Plasma homocysteine concentration is increased in preeclampsia and is associated with evidence of endothelial activation

Objective: We tested the hypothesis that the independent risk factor for atherosclerosis of increased plasma homocysteine concentration is associated with the pregnancy syndrome of preeclampsia. We further hypothesized that increased plasma homocysteine concentration during pregnancy may advance endothelial dysfunction in preeclampsia by promoting oxidative stress. Study Design: Antepartum blood samples were collected ≥6 hours after the last meal from 33 women with normal, uncomplicated pregnancies and from 21 women with preeclampsia. These plasma samples were analyzed for concentrations of total homocysteine; folate; triglycerides; creatinine; a marker of endothelial activation, cellular fibronectin; and a marker of oxidative stress, malondialdehyde. Results: The mean value of total plasma homocysteine in preeclampsia was significantly higher than that observed in normal pregnancy ( P < .04). Similarly, plasma malondialdehyde ( P < .001), triglyceride ( P < .001), and cellular fibronectin ( P < .006) concentrations were also greater in women with preeclampsia than in control subjects. However, no differences were observed between women with preeclampsia and control subjects in folate ( P = .97) or creatinine ( P = .28) concentrations. Homocysteine concentration did not correlate with plasma creatinine ( P = .61), malondialdehyde ( P = .32), or triglyceride ( P = .89) concentrations. However, cellular fibronectin concentration correlated positively with homocysteine concentration in both women with preeclampsia and control subjects ( r = 0.87, P < .0001, and r = 0.50, P < .004, respectively), and folate concentrations were weakly but negatively correlated with homocysteine values ( P = .03, r = 0.32). Conclusions: Total plasma homocysteine concentration is increased in preeclampsia and is significantly correlated with cellular fibronectin concentration, suggesting that homocysteine plays a role in promoting endothelial dysfunction in preeclampsia. Furthermore, despite the use of pregnancy multivitamins and no indications of overt folate deficiency in this subject population, homocysteine concentration weakly and negatively correlates with plasma folate concentration. (Am J Obstet Gynecol 1998;179:1605-11.)