Study to Evaluate Role of Homocysteine and Folic Acid in 1st Trimester Recurrent Pregnancy Loss

Abstract

Introduction: Recurrent pregnancy loss (RPL) is a multifactorial condition, with biochemical factors such as hyperhomocysteinemia and folate deficiency increasingly recognized as important contributors. Aim: To evaluate the association between serum homocysteine and folic acid levels in women with RPL compared to healthy controls. Materials and Methods: A hospital-based case–control study was conducted on 50 women with RPL and 50 age-matched controls. Serum homocysteine and folic acid levels were measured using high-performance liquid chromatography and chemiluminescent immunoassay, respectively. Hyperhomocysteinemia was defined as >15 µmol/L and folate deficiency as <4 ng/mL. Statistical analysis included t-test, Chi-square test, odds ratio calculation, and Pearson’s correlation. Results: Mean homocysteine levels were significantly higher in the RPL group (16.2 ± 4.5 µmol/L) compared to controls (11.8 ± 3.2 µmol/L, p<0.0001). Mean folic acid levels were significantly lower in cases (3.9 ± 1.1 ng/mL) than controls (6.2 ± 1.4 ng/mL, p<0.0001). Hyperhomocysteinemia was present in 56% of cases versus 20% of controls (OR 5.0, 95% CI 2.1–11.8), while folate deficiency was observed in 60% of cases versus 16% of controls (OR 7.5, 95% CI 3.0–18.6). A strong negative correlation between homocysteine and folic acid was noted in the RPL group (r = –0.62, p<0.001). Conclusion: Women with RPL exhibit a significant imbalance between homocysteine and folic acid, suggesting a dual biochemical mechanism involving vascular dysfunction and impaired embryogenesis. Screening and correction of these abnormalities may improve pregnancy outcomes in high-risk populations.