct an examination. To determine the genetic prerequisites, you can undergo the “Folate cycle”, “Disorders of the hemostatic system” tests, sequencing of the genes CBS, MTHFR, MTR, MTRR, MMADHC and others in medical genetics.

We have prepared for you a list of studies that will help you deal with this problem:

14 working days

Panel "Folate cycle and risk of hyperhomocysteinemia" - 10 markers

8500 ₽

More details

5 working days

Analysis of polymorphisms in folate cycle genes

4900 ₽

More details

Preparation for the procedure

Like any planned study, a blood test for homocysteine ​​should be carried out outside of acute viral and bacterial diseases, two weeks after recovery.

Taking certain medications may affect test results; It is necessary to discuss with your doctor the list of medications used and, possibly, discontinue some of them if this does not affect the quality of life.

Blood collection should be done in the morning on an empty stomach, after 8-14 hours of overnight fasting. Drinking water is allowed. It is acceptable to take the test during the day, 4-6 hours after a light meal.

Who should be tested for homocysteine ​​during pregnancy planning?

A blood test for homocysteine ​​concentration is not included in the list of mandatory examinations, since normally after pregnancy the indicator gradually decreases and returns to normal levels shortly after birth. Tests are required for the following indications:

• complicated heredity (closest blood relatives have a history of early heart attacks);
• folate deficiency anemia, not corrected by drug therapy with the use of iron supplements;
• diabetes;
• transient ischemia, early stroke or heart attack in history;
• any form of gestosis during previous pregnancies;
• history of spontaneous miscarriages (several in a row);
• several biochemical pregnancies after IVF in a row;
• history of severe placental insufficiency.

An examination for homocysteine ​​levels is carried out when diagnosing infertility, after excluding the infectious nature of the disease and the possible influence of hormonal factors.

References

1. Clinical aspects of hyperhomocysteinemia: monograph / V.A. Snezhitsky [and others]; under general editorship V.A. Snezhitsky, V.M. Pyrochkina. – Grodno: GrSMU, 2011. – 292 p. 2. Kostyuchenko G.I. Hyperhomocysteinemia: clinical significance, age-related characteristics, diagnosis and correction // Clinical gerontology. 2007. No. 4. URL: https://cyberleninka.ru/article/n/gipergomotsisteinemiya-klinicheskoe-znachenie-vozrastnye-osobennosti-diagnostika-i-korrektsiya (date of access: 08/30/2020). 3. EC/EOA GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF DYSLIPIDEMIAS 2021 Original publication European Heart Journal (2016), 37 (39): 2999-3058, doi:10.1093/eurheartj/ehw272

The dangers of high homocysteine ​​during pregnancy

Most often, when homocysteine ​​in the blood plasma increases, spontaneous abortion (miscarriage) occurs in most patients. In the case of carrying a pregnancy against the background of high homocysteine ​​values, the risk of developing postpartum complications in the mother increases: abnormalities in the functioning of the cardiovascular and circulatory systems, the formation of blood clots, etc. The newborn in such a situation experiences abnormally low weight, physical immaturity, neurological and immune disorders, etc.

If an increase in homocysteine ​​is recorded in the second half of pregnancy, then the woman may develop late toxicosis (preeclampsia), which is accompanied by such dangerous conditions as preeclampsia and eclampsia (impaired functionality of the cardiovascular and urinary systems, which can lead to the death of the mother and fetus). In addition, with elevated homocysteine, metabolic processes in the placenta are disrupted, which can lead to oxygen starvation of the fetus (hypoxia).

Another of the most dangerous consequences of elevated homocysteine ​​is infertility (defect in embryo implantation).

Homocystinuria

This is a genetically determined disease, which is characterized by an increase in the concentration of homocysteine ​​in the blood, provoked by an inborn error of methionine metabolism, and systemic damage to the nervous system, brain, blood vessels, and heart.

Signs of homocystinuria:

ophthalmological:

• visual impairment;
• retinal detachment;
• death of the optic nerve;

from the skeletal system:

• asymmetrical body structure;
• long and thin fingers;
• chest deformation;

from the cardiovascular system:

• cardiac ischemia;
• atherosclerosis;
• thrombophlebitis, etc.;
• convulsive syndrome;
• mental retardation.

The disease is inherited from mother to child, so the newborn must be tested for homocysteine ​​levels.

Risk group

An expectant mother can be considered at risk in the following cases:

• diagnosed complications in the 2-3 trimester;
• genetic predisposition to homocystinuria;
• history of thrombophilia (increased blood clotting).

Such patients need to regularly monitor homocysteine ​​concentrations throughout pregnancy.

Causes of low and high homocysteine

Homocysteine ​​concentrations from 4.5 to 13.5 µmol/l are considered normal, but the result must be assessed by the attending physician. The risks for successful pregnancy increase at levels above 7-8 µmol/l and below 6 µmol/l.

Low homocysteine ​​levels are quite rare. The causes of this condition may be a course of treatment with certain medications (penicillamine, acetylcysteine, betaine), which accelerate the metabolism of homocysteine, as well as conditions such as hyperthyroidism or the initial stage of diabetes mellitus.

High levels of homocysteine ​​(8-10 µmol/l) provoke abuse of caffeine-containing drinks, smoking, physical inactivity, diabetes mellitus and some mental disorders. The condition can also be of a medicinal nature and develop after a course of therapy using cyclosporine, theophylline, diuretics, fibrates and some other drugs.

Examination of women when planning IVF (days 2-5 of the cycle)

A comprehensive laboratory examination of a woman in preparation for the IVF procedure, including general clinical tests, a detailed analysis of hormonal levels and tests for major infections.

Synonyms Russian

Tests for a woman before IVF.

English synonyms

Female health check-up before in vitro fertilization (IVF), IVF preparation panel, female partner.

What biomaterial can be used for research?

Venous blood, a smear on a glass slide, a urogenital smear, a smear from the outer surface of the cervix, a smear from the inner surface of the cervix (from the cervical canal), an average portion of morning urine.

How to properly prepare for research?

• Eliminate alcohol from your diet for 24 hours before the test.
• Eliminate fatty foods from your diet for 24 hours before the test.
• Do not eat for 12 hours before the test; you can drink clean still water.
• Avoid (in consultation with your doctor) taking estrogens and androgens within 48 hours before the test.
• In the absence of special instructions from the doctor, it is recommended to take blood for analysis before 11 a.m.
• Avoid (in consultation with your doctor) taking diuretics for 48 hours before collecting urine.
• The study is recommended to be carried out before menstruation or 2-3 days after its end.
• Avoid physical and emotional stress for 30 minutes before the test.
• Testing for HIV infection can be carried out anonymously and confidentially. During a confidential examination, it is mandatory to present a passport.
• Do not smoke for 30 minutes before the test.

General information about the study

In vitro fertilization (IVF) is one of the most effective methods of treating infertility. The IVF procedure, however, requires careful preparation. Although the scope and composition of a woman’s laboratory examination in preparation for the IVF procedure varies between reproductive centers, it most often includes the following components:

• general clinical tests;
• study of hormonal levels;
• cytological and microscopic studies;
• tests for hidden sexually transmitted infections (STIs);
• additional tests.

General clinical tests are carried out for all women planning pregnancy, regardless of whether pregnancy occurs naturally or with the help of reproductive technologies. This group of analyzes includes:

• A clinical blood test (CBC) with a leukocyte formula and ESR is a basic study that is performed for the timely diagnosis of anemia, identifying signs of inflammation and assessing the number of platelets. This test will be repeated several times throughout pregnancy. In some cases, based on the results of the AS, additional tests are performed, for example, laboratory markers of iron metabolism are examined.
• A general urine test (UCA) with sediment microscopy is a basic test that can identify signs of genitourinary tract infection and kidney disease, which can negatively affect the course and outcome of pregnancy. In some cases, additional tests are performed based on the results of OAM, for example, measuring the exact amount of protein in the urine.
• Basic biochemical indicators: Total protein is an integral indicator of protein metabolism in the body. Of greater importance is the reduction in total protein.
• Bilirubin is a pigment formed during the breakdown of hemoglobin and some other heme-containing proteins in the liver, spleen and bone marrow. An increase in bilirubin levels can be observed in many liver diseases, including unrecognized viral hepatitis B and C.
• Liver enzymes (ALT, AST) are enzymes that catalyze the transfer of amino groups between amino acids. Just like bilirubin, changes in liver enzyme levels are a characteristic but nonspecific sign of liver disease.
• Glucose is an integral indicator of carbohydrate metabolism. Elevated glucose levels may indicate undiagnosed diabetes.
• Assessment of blood clotting. Normal pregnancy occurs against the background of a hypercoagulable state, which is probably a woman's natural defense against excessive blood loss in the postpartum period. During pregnancy, the following physiological changes are observed in the hemostatic system: Increased levels of coagulation factors VII, VIII, IX, X, XII and fibrinogen;
• decreased levels of protein S and tissue plasminogen activator.

In most cases, these changes do not lead to thrombosis. However, if a woman already has a congenital or acquired tendency to thrombus formation, changes in hemostasis during pregnancy can lead to serious complications, such as thrombosis of the placental vessels and intrauterine growth retardation (IUGR). Considering this feature, when preparing for pregnancy, including with the help of IVF, it is recommended to study the following indicators:

• Antiphospholipid antibodies IgM and IgG are a group of autoantibodies directed against various phospholipids and related molecules. The presence of antiphospholipid antibodies in the blood is associated with venous and arterial thrombosis and recurrent miscarriage (a set of symptoms called antiphospholipid syndrome, APS). Women who have been diagnosed with APS are prescribed anticoagulation therapy during pregnancy and the postpartum period.
• Homocysteine ​​is an amino acid, increased concentrations of which are also associated with the risk of venous thrombosis.
• Prothrombin, INR, fibrinogen (coagulogram No. 2) are standard tests that allow you to evaluate the final stage of blood coagulation, common to the external and internal pathways.
• D-dimer is a product of fibrin degradation, the concentration of which reflects the ongoing process of thrombus formation. As a result, the test is most useful when thrombosis is suspected.

A hormonal study is designed to assess the functioning of the pituitary gland, ovaries, adrenal glands, as well as the thyroid gland and their effect on a woman’s fertility:

• Follicle-stimulating hormone (FSH) is a hormone of the adenohypophysis and a well-known indicator of a woman’s “reproductive age”, which is used to assess the functional ovarian reserve. It is believed that an FSH level of more than 10 IU/L is associated with an insufficient ovarian response to stimulation during IVF, and even higher values ​​are associated with an unfavorable pregnancy outcome. Some reproductive centers do not recommend IVF for women if their FSH concentration exceeds a certain threshold value. It is advisable to study FSH on days 2-3 of the menstrual cycle.
• Estradiol is another hormone marker of ovarian reserve. Currently, the concentration of estradiol, together with FSH, is used to select the dose of drugs for an IVF cycle or to decide whether to abandon this procedure altogether. It is advisable to study estradiol on the 2-3rd day of the menstrual cycle.
• Luteinizing hormone (LH) is also a hormone of the adenohypophysis, one of whose roles is to stimulate ovulation. Normally, ovulation occurs within 12-20 hours after the LH peak. During the IVF procedure, they try to avoid the natural LH peak and spontaneous ovulation and therefore maintain low LH levels using gonadotropin-releasing hormone analogues. Some studies have shown that high levels of endogenous LH during the follicular phase indicate a less likely success of the IVF procedure. It is advisable to study LH in the middle of the follicular phase of the cycle.
• Anti-Mullerian hormone (AMH) is another hormone used to assess ovarian reserve. AMH is secreted by ovarian granulosa cells, and high levels usually indicate a sufficient number of eggs. In addition, AMH levels can be used as a predictor of a good ovarian response to stimulation during IVF. One study showed that the level of AMH in women whose stimulation resulted in more than 11 eggs was 2.5 times higher than in other patients. On the other hand, excessively high AMH levels (more than 3.5 ng/ml) are associated with ovarian hyperstimulation syndrome. AMH levels are independent of the phase of the menstrual cycle and can therefore be measured at any time.
• Testosterone, 17-hydroxyprogesterone and dehydroepiandrosterone sulfate are a group of steroid hormones that have an androgenic effect. An increase in each of them can lead to hyperandrogenism, disruption of the normal ovulation process and infertility. On the other hand, with timely diagnosis and treatment, hyperandrogenism can be completely eliminated, fertility can be restored, and such a complex procedure as IVF can be avoided.
• The study of thyroid hormones is necessary to identify diseases of this organ leading to hyper- or hypothyroidism. Both conditions can cause ovulation disorders and infertility. On the other hand, just as with hyperandrogenism, with their diagnosis and correction, complete restoration of fertility can be achieved. In this case, the IVF procedure is not indicated.

Cytological and microscopic examinations:

• Cytological examination of scrapings from the external uterine and cervical canal for atypical cells is carried out mainly to exclude cervical cancer (CC) and high-grade intraepithelial neoplasia (IEN) (CIN 2-3), since their detection significantly affects management tactics women planning a pregnancy using IVF. In addition, using this method you can detect signs of an inflammatory process (cervicitis).
• Microscopic examination of the discharge of the genitourinary organs is carried out to assess the quantitative and qualitative composition of the microflora of the urethra, vagina and/or cervical canal and to diagnose conditions and infections that have a negative impact on the course of pregnancy (bacterial vaginosis, chlamydia, gonorrhea and others).

Tests for hidden STIs: Mycoplasma spp, Ureaplasma spp, Chlamydia trachomatis. Although, unlike TORCH infections, these pathogens do not pose an immediate threat to normal fetal development, they can adversely affect pregnancy outcome, including increasing the risk of premature rupture of membranes and chorioamnionitis. If a woman has been diagnosed with one or more of these STIs, the couple is offered to undergo appropriate treatment before starting the IVF procedure.

Additional tests:

• Antibodies to sperm antigens are a group of immunoglobulins directed against various components of sperm. At the moment, several dozen specific sperm antigens are known, including lactate dehydrogenase C4, tail sperm antigen rSMP-B, calpastatin BS-17 and others. Antibodies to sperm antigens are believed to play a role in the development of both female and male infertility. In addition, the presence of antisperm antibodies has a negative impact on the outcome of IVF - an effect that depends on the class of immunoglobulins. Thus, the simultaneous presence of antisperm antibodies of the IgG and IgA classes, exclusively IgM or exclusively IgA was associated with a lower frequency of egg fertilization.

This comprehensive study allows us to evaluate the main clinical and laboratory parameters that are taken into account when planning IVF. It should be noted, however, that a couple's assessment often involves a unique set of tests, so some other tests may be required.

What is the research used for?

• To examine a woman in preparation for the IVF procedure.

When is the study scheduled?

• When preparing a woman for the IVF procedure.

What do the results mean?

Reference values

For each indicator included in the complex:

• [02-003] Microscopic examination of discharge from the genitourinary organs of women (microflora), 3 localizations
• [02-006] Urinalysis with microscopy
• [02-029] Clinical blood test: general analysis, leukocyte count, ESR (with blood smear microscopy to detect pathological changes)
• [03-001] D-dimer
• [03-005] Blood type ABO
• [03-008] Rh factor
• [03-015] Coagulogram No. 2 (prothrombin (according to Quick), INR, fibrinogen)
• [06-003] Alanine aminotransferase (ALT)
• [06-010] Aspartate aminotransferase (AST)
• [06-015] Plasma glucose
• [06-016] Homocysteine
• [06-035] Total protein in serum
• [06-036] Total bilirubin
• [07-009] anti-HCV, antibodies
• [07-017] Cytomegalovirus, IgG
• [07-018] Cytomegalovirus, IgM
• [07-025] HBsAg
• [07-030] Herpes Simplex Virus 1/2, IgG
• [07-031] Herpes Simplex Virus 1/2, IgM
• [07-032] HIV 1.2 Ag/Ab Combo (determination of antibodies to HIV types 1 and 2 and p24 antigen)
• [07-040] Rubella Virus, IgG (quantitative)
• [07-042] Rubella Virus, IgM
• [07-044] Toxoplasma gondii, IgG (quantitative)
• [07-046] Toxoplasma gondii, IgM
• [07-049] Treponema pallidum, antibodies
• [08-003] 17-Hydroxyprogesterone (17-OPG)
• [08-050] Testosterone free
• [08-093] Anti-Mullerian hormone
• [08-110] Dehydroepiandrosterone sulfate (DEA-SO4)
• [08-111] Luteinizing hormone (LH)
• [08-113] Total triiodothyronine (T3)
• [08-114] Free triiodothyronine (free T3)
• [08-115] Total thyroxine (T4)
• [08-116] Free thyroxine (free T4)
• [08-118] Thyroid-stimulating hormone (TSH)
• [08-119] Follicle-stimulating hormone (FSH)
• [08-120] Estradiol
• [10-002] Culture for Mycoplasma hominis with determination of sensitivity to antibiotics (with a titer of 1x10^4 and above)
• [10-003] Culture for Ureaplasma urealyticum with determination of sensitivity to antibiotics (with a titer of 1x10^4 and higher)
• [10-006] Culture for Chlamydia trachomatis with determination of sensitivity to antibiotics
• [12-001] Cytological examination of smears (scrapings) from the surface of the cervix (external os) and cervical canal for atypia
• [13-003] Antibodies to sperm antigens (in blood)
• [13-013] Antiphospholipid antibodies IgM
• [13-019] Antiphospholipid IgG antibodies
• [13-087] Antithyroglobulin antibodies (antiTG)
• [13-088] Anti-thyroid peroxidase antibodies (anti-TPO)


Important Notes

• To obtain an accurate result, you must follow the recommendations for preparing for the test;
• The results of the study are assessed taking into account additional clinical, instrumental and laboratory data.

Also recommended

[40-520] Hormonal tests when planning IVF (20-23 days of the cycle)

[40-518] Examination of a man when planning IVF

[90-067] Ultrasound examination - Folliculometry (ultrasound monitoring of follicle maturation)

Who orders the study?

Gynecologist, reproductive specialist.

Literature

• Abigail Delaney, Jani R. Jensen, Dean Morbeck. Fertility Testing. How Laboratory Tests Contribute to Successful Infertility Treatments. Clinical Laboratory News, November 01, 2012.

Homocysteine ​​levels during pregnancy

Factors of influence

The factors listed below provoke a temporary increase in homocysteine. With changes in lifestyle, nutrition, and treatment, deviations in the analysis results are leveled out.

• Features of the diet (diet, fasting, vegetarianism, etc.);
• Unbalanced diet (the menu is dominated by animal proteins);
• Lack of B vitamins and folic acid;
• Poor lifestyle (bad habits, abuse of alcohol and caffeine-containing drinks);
• Physical inactivity (sedentary lifestyle);
• Taking medications (phenytoin, methotrexate, etc.), as well as vitamins.

Hyperhomocysteinemia

The following forms of hyperhomocysteinemia are distinguished:

• Heavy;
• Moderate;
• Easy.

A severe form of hyperhomocysteinemia develops in patients with an increase in homocysteine ​​levels greater than 100 micromol/l. The disease occurs for the following reasons:

• Hereditary homocystinuria due to homozygosity for defective genes for enzymes of methionine biosynthesis (cystathionine-b-synthase or 5,10-methylenetetrahydrofolate reductase);
• Hereditary disorders of vitamin B12 utilization;
• severe vitamin B12 deficiency.

When homocysteine ​​levels increase to 30–100 µmol/l, a moderate form of homocysteinemia develops. It occurs with severe renal impairment (reduced clearance of homocysteine ​​by the kidneys), moderate vitamin B12 deficiency, and severe folate deficiency.

A mild form of hyperhomocysteinemia develops when homocysteine ​​levels rise to 10–30 µmol/L. The disease is caused by the following reasons:

• Heterozygosity for the defective cystathionine b-synthase gene, homozygosity for the C677T base substitution in the 5,10-methylenetetrahydrofolate reductase gene;
• Kidney transplantation;
• Kidney failure;
• Slight deficiency of vitamin B12 and folate;
• Lack of thyroid hormones;
• Certain medications (penicillamine, methotrexate, cyclosporine, phenytoin, carbamazepine, 6-azauridine, nitrous oxide).

Hyperhomocysteinemia can be caused by genetic mutations: defects in the enzymes methylenetetrahydrofolate reductase, cystathionine γ-lyase or cystathionine β-synthase.

Homocysteine-lowering therapy reduces the risk of developing cardiovascular disease. Its goal is to reduce homocysteine ​​concentrations in patients at high risk of heart disease to 10 µmol/L. In order to achieve a decrease in homocysteine ​​levels to normal in patients with low and moderate forms of hyperhomocysteinemia, folic acid is prescribed from 0.4 to 5 mg / day or vitamin B12 in a dose from 0.5 to 1 mg / day, or both drugs are used. A combination drug is used that contains coenzymes B1, B6, B12, as well as lysine and carnitine and lysine. Folic acid is present in spinach, most plant foods that have leaves, green vegetables, liver and fish. A promising direction in the treatment of homocysteinemia is the use of statins.

Hyperhomocysteinemia in pregnant women

Hyperhomocysteinemia in pregnant women remains one of the leading causes of neural tube defects (anencephaly, meningocele and spina bifida), lower limb defects and congenital heart defects in the fetus, and can also have direct fetotoxic and teratogenic effects. In later stages of pregnancy, hyperhomocysteinemia is the main cause of the development of chronic placental insufficiency and chronic intrauterine fetal hypoxia, which leads to a decrease in the genetically determined weight of the fetus and a decrease in the functional reserves of all life-supporting systems of the newborn.

In the presence of homocysteine ​​in excess concentrations, sodium-potassium adenosine triphosphatase in the membrane of vascular smooth muscle cells is inhibited, intracellular sodium concentration increases, and electrolyte disturbances develop. This causes vasospasm and becomes an essential element of the vicious circle that underlies the mechanism of development of arterial hypertension, preeclampsia and associated complications. In this regard, gynecologists conduct a dynamic assessment of blood homocysteine ​​levels in pregnant women suffering from various forms of arterial hypertension.

This indicator is a marker of endothelial dysfunction and a prognostic indicator of the development of obstetric complications. In chronic arterial hypertension, the highest level of blood homocysteine ​​is detected in the first trimester of pregnancy. In preeclampsia and preeclampsia against the background of chronic arterial hypertension, higher levels of blood homocysteine ​​are found in the second and third trimesters of pregnancy. Blood homocysteine ​​levels in the third trimester of pregnancy above 5.8 µmol/l are associated with the development of preeclampsia.

Clinical relevance

1. Determination of Homocysteine ​​is indicated for any etiological assessment of venous or arterial thrombosis, especially at a young age. It is recommended to simultaneously measure vitamin B12 and folic acid to determine (rule out) hyperhomocysteinemia due to vitamin deficiencies.2. Examination of patients with suspected hereditary disorders of methionine metabolism, including: deficiency of cystathionine beta synthase (homocystinuria) and deficiency of methylenetetrahydrofolate reductase (MTHFR) and its heat-labile variants: methionine synthase deficiency, disorders of cobalamin metabolism.

Indications

• Assessment of the degree of deficiency of folic acid and B vitamins;
• Diagnosis of homocystinuria;
• Homocystinuria in the family history in the absence of symptoms of the disease (preventive examination);
• Determination of the degree of risk of diseases of the cardiovascular system, disorders of placental circulation;
• Genetic predisposition to pathologies of the coronary arteries;
• Management of pregnancy in patients at risk;
• Diagnosed diabetes mellitus in a pregnant woman.

The interpretation of the analysis results is carried out by specialists: gynecologist, endocrinologist, therapist, family doctor.