Erythrocyte Folate and Homocysteine in Hypertensive Disorders of Pregnancy: Associations with Pregnancy Outcomes

Hypertensive disorders complicating pregnancy (HDCP) are a major cause of maternal and fetal morbidity. This study aims to examine the relationship between red blood cell folate (RBCF) and homocysteine (Hcy) levels and HDCP severity, as well as to assess their predictive value for pregnancy outcomes.

This retrospective study included 326 HDCP patients and 153 controls. The diagnostic criteria for HDCP were based on the American College of Obstetricians and Gynecologists. RBCF and Hcy levels were measured at diagnosis using automated immunoassays. ROC curve analysis was performed to assess the predictive value of RBCF and Hcy for poor pregnancy outcomes.

A total of 326 women with HDCP and 153 normotensive controls were included. Blood pressure was significantly higher in the HDCP group (both p < 0.001). HDCP patients exhibited markedly lower RBC folate (286.08 ± 59.04 vs 334.83 ± 51.95 ng/mL, p < 0.001) and higher Hcy levels (8.41 ± 1.39 vs 7.58 ± 1.40 μmol/L, p < 0.001) than controls. Across HDCP severity, RBCF declined progressively from gestational hypertension to mild and severe preeclampsia, while Hcy increased correspondingly. Among HDCP patients, adverse pregnancy outcomes occurred in 44.5%, including prematurity (34.4%), low birth weight (19.3%), and fetal distress (12.9%). Compared with women with good outcomes, those with poor outcomes had significantly lower RBCF (255.61 ± 51.56 vs 310.45 ± 53.13 ng/mL, p < 0.001) and higher Hcy (9.04 ± 1.36 vs 7.90 ± 1.25 μmol/L, p < 0.001). ROC analysis showed that combined RBCF-Hcy testing provided the highest predictive performance for adverse outcomes (AUC = 0.85, 95% CI 0.81-0.89; sensitivity 85.52%; specificity 75.14%), outperforming either biomarker alone.

RBCF and Hcy are crucial biomarkers for assessing the severity of HDCP and predicting adverse pregnancy outcomes.