Aim. To revisit the role of first trimester homocysteine levels with the maternal and fetal outcome. Methods. This was a cohort study comprising 100 antenatal women between 8 and 12 weeks of gestation. Serum homocysteine levels were checked after overnight fasting. Results. There were significantly elevated homocysteine levels among women with prior history of hypertensive disorders of pregnancy and prior second or third trimester pregnancy losses. There was no significant difference in homocysteine levels among women with previous gestational diabetes mellitus, preterm deliveries, or fetal malformations. Homocysteine levels were significantly elevated in those who developed hypertensive disorder of pregnancy, oligohydramnios, and meconium stained amniotic fluid, had a pregnancy loss, or delivered a low birth weight baby. There was no significant difference in homocysteine levels for those who developed gestational diabetes mellitus. Conclusions. Increased first trimester serum homocysteine is associated with history of pregnancy losses, hypertensive disorders of pregnancy, and preterm birth. This is also associated with hypertensive disorders of pregnancy, pregnancy loss, oligohydramnios, meconium stained amniotic fluid, and low birth weight in the current pregnancy. This trial is registered with ClinicalTrials.gov CTRI/2013/02/003441. 1. Introduction Homocysteine is an amino acid which has sprung into prominence in the past few decades [1]. Homocysteine is intricately linked to folate metabolism and one methyl transfer. Elevated homocysteine levels have been shown to be deleterious on vascular endothelium [1, 2]. Elevated homocysteine has also served as an early marker for insulin resistance due to the effects of insulin on homocysteine metabolism and renal clearance [3]. These relationships of homocysteine to disease states in the nonpregnant adult population have been extrapolated to link it to the pregnancy specific conditions of gestational diabetes mellitus and hypertensive disorders of pregnancy. Homocysteine levels decline during pregnancy [4], and the levels are the lowest during second trimester of pregnancy and increase in the second half of the third trimester of pregnancy. Hence, samples taken within strict time frame, such as 4 weeks (between 8 to 12 weeks of gestation), would have a better success at correlating the homocysteine levels with the pregnancy outcome, by minimising the gestational age bound variation of homocysteine. In addition, most maternal complications such as hypertensive disorders of pregnancy and gestational diabetes
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