Homocysteine combined with multi-index screening for pregnancy complications: a narrative review

Employing a narrative review approach, this article examines the value of combining homocysteine (Hcy) with multiple indicators for screening pregnancy complications. Hcy serves as a key biomarker in one-carbon metabolism and vascular endothelial function. Elevated Hcy levels are significantly correlated with adverse pregnancy outcomes, including preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM), and intrahepatic cholestasis of pregnancy (ICP). Hcy levels are influenced by nutritional factors (folate, vitamin B12) and genetic factors (MTHFR polymorphisms). However, the predictive power of Hcy alone is limited due to variations in gestational age, ethnicity, nutritional status and genetic background. Recent studies have therefore explored combined screening strategies: Hcy together with platelet parameters helps differentiate the risk of ICP from that of GDM; adding uterine artery (UtA) Doppler ultrasonography improves the diagnostic sensitivity for detecting PE and FGR; integrating glycolipid metabolic markers (Glycosylated Serum Protein, Cystatin-C, apoB/apoA1) provides additional predictive value for adverse outcomes in GDM. Positioning Hcy as a functional endpoint of gene-nutrient interactions and combining it with nutritional and genetic assessments may facilitate early warning of pregnancy complications and enable individualized intervention.