Is Maternal Serum Homocysteine a Novel Diagnostic Biomarker for Predicting Placenta-Mediated Disorders?

Background Uteroplacental insufficiency and related disorders, though a significant cause of undesirable maternal and fetal outcomes, are complex and poorly understood. The newer screening modalities are expensive and difficult to procure for day-to-day use in developing countries. This study aimed to examine the association of mid-trimester maternal serum homocysteine levels with maternal and neonatal outcomes. Methodology This was a prospective cohort study involving 100 participants between 18 and 28 weeks of gestation. The study was conducted at a tertiary care center in south India from July 2019 to September 2020. Maternal blood samples were analyzed for serum homocysteine levels and correlated with the third-trimester pregnancy outcomes. Statistical analysis was done, and diagnostic measures were computed. Results The mean age was found to be 26.8 ± 4.8 years. Of the participants, 15% (n = 15) were diagnosed with hypertensive disorders during pregnancy, while 7% (n = 7) had fetal growth restriction (FGR) and 7% (n = 7) were complicated by preterm birth. An elevated maternal serum homocysteine level was positively associated with adverse pregnancy outcome measures such as hypertensive disorders (p = 0.001), with sensitivity and specificity of 27% and 99%, respectively, and FGR (p = 0.03) with sensitivity and specificity of 28.6% and 98.6%, respectively. Moreover, a statistically significant outcome was noted with preterm birth before 37 weeks (p = 0.001) and a low Apgar score (p = 0.02). No association was established with spontaneous preterm labor (p = 1.00), neonatal birth weight (p = 0.42), and special care unit admission (p = 1.00). Conclusions Such a simple and affordable investigation has the potential to go a long way in the early diagnosis and management of placenta-mediated disorders in pregnancy during the antenatal period, especially in low-resource settings.