Maternal Serum Homocysteine as a Severity-Linked Biomarker Across the Spectrum of Hypertensive Disorders of Pregnancy: A Prospective Observational Study.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) remain a leading cause of maternal and perinatal morbidity worldwide. Endothelial dysfunction is central to the pathogenesis of preeclampsia, and serum homocysteine, a pro-oxidant amino acid, has been implicated in vascular injury and placental insufficiency.

METHODS: This prospective observational study included 200 pregnant women beyond 20 weeks of gestation, stratified into four equal groups: normotensive controls, non-severe preeclampsia, severe preeclampsia, and eclampsia (n = 50 each). Serum homocysteine levels were measured at admission prior to therapeutic intervention. Clinical and demographic variables were recorded. Continuous variables were analysed using one-way ANOVA and categorical variables using the χ² test, with statistical significance set at p < 0.05.

RESULTS: Maternal serum homocysteine levels demonstrated a significant and progressive increase with disease severity, rising from 12.04 ± 2.34 µmol/L in normotensive women to 26.74 ± 6.58 µmol/L in eclampsia (p = 0.0251). Primigravidity was more common in severe disease groups (p = 0.0375), and maternal body mass index increased with severity (p = 0.0461). Caesarean section rates were significantly higher in severe preeclampsia (70%) and eclampsia (80%) compared with controls (p < 0.001). Blood pressure normalised across all groups at 12 weeks postpartum.

CONCLUSIONS: Maternal serum homocysteine is strongly associated with both the presence and severity of HDP. Its progressive elevation across the disease spectrum highlights its potential role as a clinically useful biomarker for early risk stratification and management. Integration of homocysteine assessment into routine obstetric care may enhance the prediction of severe disease and improve maternal outcomes.