Hyperhomocysteinemia is a risk factor in obstetrical complications such as
pre-eclampsia, '
hemolysis, elevated liver
enzymes, low platelet' (
HELLP)-syndrome and
placental insufficiency. The aim of our study was to investigate the alterations of
homocysteine catabolism in these patients in relation to serum
B-vitamins and renal function. Maternal fasting serum from
pre-eclampsia (n=24), HELLP (n=20) and
placental insufficiency (n=25) patients at the time of diagnosis and pregnant controls (n=34) was analyzed for
homocysteine and its metabolites
cystathionine and
methylmalonic acid, the
vitamins B6, B12 and
folate, renal and additional parameters.
Cystathionine, a parameter of
homocysteine catabolism, was significantly increased in
pre-eclampsia and HELLP compared with controls and
placental insufficiency patients (mean concentrations: 343, 324, 248, 227 nmol/l; p=0.001).
Homocysteine,
folic acid,
vitamin B6 and
methylmalonic acid, however, did not differ significantly between groups. The main determinants of
cystathionine are
cystatin C and
vitamin B6, whereas the main determinants of
homocysteine are
folate and
uric acid. The strongest dependency of
cystathionine on
vitamin B6 was observed in
pre-eclampsia and HELLP patients. The results suggest that the
vitamin B6-dependent trans-sulfuration pathway is activated in
pre-eclampsia and
HELLP syndrome, probably by oxidative stress. Therefore, the demand for
vitamin B6 is increased in these patients. Furthermore, renal dysfunction and low
vitamin B6 levels contribute to the increase of
cystathionine in
pre-eclampsia and HELLP patients.