Clinical Report: Link Between Elevated Homocysteine Levels and Unexplained Recurrent Pregnancy Loss
Overview
This meta-analysis evaluates the association between elevated homocysteine levels and unexplained recurrent pregnancy loss (uRPL). The findings show that hyperhomocysteinemia is associated with increased odds of uRPL, with variations in homocysteine cutoff definitions contributing to heterogeneity among studies.
Background
Unexplained recurrent pregnancy loss (uRPL) affects 2-5% of women of reproductive age and presents a significant clinical challenge. Despite extensive evaluations, many cases remain unexplained.
Data Highlights
Study Type
Cases (uRPL)
Controls
Pooled OR (95% CI)
Case-Control
1,473
1,605
3.46 (2.33–5.14)
Key Findings
Elevated homocysteine levels are significantly associated with uRPL (OR 3.46, 95% CI 2.33–5.14).
Subgroup analyses show higher pooled ORs in Asia (4.41), Europe (2.96), and Africa/Middle East (2.59).
The association is stronger in studies with homocysteine cutoff > 12 μmol/L (OR 4.02) compared to ≤ 12 μmol/L (OR 2.00).
Studies using HPLC or immunoassay methods report stronger associations (OR 3.59 and 4.53) than those using enzymatic methods (OR 1.84).
Meta-regression indicates that homocysteine cutoff is a significant contributor to study heterogeneity (coefficient = 0.044, p = 0.04).
Clinical Implications
The findings indicate that elevated homocysteine levels may be associated with uRPL.
Conclusion
The association between elevated homocysteine levels and uRPL warrants further investigation.
