Hyperhomocysteinemia and pregnancy: about a case and literature review

Homocysteine ​​(Hct) is a substance produced in the metabolism of methionine that can be found in our daily diet. Mutation of the methylenetetrahydrofolate reductase (MTHFR) gene, especially in women with low folate intake. Hyperhomocysteinemia (HHct) can be caused by several factors, such as lack of folic acid, vitamin B6 and B12 deficiency, hypothyroidism, medications, genetic abnormalities, aging and kidney dysfunction. Increased homocysteine ​​in peripheral blood can lead to vascular disease, coronary artery dysfunction, atherosclerotic changes, and embolic disease. Thus, upstream of the trophoblastic plugs, any increase in the thrombogenic power of pregnant women will lead to the formation of a clot and the termination of pregnancy. Recent studies have reported that hyperhomocysteinemia is associated with numerous pregnancy complications, including abortion disease, preeclampsia, preterm birth, hematoma placentae, fetal growth restriction, and gestational diabetes. To avoid thrombosis, the treatment will therefore be based on anticoagulants, sometimes combined with low-dose aspirin because of the anti-aggregating action of the latter. In this article, we report the case of a patient with a history of abortive disease on hyperhomocysteinemia who carried a pregnancy to term, while recalling the metabolism of homocysteine, its impact on pregnancy, and the interest of supplementation folic acid to prevent complications due to hyperhomocysteinemia.