Homocysteine ​​when planning pregnancy - an extremely important analysis

Why is the level important?

Homocysteine ​​is an important and essential amino acid for the human body, especially during pregnancy and its planning.
An increase in homocysteine ​​levels can lead to unpleasant consequences, so it is very important to take a blood test for homocysteine ​​at the stage of planning pregnancy or during it if you have a history of miscarriages. As already mentioned, homocysteine ​​is an amino acid variety and is an active substance. Unlike other amino acids, this enzyme does not enter the body with food, but is synthesized by methionine and is considered a product of its processing. Methionine enters the body through food products of animal origin.

• Homocysteine ​​levels vary depending on age, but in general the amount should be minimal. Without folic acid and B vitamins, homocysteine ​​metabolism is impossible.
• When there is a shortage of them, the level increases greatly, as a result of which the processed product is released into the blood. After this, the walls of blood vessels begin to collapse, against which atherosclerotic plaques and blood clots form.

So, in order for homocysteine ​​levels to be normal, it is necessary to ensure that the body receives folic acid and vitamins B6, B12 in sufficient quantities. If a person is deficient in these vitamins and your diet contains too much protein, then homocysteine ​​levels increase.

A blood test for homocysteine ​​is needed for:

• preventing miscarriage caused by increased homocysteine;
• timely detection of deficiency of B vitamins and folic acid;
• determining the risk of heart and vascular disease;
• detection of a hereditary predisposition to a disease called homocystinuria.

Homocystinuria refers to a genetic disease that entails consequences such as mental retardation, thinness, atherosclerosis and other diseases of the blood vessels, heart, visual apparatus, and skeletal system.

Most often, during pregnancy, homocysteine ​​is reduced, which helps improve blood circulation in the placenta. This is a physiologically normal phenomenon.

Every woman planning a pregnancy and having a history of more than 2 miscarriages must undergo a blood test for homocysteine. If a deviation is detected, drug therapy aimed at balancing the level of folic acid and B vitamins is necessary.

In a healthy adult, the normal homocysteine ​​level should be:

• absence or planning of pregnancy – 4.44-13.56 µmol/l;
• during pregnancy - 4.6-12.4 µmol/l, deviations in each direction of 0.5 µmol/l are possible.

In some laboratories, the norm for pregnant women is up to 10 µmol/l, and for non-pregnant women – up to 15 µmol/l, so it is still recommended to focus on the norms of the laboratory where the test was taken!

When homocysteine ​​levels exceed the norm, doctors make a diagnosis of hyperhomocysteinemia. Increasing the level of this amino acid may not always lead to unpleasant consequences. This only increases the risk of miscarriage or other adverse consequences, but if the situation is changed in time, then this risk is minimized.

Causes and consequences

Causes of hyperhomocysteinemia:

1. Since methionine comes with some products of animal origin, the risk of pathology occurs when a woman consumes large quantities of meat, dairy products (especially cottage cheese) and eggs.
2. Lack of B vitamins and folic acid in the body, which in turn occurs with an unbalanced diet.
3. Some diseases of the gastrointestinal tract (atrophic gastritis, etc.), which impair the absorption of nutrients from the gastrointestinal tract.
4. Presence of renal failure and/or hypothyroidism.
5. Drinking large quantities of coffee, alcoholic beverages, smoking.
6. A sedentary lifestyle or, conversely, excessive physical activity.
7. Strict diets, malnutrition.

Note that homocysteine ​​levels are rarely elevated in vegetarians. However, this does not speak in favor of vegetarianism, since with this type of nutrition for a pregnant woman, the fetus does not receive enough other useful substances (in particular, protein and iron, which are so necessary for the normal development of the fetus).

Unpleasant consequences:

• spontaneous miscarriage;
• preeclampsia and eclampsia;
• fetal developmental delay;
• fetal hypoxia;
• placental insufficiency in chronic form;
• placental abruption;
• venous thromboembolism;
• nephropathy and retinopathy, as a complication if a pregnant woman has diabetes.

The most effective treatment for high homocysteine ​​levels is vitamin therapy. In general, treatment can be like this:

1. Prescription of folic acid (5 mg per day) and B vitamins in large quantities. This allows you to replenish the deficiency of these substances in the body and balance the synthesis of homocysteine. In addition, hematopoiesis is stimulated, the functionality of internal organs is improved, metabolic processes are accelerated, and many amino acids are synthesized. Plus, blood clotting is normalized, nucleic acids are formed in sufficient quantities, and cell growth and division are accelerated. But the main thing is that the embryo develops correctly.
2. Following a diet aimed at reducing protein consumption and increasing the proportion of vegetables and fruits in the diet.
3. Antiplatelet treatment involves taking aspirin in small doses (up to 100 mg per day) or heparin drugs - fraxiparin, clexane, fragmin, etc. This reduces the risk of developing atherosclerosis (formation of cholesterol plaques) and thrombophlebitis.

If elevated homocysteine ​​levels are detected, it is also recommended to donate blood for sugar, creatinine and TSH.

Prevention:

• get rid of bad habits;
• eat more foods rich in vitamins B 6, B 9, B 12;
• do not drink a lot and often of coffee;
• lead an active lifestyle, but without fanaticism (strength training in the gym is already too much for those planning a pregnancy and for pregnant women; only light weights in the form of dumbbells are allowed);
• walk more in the fresh air;
• strictly monitor your diet (protein is very important for the developing fetus, but there should also be enough vegetables).

Taking aminophylline may temporarily increase homocysteine ​​levels. Therefore, during treatment with aminophylline, blood is not tested for homocysteine.

Reduced levels of homocysteine ​​during pregnancy are not dangerous, but, on the contrary, are beneficial. The fact is that this significantly improves blood supply to the placenta, as a result of which the embryo receives a sufficient amount of nutrients. Therefore, a pregnant woman should not worry if the level of homocysteine ​​in her blood is below normal.

The only negative side is a feeling of weakness, fatigue and deterioration in general well-being, but it happens that such symptoms are not observed. It all depends on the characteristics of the pregnant woman’s body.

Causes, consequences

The main reasons for decreased homocysteine ​​levels:

1. Onset of pregnancy. A decrease in homocysteine ​​levels in the first trimester of pregnancy is not a deviation. Next, the level must reach the established norm.
2. Multiple sclerosis, which affects the spinal cord and brain.

In order for a woman to feel good and for weakness to not cause discomfort, the following rules must be followed:

1. It is strictly forbidden to lead a sedentary lifestyle, this will only worsen the situation. If a person has a sedentary job, he needs to do light exercise every hour to tone the body.
2. Take walks in the fresh air. If possible, visit the botanical garden and other places with a large number of living plants where fresh air abounds.
3. Be careful about your diet. Eat more fresh vegetables, berries and fruits. Avoid foods high in cholesterol (smoked, canned, etc.).
4. Don't drink coffee or strong tea; it's better to take vitamin premixes. If you really can’t do without caffeine, then drink 1-2 cups of coffee a day, but not strong coffee.
5. Visit your doctor promptly.

If you adhere to all the requirements and rules during pregnancy and its planning, your homocysteine ​​level will always be normal.

Its level should be monitored for two reasons:

1. To make sure that the baby’s development period proceeds without complications.
2. Identification of deficiency of B vitamins, which improve cellular metabolism in all organs and systems.
3. To exclude the presence of a rare hereditary disease in the fetus - homocysteinuria.

Causes of low and high homocysteine

Homocysteine ​​concentrations from 4.5 to 13.5 µmol/l are considered normal, but the result must be assessed by the attending physician. The risks for successful pregnancy increase at levels above 7-8 µmol/l and below 6 µmol/l.

Low homocysteine ​​levels are quite rare. The causes of this condition may be a course of treatment with certain medications (penicillamine, acetylcysteine, betaine), which accelerate the metabolism of homocysteine, as well as conditions such as hyperthyroidism or the initial stage of diabetes mellitus.

High levels of homocysteine ​​(8-10 µmol/l) provoke abuse of caffeine-containing drinks, smoking, physical inactivity, diabetes mellitus and some mental disorders. The condition can also be of a medicinal nature and develop after a course of therapy using cyclosporine, theophylline, diuretics, fibrates and some other drugs.

Introduction

Severe complications of the second half of pregnancy (preeclampsia, eclampsia, placental abruption, intrauterine fetal death) are among the most dangerous obstetric complications. In many cases, the severity of the condition (high levels of arterial hypertension and proteinuria, convulsive syndrome) and the rapid progression of the pathological process forces doctors to prematurely terminate such a pregnancy in order to save the woman’s life.

At the same time, children born prematurely often find themselves in a serious condition due to prolonged intrauterine suffering due to fetoplacental insufficiency and hypoxia and, despite the full range of resuscitation and intensive care measures, are not able to adapt to the conditions of extrauterine existence.

It is important to emphasize that routine examination outside and in the early stages of pregnancy (general clinical blood tests, urine tests, hormonal screening tests and examination for STDs), as a rule, does not reveal serious pathology in such patients. Recent studies have shown that many types of obstetric pathology are based on the development of generalized microangiopathy and thrombophilia associated with autoimmune disorders (including antiphospholipid syndrome), hyperhomocysteinemia, and hereditary hemostasis defects (10), (13)

Clinical manifestations of these pathological conditions may be early onset and/or severe course of gestosis, fetoplacental insufficiency, intrauterine fetal growth restriction (IUGR), placental abruption, intrauterine fetal death (14)

Recent studies have shown that many types of obstetric pathology are based on the development of generalized microangiopathy and thrombophilia associated with autoimmune disorders (including antiphospholipid syndrome), hyperhomocysteinemia, and hereditary hemostasis defects (10), (13). Clinical manifestations of these pathological conditions may be early onset and/or severe gestosis, fetoplacental insufficiency, intrauterine fetal growth restriction (IUGR), placental abruption, and intrauterine fetal death (14).

In many cases, each of the named etiopathogenetic factors separately may not be accompanied by a pathological course of pregnancy. However, their combination leads to a significant decrease in the adaptive abilities of the woman’s body to the conditions of gestation and can become a kind of “trigger” in the cascade of pathological reactions for the development of generalized microangiopathy and thrombophilia (12), (14).

Hence, women with a combination of these factors are likely to have a high risk of placentation disorders and, as a consequence, the development of recurrent miscarriage, placental insufficiency, IUGR, late toxicosis (preeclampsia), conditions threatening placental abruption, obstetric hemorrhage, and intrauterine fetal death.

One of the options for solving the problem of prevention and early diagnosis of these conditions may be the identification of additional risk factors for the development of thrombophilias, the study of possible options for their combination and mutual influence on each other, the formation of risk groups for the development of complications in the second half of pregnancy and the search for reliable markers and new effective methods of correction detected deviations.

What is homocysteine?

Methionine, one of the essential amino acids, enters the human body with protein foods. As a result of protein processing from methionine, homocysteine ​​is synthesized - its by-product.

It is also an amino acid, but, unlike methionine, it cannot be obtained from foods. Methionine is an important component of metabolism and is found in large quantities in meat, dairy products and eggs. There is especially a lot of it in cottage cheese.

Normally, homocysteine ​​is found in the body in very small quantities. B vitamins and folic acid play an important role in the metabolism of homocysteine.

If there are not enough of these substances for processing, then the level of homocysteine ​​increases. In this case, the body triggers defense mechanisms and releases it into the blood in large doses.

An increase in the level of this amino acid leads to weakening of the walls of blood vessels and, as a result, the development of atherosclerosis and the formation of blood clots. Older people have an increased risk of developing Alzheimer's disease and age-related encephalopathy.

Elevated homocysteine ​​during pregnancy can lead to fetal death, and in people with diabetes, the risk of vascular complications increases.

Normal indicators

Homocysteine ​​level test - what is this test? This is a study at different stages of gestation.

In each period, this indicator in the blood plasma is different.

It is believed that a maximum value of up to 12 kmol/l is considered normal throughout the entire period.

Negative consequences in the body of the mother and fetus are caused by a deviation in homocysteine ​​levels towards a decrease or increase. Having received timely information about the complications and consequences of these abnormalities, the pregnant woman begins to monitor the level of homocysteine ​​in the blood, take measures to reduce this indicator, thereby avoiding an extremely life-threatening condition for the fetus and mother - gestosis.

Homocysteine ​​during pregnancy is normally in the range from 4.6 to 12.4 µmol/l. In childhood (up to 14 years), its level is 5 µmol/l, regardless of gender, in adolescence – 10-11 µmol/l. The normal levels of this amino acid in men are slightly higher - 3.5-20.5 µmol/l, while in non-pregnant women the norm is 5.9-16.0 µmol/l. During pregnancy, the norm of homocysteine ​​levels is divided depending on the period:

• The first trimester is the norm 4.6-12 µmol/l.
• Second trimester – norm 5.5-12.2 µmol/l.
• Third trimester – norm 6-12.4 µmol/l.

With a nutritious diet, the mother guarantees her baby’s development and health, since the balance of the most important nutrients (amino acids, vitamins) is maintained. A slight downward deviation in homocysteine ​​levels in the first weeks of pregnancy, as well as at the beginning of the second trimester, may be physiological (no more than 0.5 µmol/l).

A situation where homocysteine ​​is reduced to lower levels (by 3 µmol/l) often causes the mother to feel unwell, with virtually no effect on the vital functions of the fetus. Gynecologists claim that such a decrease protects the blood vessels of the placenta, as well as the blood vessels of the baby’s heart and brain, from ischemic processes, which has a good prognosis in the future.

Accumulating in the vascular walls and endothelium of the arteries, homocysteine ​​during pregnancy can have a damaging effect on these vessels. High levels of homocysteine ​​lead to the formation of blood clots, plaques, and the appearance of atherosclerotic changes in blood vessels. For the mother and fetus in such a situation, there is a threat of miscarriage due to thrombosis and impaired placental circulation. In the last trimester and in the prenatal period, there is a threat of intrauterine fetal hypoxia.

Homocysteine ​​is an amino acid that does not come with food, but is independently synthesized in the human body from methionine. It gradually increases throughout life, but in women during pregnancy there is a physiological decrease.

• The restoration of normal amino acid concentrations occurs 2-3 days after birth.
• When planning pregnancy, homocysteine ​​is an important indicator of the body's saturation with B vitamins and folic acid, as well as a prognostic sign of successful pregnancy.
• Normally, homocysteine ​​should not accumulate in significant quantities. Under the influence of vitamin B6, it is converted into cysteine, and from it, through several biochemical reactions, into taurine.

It is a sulfonic acid that accumulates in bile and is also present in tissues.

Taurine is necessary for binding bile acids in the liver, and in the intestines for emulsification and absorption of lipids from food.

• With a lack of pyridoxine or vitamin B6, as well as vitamins B1 and B12, the chain of transformation of homocysteine ​​into other substances is interrupted. It accumulates in the blood and damages the endothelium, the inner layer of the arteries.
• This leads to impaired blood flow and increases the risk of vascular thrombosis.
• When planning pregnancy, homocysteine ​​is responsible for the correct formation of the vessels of the functional layer of the endometrium and the subsequent formation of the chorion.

It is not necessary for all women to donate blood to determine homocysteine ​​levels when planning pregnancy. This study is not included in the minimum diagnostic list. The gynecologist recommends examination in the following cases:

• recurrent miscarriage – for women who have had 2 or more spontaneous miscarriages in a row;
• during a previous pregnancy there was gestosis or any of its forms;
• cases of severe feto-placental insufficiency in the anamnesis;
• 3 biochemical pregnancies after IVF in a row;
• with B12 or folate deficiency anemia that cannot be treated with iron supplements;
• transient ischemic attacks, stroke, heart attack at a young age;
• diabetes;
• hereditary burden - parents had a heart attack before the age of 45.

When searching for causes of infertility of secondary origin, after excluding infectious factors, hormonal disorders that cause disruption of egg maturation or implantation, an examination is carried out to determine compliance with the homocysteine ​​level.

Minimum levels of homocysteine ​​are observed during the neonatal period. In children under one year of age they correspond to 2.87-9.99 µmol/l. For teenage girls, the norm is considered to be 4.07-10.36 µmol/l.

For women over 19 years of age, the norm is 4.44-13.56 µmol/l. But research shows that the concept of norms that were adopted more than 50 years ago is greatly overestimated. Initially, the studies were conducted on older people who were at risk of developing cardiovascular disease. Therefore, the homocysteine ​​norm for women planning a pregnancy appeared much later.

• The American Heart Association published research results in 2004 that show that homocysteine ​​of 7 µmol/L or more is considered high, and when planning pregnancy this figure should remain minimal. Studies have confirmed an increase in the risk of blood flow disturbances and endothelial damage by 26% with homocysteine ​​8-9 µmol/l. For women planning a pregnancy, the optimal indicator is below 6.
• Attention! When you receive the test results form from the laboratory, the results must be interpreted by a doctor. In most medical centers, the norm printed on the form corresponds to 4.4-13.56 µmol/l. But you need to remember that to plan a pregnancy, the result should tend to the minimum value.

Low homocysteine ​​concentrations are very rare. This is due to its constant synthesis from methionine. The following conditions cause concentrations below normal:

• hyperthyroidism;
• initial stage of diabetes mellitus;
• Down syndrome;
• treatment with certain drugs.

The following medications cause acceleration of homocysteine ​​metabolism and a decrease in blood levels:

• Penicillamine;
• Acetylcysteine;
• Mesna;
• estrogen preparations;
• Tamoxifen;
• Betaine;
• Simvastatin.

If a woman gets enough folic acid and B vitamins from her diet, homocysteine ​​will not linger in the bloodstream for long. In the absence of other factors contributing to an increase in the level, it will remain at the lower limit of the norm. This has a beneficial effect on planning conception and subsequent pregnancy.

Homocysteine ​​levels of 10 µmol/l or more should cause serious concern when planning pregnancy. This indicator fits into the norm of most laboratories, but is not suitable for women preparing to conceive. High homocysteine ​​can cause the following conditions:

• diabetes;
• some mental disorders;
• smoking;
• drinking a lot of coffee.

The negative effects of coffee and caffeine-containing drinks are associated with changes in kidney function. In women who drink more than 6 cups per day, the amino acid level is 2-3 µmol/l higher compared to those who do not drink it. Women who smoke and suffer from physical inactivity have a tendency to have elevated homocysteine ​​levels.

Some medications may affect the test result:

• Methotrexate and other folate antagonists;
• nitrous oxide;
• Metformin;
• Niacin;
• Theophylline;
• L-dopa;
• androgens;
• Cyclosporine;
• fibrates;
• diuretics;
• Cystine.

That is why, when preparing for the study, it is necessary to wait a few days after taking the medications.

In 2014, joint studies by scientists from Canada and South Korea were completed, which were aimed at establishing the relationship between pregnancy complications and the level of folate, homocysteine ​​in the pregnant woman and the fetus. The results confirmed that in women with concentrations above 6, the risks of the following complications increase:

• premature birth;
• gestational diabetes mellitus;
• preeclampsia;
• placenta previa;
• premature detachment of a normally located placenta;
• low fetal weight.

An analysis result that is higher than normal may indirectly indicate a lack of folate and other B vitamins. A deficiency of folic acid at the planning stage of conception and in the first months of pregnancy can cause the development of neural tube defects in the fetus and other developmental anomalies.

How much homocystene should be present when planning pregnancy depends on individual characteristics, but you should strive for 5 µmol/l. If there is a slight deviation - up to 5.32, this should not be considered a pathology.

• To reduce blood concentrations, it is necessary to change your lifestyle and diet. Giving up bad habits helps. Women who want to give birth to a healthy child need to quit smoking, or better yet, not start.
• Moderate physical activity helps. Untrained women who lead a predominantly sedentary lifestyle should start with simple exercises, vigorous walking, swimming, and cycling. Later, you can increase the load and move on to training in the gym.
• The main way to influence homocysteine ​​levels is to take vitamin tablets.

When planning pregnancy, folic acid is recommended in a dosage of 400-600 mcg per day, if there were no complications associated with its deficiency in previous pregnancies.

In case of a complicated obstetric history, the dosage is increased to 800-1000 mcg. Women with folate cycle gene polymorphisms are recommended to take folic acid in the easily digestible form of methylfolate.

A detailed comparison of methylfolate and folic acid from a gynecologist.

Vitamins B6 and B12 also help restore normal homocysteine ​​levels. They are available in ampoules for injection or as part of complex preparations:

• Angiovit – includes B6, B12 and B9;
• Neurovitan – a complex with vitamins B1, B2, B6 and B12;
• Neurobex is a complex of vitamins B and C.

Who should be tested for homocysteine ​​during pregnancy planning?

A blood test for homocysteine ​​concentration is not included in the list of mandatory examinations, since normally after pregnancy the indicator gradually decreases and returns to normal levels shortly after birth. Tests are required for the following indications:

• complicated heredity (closest blood relatives have a history of early heart attacks);
• folate deficiency anemia, not corrected by drug therapy with the use of iron supplements;
• diabetes;
• transient ischemia, early stroke or heart attack in history;
• any form of gestosis during previous pregnancies;
• history of spontaneous miscarriages (several in a row);
• several biochemical pregnancies after IVF in a row;
• history of severe placental insufficiency.

An examination for homocysteine ​​levels is carried out when diagnosing infertility, after excluding the infectious nature of the disease and the possible influence of hormonal factors.

Increased homocysteine ​​during pregnancy

You have elevated homocysteine ​​- this is a diagnosis women may hear when carrying a child. But anyone who is far from biology and chemistry is unlikely to understand what kind of substance this is. However, let's try to shed some light on this phenomenon.

Homocysteine ​​is a substance that is formed in the human body as a result of the processing of the amino acid methionine. In turn, methionine enters the body with food. By the way, the amino acids methionine are very useful; they are found in meat, eggs and dairy products. The level of homocysteine ​​constantly changes throughout life.

But an increase in this substance during pregnancy can lead to serious problems. We are even talking about termination of pregnancy and miscarriage. Moreover, increased homocysteine ​​can damage blood vessels, because it makes their walls more loose. As a result, cholesterol and calcium easily settle on damaged vessels and a “cholesterol plaque” is formed. All this leads to the appearance of blood clots, and here we are talking about a risk to human health and life.

Why does homocysteine ​​increase during pregnancy?

The fact is that the level of this substance in the blood is influenced by many factors. Among them are smoking, alcohol abuse, and drinking large quantities of coffee. Unfortunately, the statistics are not encouraging yet. Nowadays, many women lose their fetus if they have elevated homocysteine ​​in their blood. If you still manage to maintain the pregnancy, then during childbirth there is a high risk of complications that are thrombotic or microcircular in nature.

As for the consequences of increased homocysteine ​​levels, this may include infertility. It appears due to a defect that occurs during embryo implantation. If homocysteine ​​exceeds the norm in the second or third trimester of pregnancy, late gestosis may occur or fetal asphyxia may occur.

According to statistics, pregnant women diagnosed with “high homocysteine” give birth to babies with low birth weight. In addition, such children are easily exposed to a wide variety of diseases even in infancy. All this happens due to the fact that homocysteine ​​easily passes through the placenta to the child in the early stages of pregnancy and this negatively affects the development of the fetus in the future.

Many people are interested in how low homocysteine ​​affects pregnancy. You should know that this is a normal condition in pregnant women and does not require any treatment. But sometimes homocysteine ​​has a somewhat negative effect on the well-being of a pregnant woman. There is a risk group that doctors constantly advise to monitor the level of homocysteine ​​in the blood.

For example, we are talking about women who plan to become a mother for the second time; women in the second and third trimester of pregnancy are also at risk if they have complications. In addition, an increase in homocysteine ​​levels may be associated with a genetic predisposition or certain hereditary pathologies.

Women who suffer from thrombophilia are also at risk. If after all you are worried about the condition of the fetus, then nothing prevents you from doing a test for homocysteine ​​in the blood. The norm for a pregnant woman is from 4.6 to 12.4 µmol/l. Flawless, some deviations are allowed, but no more than 0.5 in each direction.

Reduced homocysteine ​​levels

The most common recommendation for reducing homocysteine ​​levels is to consume folic acid.

However, to achieve maximum benefits, the vitamin should be taken with a group of other water-soluble B vitamins: B12, B6 and B2. A recent study clearly shows by what percentage the use of a vitamin or group of vitamins reduces homocysteine ​​levels:

• by 17% when consuming folic acid;
• by 19% when consuming vitamin B12;
• by 57% when consuming folic acid and vitamin B12;
• by 60% when consuming folic acid, vitamin B12 and B6.

In another New Zealand study, high homocysteine ​​levels were reduced by 18% in dozens of patients with chronic kidney failure who took 4 g of betaine, 50 mg of vitamin B6 and 5,000 mcg of folic acid daily for three months (compared with patients taking only B6 and folic acid).

The second most important point after taking vitamins is proper nutrition and a healthy lifestyle.

In their book, The Homocysteine ​​Solution, leading nutritionist Patrick Holford and Dr. James Braley describe several simple principles that lead to lower homocysteine ​​levels.

1. Eat less fatty meat and more plant protein. Vary your diet with soy-containing foods, baked beans, kidney beans and chickpeas.

2. Eat more greens, at least five servings of vegetables or fruits daily. Change your diet from day to day. Before every meal, make sure that half your plate is filled with vegetables.

3. Eat one clove of garlic every day or use garlic oil capsules.

4. Reduce your intake to one cup of coffee or two cups of black tea per day. Instead of traditional drinks, you can use herbal teas or freshly ground coffee.

5. Limit your alcohol consumption. Half a bottle of beer or one glass of red wine per day is allowed. Ideally, two bottles of beer or four glasses of wine per week.

6. Reduce stress. If your work involves constant stress or you are exposed to heavy loads, then you should think about eliminating these problems. A simple solution is to practice yoga, meditation or see a therapist.

7. Quit smoking. The habit of smoking is slow suicide. In this case, you should either make the right decision yourself or seek help from a specialist. The sooner you stop smoking, the longer you will live.

8. Take a daily multivitamin. A daily intake of at least 20 mg of vitamin B6, 200 mcg of folic acid and 10 mcg of vitamin B12 will help reduce homocysteine ​​levels.

Reasons for deviations

A decrease in indicators is not the object of attention of doctors monitoring the child’s development. Its low level in dynamics during the period of planning conception and gestation indicates the development of multiple sclerosis or endocrine diseases.

An increase is not alarming when it is about 20-30 kmol/l. This is a moderately elevated condition that can easily be corrected with proper diet and a healthy lifestyle.

Impaired absorption of B vitamins through the gastrointestinal tract is of major importance for the normal synthesis of homocysteine.

All this is due to the presence of complex diseases in the expectant mother in the anamnesis. She should know about the presence of risks in advance. Each of the consequences of an increased amino acid level is a serious violation and entails danger not only for the fetus, but also for herself.

In order to reduce the risks of an unfavorable course of the perinatal period, constant monitoring of the woman’s health should be carried out. The dynamics of the results of general tests with certain deviations from the norm gives rise to other laboratory tests.

Early signs of increased homocysteine ​​in the blood of the expectant mother are:

1. Increased thirst.
2. Gain weight in a short time.
3. Decreased diuresis.
4. Swelling of the legs, sometimes arms and body.

Homocysteine ​​when planning pregnancy is an extremely important factor in a woman’s health. To prevent complications during pregnancy, it is necessary to know the limits of normal homocysteine ​​values, since it is this that has a very great influence on the fetus. It is highly advisable to be examined for the level of homocysteine ​​in the blood before pregnancy, since an elevated level of this amino acid is often the reason for a woman’s childlessness or miscarriage.

It has been proven that by quitting smoking, as well as consuming large amounts of caffeine, the homocysteine ​​level during pregnancy returned to normal. Additionally, the gynecologist observing the woman necessarily prescribes folic acid and vitamin B in preventive or therapeutic doses, depending on the level of the indicator.

Reasons when low homocysteine ​​is detected during pregnancy:

1. Genetic predisposition. As a rule, a genetic defect in the absorption of amino acids (methionine) causes metabolic disorders and poor tolerance of protein foods. Not only the level of homocysteine ​​(increased) and methionine suffers, but the functions of the joints, blood vessels, heart, and nervous system are also impaired.
2. Vitamin deficiencies. Lack of B vitamins and folic acid in food leads to hyperhomocysteinemia. Most often, the administration of vitamins leads to an improvement in the condition.
3. Low activity during the day and bad habits. Due to poor metabolism due to poor nutrition and lack of physical activity, the breakdown of homocysteine ​​slows down and accumulates in the walls of blood vessels and blood, that is, it increases. Even moderate physical activity, walking, swimming, cycling, skiing, skating, giving up alcohol and smoking, significantly improves your general condition.
4. Taking medications, especially for the treatment of autoimmune diseases, taking antidepressants. These drugs destroy B vitamins (thiamine, cobalamin, pyridoxine) in the body and lead to the phenomenon of vitamin deficiency. In the treatment of psoriasis, drugs are used that neutralize folic acid, which also leads to its vitamin deficiency.
5. Hormonal problems with the thyroid gland, kidney disease, diabetes, stomach and intestinal diseases.

Biological role

Throughout life, homocysteine ​​levels in the blood gradually increase, in some cases leading to health problems. Elevated concentrations of the amino acid may increase the risk of developing cardiovascular disease, deep vein thrombosis and Alzheimer's disease. According to a study published in the British Medical Journal, excess homocysteine ​​in the blood plasma of older people is more dangerous than high levels of cholesterol and blood pressure.

High homocysteine ​​levels are strongly associated with poor concentration, dementia and low mood.

During a normal pregnancy, the concentration of homocysteine ​​decreases, creating comfortable conditions for the placental circulation of the fetus. However, there is a category of women with elevated levels of an amino acid that freely crosses the placental barrier and causes fetal damage. In the absence of special tests, in most cases the danger remains undetected for several weeks.

According to a study by specialists from the Department of Obstetrics and Gynecology at Dalhousie University, women with elevated homocysteine ​​concentrations during planning and early pregnancy are at increased risk of fetal loss and preeclampsia. “Consumption of folic acid reduces homocysteine ​​levels, a major risk factor for preeclampsia. However, we do not know the optimal dose for taking the vitamin,” says one of the authors of the study, Linda Dodds.

What does homocysteine ​​indicate when planning pregnancy?

Normally, homocysteine ​​should not accumulate in significant quantities. Under the influence of vitamin B6, it is converted into cysteine, and from it, through several biochemical reactions, into taurine. It is a sulfonic acid that accumulates in bile and is also present in tissues. Taurine is necessary for binding bile acids in the liver, and in the intestines for emulsification and absorption of lipids from food.

With a lack of pyridoxine or vitamin B6, as well as vitamins B1 and B12, the chain of transformation of homocysteine ​​into other substances is interrupted. It accumulates in the blood and damages the endothelium, the inner layer of the arteries. This leads to impaired blood flow and increases the risk of vascular thrombosis. When planning pregnancy, homocysteine ​​is responsible for the correct formation of the vessels of the functional layer of the endometrium and the subsequent formation of the chorion.

Homocysteine ​​levels during pregnancy

Factors of influence

The factors listed below provoke a temporary increase in homocysteine. With changes in lifestyle, nutrition, and treatment, deviations in the analysis results are leveled out.

• Features of the diet (diet, fasting, vegetarianism, etc.);
• Unbalanced diet (the menu is dominated by animal proteins);
• Lack of B vitamins and folic acid;
• Poor lifestyle (bad habits, abuse of alcohol and caffeine-containing drinks);
• Physical inactivity (sedentary lifestyle);
• Taking medications (phenytoin, methotrexate, etc.), as well as vitamins.

Diagnostics

Homocysteine ​​levels in the blood are monitored by regularly donating blood. The night before, a light meal is allowed 10 hours before the test; 3-5 days before the test, increased food loads of smoked and fried meat are excluded. Blood is taken from a vein on an empty stomach. To differentiate from other pathologies, doctors often perform a stress test with methionine: early in the morning (8-9 a.m.), the pregnant woman takes methionine, and then a blood sample is taken for homocysteine.

As additional studies, tests are often performed for thyroid antibodies, antiphospholipids, and lupus anticoagulant. When a pathology is detected, the doctor prescribes treatment and diet. To lower homocysteine, foods rich in protein are excluded: cottage cheese, hard cheeses, eggs, nuts, all types of fried meat (pork, beef, chicken, lamb), fried fish, as well as canned fish.

Diagnosis in the perinatal period should not be neglected. Delay is harmful both to the mother’s body and to the health of the unborn child.

In order to correctly donate blood for homocysteine, you need to follow simple rules.

1. Follow a diet that excludes fatty foods on the eve of the test.
2. Do not smoke or drink alcohol.
3. Stop taking medications.

They can significantly affect the reliability of the results. The test can be taken after finishing taking the medications in 3-5 days.

When planning which day of the cycle to take a homocysteine ​​test, it does not matter.

Up to 2 ml of blood serum is used for diagnosis. It is taken from a vein.

This happens in a antenatal clinic in a doctor's office. After blood is taken, it should be stored in the refrigerator for no more than two hours until the test.

The examination does not begin with identifying diseases of the gastrointestinal tract.

Causes of deviations and ways to normalize homocysteine ​​in the blood

Homocysteine ​​is an amino acid formed during the metabolism of methionine and is found in the blood plasma mainly in protein-bound form. Blood test results show total homocysteine ​​(free and bound). The bulk of free homocysteine ​​undergoes reverse methylation (the addition of a methyl group - CH3), forming methionine. In parallel, an irreversible conversion to cysteine ​​and glutathione occurs.

This amino acid is not found in food; the source of its synthesis in the human body is methionine, which is found in large quantities in meat products and eggs. Normally, homocysteine ​​is constantly synthesized and degraded, and its equilibrium concentration is not high. However, if some mechanism fails, for example, with a large amount of methionine-containing products, or a violation of the mechanism of homocysteine ​​breakdown, its concentration in the blood can increase significantly (hyperhomocysteinemia). According to medical research, more than a third of the Russian population has 50% excess homocysteine ​​in the blood.

Metabolism of this organic compound is not possible without folic acid and B vitamins (especially B6 and B12). With age, the concentration of homocysteine ​​in the blood increases, and gender differences are also noted. Thus, in the age range of 18-50 years, the content of this amino acid in the blood of men is higher than that of women. The norm for homocysteine ​​in men (up to 60 years of age) is not higher than 11.2 µmol/l; for older people over 60 years of age (both men and women) this figure should not exceed 11.9 µmol/l.

The causes of disturbances in homocysteine ​​metabolism have been studied in sufficient detail. Most often this process is caused by:

• genetic defects of enzymes involved in metabolism;
• deficiency of essential vitamins.

Modulator to reduce homocysteine ​​levels.

The most common reason why homocysteine ​​levels increase is a lack of folic acid. However, even if folic acid is supplied in sufficient quantities, but there is not enough vitamin B12, the content of this amino acid continues to increase. By the way, insufficient intake of cyanocobalamin (B12) and folic acid (PP), even without reference to the subject of discussion, increases the risk of problems with the cardiovascular system.

The norm of homocysteine ​​is significantly exceeded in patients diagnosed with homocystinuria. This disease is caused by a genetic disorder in the metabolism of this substance. The symptoms are very serious: mental retardation, atherosclerosis at an early age, thromboembolism. A slight increase in homocysteine ​​concentration may be accompanied by a number of other, less severe hereditary diseases.

What is the danger?

Accumulating inside cells to critical concentrations, homocysteine ​​penetrates into the intercellular space, and then into the plasma. A high concentration of this amino acid in the blood is toxic to vascular cells: over time, their surface loosens, creating the preconditions for the formation of blood clots or cholesterol plaques. Further, the lumen of the vessels gradually becomes blocked, and the disruption of blood supply can cause a heart attack or stroke. In addition, blood viscosity increases significantly, which puts additional stress on the heart muscle. According to research results, if the homocysteine ​​norm is exceeded by 5 micromol/liter, then the risk of developing atherosclerosis increases by 80% in men and by 60% in women. A direct relationship has also been noted between the concentration of this amino acid and the incidence of Alzheimer's disease and senile dementia. Homocysteine ​​is especially critical for people suffering from diabetes: even a slight increase in the concentration of this amino acid can lead to the development of severe complications: nephropathy, retinopathy, peripheral vascular damage

Risk group

Doctors identify several categories of people who have a significantly increased risk of hyperhomocysteinemia. First of all, these are elderly people over 60 years of age (especially men). Additional risk factors are smoking and frequent drinking. Coffee lovers may also need to reconsider their habits: according to research, people who drink more than 6 cups of this drink daily are at risk of elevated homocysteine. Also, this indicator should be constantly monitored in persons suffering from type 2 diabetes mellitus, renal failure, and certain endocrine and genetic diseases.

Homocysteine ​​during pregnancy

An increase in homocysteine ​​concentration during pregnancy is especially dangerous: it is often the cause of abortions in the first months, as well as dangerous complications of the last trimester - eclampsia and venous thromboembolism. The norm of homocysteine ​​during pregnancy is 4.6-12.4 micromol per liter and depends on the period: at the end of the first – beginning of the second trimester, there is a tendency for homocysteine ​​concentrations to decrease; a return to normal values ​​occurs 4-5 days after birth.

Homocysteine ​​test

A blood test for the level of this amino acid is prescribed to assess the risk of developing vascular and heart diseases. For a more complete picture, it is desirable to simultaneously obtain data on cholesterol, lipoproteins, and fibrinogen. According to the results of numerous clinical studies, if the homocysteine ​​norm is exceeded by one and a half times, the risk of premature death from heart and vascular diseases increases by 70%. That is why every effort must be made to reduce its concentration in the blood as much as possible. Fortunately, in the absence of serious genetic pathology, the content of this amino acid in the blood is successfully regulated with the help of a properly balanced diet. This is especially true for those women who are planning a pregnancy. By the way, the norm of homocysteine ​​in women is slightly lower than in men, which is explained by a lower percentage of muscle mass.

Venous blood is taken to test for homocysteine. The study is performed on an empty stomach (at least 8 hours after eating). For correct results on the eve of the study, it is advisable to exclude fatty meat dishes from the diet, and also refrain from taking certain medications (cyclosporine, carbamazepine, methotrixate).

Homocysteine ​​is higher than normal, influence during planning, and with B

My first pregnancy was normal. The second ST (October 5, 2014) at 6 weeks (it came out at 7 weeks, a day later when I found out, then they cleaned it up a little). I decided to get examined, took all sex hormones (by days of the cycle at the beginning and after ovulation (ovulation was tracked by folliculometry)), thyroid hormones, an extended coagulogram, plus antiphospholipid syndrome, homocysteine, d dimer, antisperm bodies, hCG antibodies, eli-p test and mutations of the hemostatic system (11 indicators), ultrasound at the beginning and in the middle of the cycle.

Result: everything is normal, except for elevated homocysteine ​​18.7 when normal (4-12). Well, and mutations of the genes responsible for the absorption of folklore.

The gynecologist prescribed drinking (before and during B) chimes every 10 days, 3 tablets per day, and vitamins, https://www.baby.ru/pharmacy/12958-angiovit/ 1 tablet per day, and femibion ​​1 to 1 tablet per day.

The gynecologist allowed me to get pregnant because... Homocysteine ​​isn't that bad.

Are these medications enough? How did you lower homocysteine, in what dosages? How then did they carry you to term and give birth?

• 5 Reasons for the downgrade

What is homocysteine

Homocysteine ​​is an amino acid that is synthesized from methionine, which is part of the group of essential amino acids in the human body. Methionine enters the body with protein foods of animal origin and is involved in the process of converting protein into energy. Homocysteine ​​is a byproduct of methionine digestion.

Homocysteine ​​is usually found in the body in small quantities. Its excess is metabolized into cystathionine and excreted from the body. Folic acid, as well as vitamins B6 and B12, play an important role in the metabolism of homocysteine. Their insufficient quantity leads to a dangerous increase in homocysteine.

A large concentration of homocysteine ​​can be toxic to cells, therefore, with the help of protective mechanisms in the body, it is neutralized by being released into the blood. Genetic pathologies of some people can complicate the processes of removing homocysteine ​​from cellular tissues.

Homocysteine ​​is constantly synthesized in the human body and then decomposed, as a result of which its concentration becomes low. But when some mechanisms in the body fail, the concentration of homocysteine ​​can increase sharply and cause the development of many diseases.

According to research, 30% of the Russian population has homocysteine ​​levels 50% higher than normal.

Norms

Homocysteine ​​levels gradually increase with increasing age. Its indicators depend on age and gender:

• In children, regardless of gender, the norm is 5 µmol/l.
• In adolescents, the level of homocysteine ​​is 6-7 µmol/l, and it is always higher in boys.
• In adult men, the norm is 5-15 µmol/l.
• In adult women, the norm is 5-12 µmol/l.

Homocysteine ​​levels during pregnancy and planning

During pregnancy, homocysteine ​​levels range from 4.6 to 12.4 µmol/l, which is considered normal. In this case, fluctuations in different directions by 0.5 µmol/l are allowed. Homocysteine ​​decreases, as a rule, at the beginning of pregnancy. After childbirth, homocysteine ​​levels return to normal within 4-5 days.

Monitoring the level of homocysteine ​​in the blood is very important when planning pregnancy. Its increase is extremely dangerous and can cause the development of severe pathologies in a newborn child and even provoke a miscarriage.

If the analysis showed an increase in homocysteine, it means that before pregnancy it is necessary to bring it back to normal. To do this, you should balance your diet and enrich it with B vitamins and folic acid. Light exercise also lowers homocysteine ​​levels.

Who needs to get tested for homocysteine?

There are several risk factors for increasing the concentration of homocysteine ​​in the blood, in which a study of its level in the body is prescribed:

• dysfunctions of the cardiovascular system, arterial and venous thrombosis;
• heredity associated with the risk of heart attack or stroke;
• diabetes mellitus, renal failure;
• some endocrine and genetic diseases;
• old age after 60 years;
• alcohol or drug addiction;
• undergone gastric surgery.

Recent studies show that every person needs to know their homocysteine ​​level. A critical increase in homocysteine ​​may not manifest itself in any way, but it increases the risk of developing many diseases.

To check homocysteine ​​levels, blood is taken from a vein. Blood should be donated on an empty stomach. To get the most accurate picture during the analysis, on the eve of the study it is necessary to exclude fatty meat foods and drink only water from liquids.

Causes of increased homocysteine, consequences and treatment

An increased concentration of homocysteine ​​in the blood is called hyperhomocysteinemia . Accumulating in blood vessels in excess amounts, homocysteine, due to its toxic effect, corrodes and damages the internal walls of blood vessels. In order to protect itself, the body tries to “patch up” damaged areas with calcium deposits or cholesterol plaques. As a result, the vessels gradually narrow, become clogged, and further formation of blood clots occurs with all the ensuing consequences.

It has been proven that an increase in homocysteine ​​concentration by approximately 5 µmol/l increases the risk of vascular damage in women by 80%, in men by 60%. There are several reasons for increased homocysteine:

• lack of folic acid and B vitamins in the body;
• smoking and drinking alcohol;

Why is homocysteine ​​important during pregnancy?

During pregnancy, homocysteine ​​tends to decrease slightly and this is normal, because the main thing is that it is not elevated. Such indicators should fall between the first and second trimester, then everything returns to normal and this level remains more or less stable. Immediately after birth, or to be more precise, after 2-3 days, everything returns to normal.

Why does homocysteine ​​decrease during pregnancy, when the norm in a non-pregnant woman is higher? It has been proven that it is homocysteine ​​that is responsible for the blood supply to the fetus through the placental circle, and this causes a slight decrease in it.

An increased level of the amino acid at the beginning of pregnancy can cause miscarriage and fetal death. This is the nature of this indicator.

In addition, after such a situation, the risk of complications in the future increases, for example:

• Habitual miscarriage;
• Infertility.

And when the level of homocysteine ​​begins to increase after the second or third trimester, it becomes dangerous for the life of the unborn baby.

In such cases, late gestosis may occur, which is characterized by:

• Complications during the development of organic systems of the fetus;
• Violations of their work;
• Asphyxia may occur. Asphyxia is usually understood as suffocation, cessation of breathing while cardiac activity continues (imaginary death). That is, obstructed blood flow through the placental circle.

How do fluctuations in non-proteinogenic amino acids affect a born child:

• The baby may be born underweight;
• Their immunity is low;
• There is a risk of developing pathology - cerebral palsy;
• Decreased natural reflexes;
• Increased muscle tone;
• In general, it can affect both mental development and physical development, which is a double hazard.

In such cases, gynecologists recommend that expectant mothers keep their own pregnancy calendar, on which they note all homocysteine ​​levels. This will help to identify deviations as early as possible and avoid serious consequences.

Of course, nothing happens without a miracle, and in such situations one cannot do without it. There are life stories in which pregnant women had an increased level of amino acids in the body, while carrying them to term normally and giving birth to healthy, strong babies without any abnormalities.

But as they say, it’s better to be safe than to live in constant fear.

Treatment of hyperhomocysteinemia

Hyperhomocysteinemia is a high amount of a special substance called homocysteine ​​in the blood. This pathological condition of the body and timely diagnosis will make it possible to prescribe simple, safe and effective treatment, which will greatly reduce the risk of complications in the mother and child.

If the doctor, based on the results of the analysis, diagnoses hyperhomocysteinemia, then special therapy is selected.

Its essence is as follows:

• High doses of folic acid;
• Plus a vitamin B complex. Most often, vitamin deficiency is caused by the body’s inability to absorb them through the gastrointestinal tract, so the body takes vitamins by injection.

When the amino acid level decreases, the dose of therapy is changed to maintenance.

During pregnancy, the same therapy, the only thing that can be added is antiplatelet treatment.

By this we mean:

• A small dose of aspirin, which is a kind of vitamin for a pregnant woman;
• And a small dose of heparin drugs (anticoagulants).

In cases where antiphospholipid syndrome is detected, additional therapy is prescribed.

Timely treatment of a pathological condition is the key to the health of the unborn child and the pregnant woman.