High level of homocysteine is associated with pre-eclampsia risk in pregnant woman: a meta-analysis

Abstract

Objective

We aimed to investigate the correlation between blood homocysteine (Hcy) levels and pre-eclampsia (PE) risk in pregnant women.

Methods

Related articles were searched using PubMed, Embase, and Web of Science databases. Methodological quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Cochran's Q and I² tests were used to evaluate heterogeneity. Egger’s test was used to evaluate publication bias. A sensitivity analysis was performed to test stability of the results using a one-by-one elimination method. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence.

Results

Nine studies (4384 PE and 26021 non-PE patients) were included in the meta-analysis. The methodology of them was of good quality, with NOS scores of 5–8. However, there was a significant heterogeneity among included studies. Therefore, the random effect model was generated and combined results suggested a significant association between increased level of Hcy in pregnant women and PE risk. Although a significant publication bias was found in the current study with a P value of 0.006 in the Egger test, sensitivity analysis showed that the combined results were stable and did not vary significantly from any single study. However, the GRADE evidence quality was very low, which may lower the recommendation of pooled results.

Conclusions

Increased levels of Hcy in maternal blood were significantly associated with the risk of PE, but low certainty of evidence need to be improved by more high-quality studies.

摘要

目的

探讨孕妇血清同型半胱氨酸（Hcy）水平与先兆子痫（PE）风险的相关性

方法

使用 PubMed、Embase和Web of science数据库搜索相关文章。使用纽卡斯尔-渥太华质量评估量表（NOS）评估纳入研究的方法学质量。Cochran的Q和i2检验用于评估异质性。Egger检验用于评估发表偏倚。使用一对一消除方法进行敏感性分析评估结果的稳定性。推荐的分级、评估、制定与评价 (GRADE) 用于评估证据的确定性。

结果

荟萃分析纳入九项研究（4384名PE患者和 6021名非PE患者）。它们的方法学质量很好, NOS得分为5-8。然而, 纳入的研究之间存在显著的异质性。因此, 生成了随机效应模型, 综合结果表明孕妇Hcy水平升高与PE风险之间存在显著相关。尽管在本研究中发现了显著的发表偏倚, 在Egger检验中P值为0.006, 但敏感性分析表明, 综合结果是稳定的, 与任何一项研究都没有显著差异。然而, GRADE证据质量非常低, 这可能会降低综合结果的推荐性。

结论

孕妇血Hcy水平升高与PE风险显著相关, 但需要通过更多高质量研究来改善低质量证据。

Keywords:

• Homocysteine
• pre-eclampsia
• pregnant woman
• meta-analysis

关键词:

• 同型半胱氨酸
• 子痫前期
• 孕妇
• 荟萃分析

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (grant number: 31771667).