مقایسه سطح هموسیستئین خون در زنان باردار مبتلا به کندگی زودرس جفت نسبت به افراد حامله طبیعی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی تهران، تهران، ایران

2 دانشیار گروه زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی همدان، همدان، ایران

3 متخصص زنان و زایمان

چکیده

مقدمه: خونریزی سه‌ماهه سوم به علت جدا‌شدن زودرس جفت در 5/0تا 1 درصد بارداری‌های اتفاق می‌افتد و عامل 10تا 15 درصد موارد مرگ و میر جنینی و مادریِ حول و حوش زایمان است. علت آن در اکثر موارد ناشناخته است. یکی از عواملی که به عنوان عامل خطر جدا شدن زودرس جفت مطرح می باشد هموسیستئین بالای خون است. هدف این بررسی مقایسه سطح هموسیستئینِ زنان مبتلا به جداشدن زودرس جفت با گروه شاهد آن هاست.
روش کار: این مطالعه مورد شاهدی، بر روی 52 نفر زنان باردار سه ماهه سوم که بر مبنای علایم بالینی و مشاهده جفت، تشخیص جدا‌شدن زودرس جفت داشتند (گروه مورد) و 52 نفر زن باردار بدون مسأله طبی ( گروه شاهد) انجام شده است. هموسیستئین‌خون به‌دنبال هشت ‌ساعت ناشتایی در دو گروه با کیت ELA Axis R Homocystein ساخت شرکت IBL در آزمایشگاه مشترک اندازه‌گیری و مقایسه گردید. تجزیه و تحلیل داده ها با آزمون های آماری t و مجذور کای انجام شد.
یافته ها: دو گروه از نظر سن، تعداد حاملگی و تعداد زایمان اختلاف معنی‌داری نداشتند. میانگین سطح هموسیستئین در گروه مورد 7/2± 8/6 و در گروه شاهد 2/2± 5/5 میکرومول در لیتر بود که اختلاف این دو مقدار معنی‌دار بود (013/0=p).
نتیجه‌گیری: میانگین هموسیستئین گروه جداشدن زودرس جفت بیش تر از گروه شاهد بوده است. این مسأله می تواند در تحقیقات آینده کاربرد روش های مختلف از جمله اسیدفولیک را در کاهش سطح هموسیستئین و جداشدن زودرس جفت از نظر بالینی مطرح نماید.

کلیدواژه‌ها

عنوان مقاله [English]

Comparison of Serum Homocystein in Abruptio Placenta and Normal Pregnancies

نویسندگان [English]

  • Malihe Arab 1
  • Soghra Rabiee 2
  • Shamsi Pilehvari 3
1 Associate Professor of Obstetrics and Gynecology, Shaheed Beheshti Medical University
2 Associate Professor of Obstetrics and Gynecology, Hamadan University of Medical Sciences, Hamadan, Iran.
3 Obstetrician & Gynecologist
چکیده [English]

Introduction: Third-trimester vaginal bleeding due to placental abruption occurs in 0.5-1% of pregnancies and is associated with 10-15% of maternal and perinatal mortality and morbidity. The etiology is unknown in most cases. Hyperhomocysteinemia is recognized as one of the independent risk factors of placental abruption. The objective of this study is to comparably measure the serum homocysteine in abruption group and normal control subjects.
Methods: This case-control study is performed on 52 third- trimester pregnant women with clinical findings of abruption confirmed by after-delivery placental observation (case group) and 52 control subjects who had normal pregnancies. Samplings were done following an 8 hours of fasting. Serum homocysteine was measured with Axis R homocystein ELA kits manufactured by IBL company. Data were analyzed by chi-square and t-test.
Results: It was revealed that measures like age, number of pregnancies and deliveries did not show a statistically significant difference between two groups. Mean concentration of homocysteine in abruption and control groups were 6.8±2.7 and 5.5±2.2 μmol/L, respectively (p=0.013).
Conclusion: Mean serum homocystein of abruption group was higher than that of controls’. This finding may light up brand ideas for future clinical trials about reducing the serum homocysteine level and therefore, reduction of placental abruption.

کلیدواژه‌ها [English]

  • Third trimester
  • folic acid
  • Placenta disease
  • Hyperhomocysteinemia

مراجع

1. Anath CV, Savitz DA, BowesJr WA, Luther ER. Influence of hypertensive disorders and cigarette smoking
on placental abruption and uterine bleeding during pregnancy. Br J Obstet Gynaecol 1997;104:572-8.
2. Cunningham FG, Macdonald PC, Gant NF, Leveno KJ, Gilstrup LC, Hankins GDV, et al. Williams
obstetrics. 22nd ed. New York: Appleton & Lange; 2005. p.746-1078.
3. Ananth CV, smulian JC, Strinvas N, Getahun D, Salihu HM. Risk of infant mortality among twins in
relation to placental abruption contribution of preterm birth and restricted fetal growth. Twin Res Hum
Genet 2005;8:524-31.
4. Gaufberg SV, Abruption placenta. [online webpage] 2001 Mar [cited 2003 Jul 15]; [24 screens]. Available
from URL: http://www.emedicine.com/emerg/topic12.htm.
5. Hubbard JL, Hosmer SB. Couvelaire uterus. J Am Osteopath Assoc 1997; 97(9):536-7.
6. Rasmussen S, Irgens LM, Bergsjo P, Dalaka K. The occurrence of placental abruption in Norway 1967-
1991. Acta Obstet Gynecol Scand 1996;75(3):222-8.
7. Ananth CV, Getahun D, peltier MR, Smulian JC. Placental abruption in term and preterm gestations:
evidence for heterogeneity in clinical pathways. Obstet Gynecol 2006;107:785-92.
8. Scott JR, Gibbs RS, Kaylan BY, Haney AF. Danforth’s obstetrics and gynecology. 9th ed. Philadelphia:
Lippincott Williams & Wilkins; 2003. p.635-52.
9. Toivonen S, Heinonen S, Anttile M, Kosma VM, Saarikoski S. Reproductive risk factors, Doppler findings,
and outcome of affected births in placental abruption. Am J Perinatol 2002;19(8):451-60.
10. Sheiner E, Shoham- Vardi I, Hallak M, Hadar A, Gortzak- Uzan L, Katz M, et al. Placental abruption in term
pregnancies: clinical significance and obstetric risk factors. J Matern Fetal Neonatal Med 2003;13(1); 45- 9.
11. Abu- Heiji A, al Chalabi H, el Iloubani N. Abruptio placentae risk factors and perinatal outcome.
J Obstet Gynecol Res 1998;24(2):141- 4.
12. Williams MA, Leiberman E, Mittendorf R, Monson RR, Schoenbaum SC. Risk factors for abruption
placentae. Am J Epidemiol 1991;134(9):965-72.
13. Ananth CV, Oyelese Y, Yeo L, Pradhan A, Vintzileos AM. Placental abruption in the United States, 1979
through 2001: temporal trends and potential determinants. Am J Obstet Gynecol 2005;192:191-8.
14. Ananth CV, Oyelese Y, Srinivas N, Yeo L, Vintzileos AM. Preterm premature rupture of membranes,
intrauterine infection, and oligohydramnios: risk factors for placental abruption. Obstet Gynecol
2004;104:71-7.
15. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and
placental abruption. Obstet Gynecol 2006;107:771-8.
16. Eskes Tk. Clotting disorders and placental abruption: homocystein risk factor. Eur Obstet Gynecol Reprod Biol
2001; 95(2):206-12.
17. Hernandez –Diaz S, Wu XF, Hayes C. Methylenetetrahy-drofolate reductase polymorphisms and risk of
gestational hypertension. Epidemiology 2005;16:628-34.
18. Glanville T, Yates Z, Ovadia L, Walker JJ, Lucock M, Simpson NA. Fetal folate C677T methylene
tetrahydrofolate reductase gene polymorphism and low birth weight. J Obstet Gynaecol 2006;26:11-4.
19. Kaul S, Zader AA, Shah PK. Homocysteine hypothesis for atherothrombotic cardiovascular diseases not
validated. J Am Coll Cardiol 2006;48:914-23. 
 
20. Ciaecio M, Bivona G, Bellia ch. Therapeutical approach to plasma homocystein and cardiovascular risk
reduction. Ther Clinical Risk Manag 2008;4(1):219-24.
21. Anand P, Awasthi Sh, Mahdi A, Tiwari M, Agarwal GG. Serum homocysteine in Indian adolescents.
Indian J Pediatr 2009;16:150-3.
22. Gillum RF. Distribution of total serum homocysteine and its association with parental history and
cardiovascular risk factors at ages 12-16 years: the third national health and nutrition examination survey.
Ann Epidemiol 2004;14:229-33.
23. Refsum H, Nurk E, Smith AD, Ueland PM, Gjesdal CG, Bjelland I, et al. The hordaland
homocysteine study: a community- based of homocysteine, its determinants and associations with disease.
J Nutr 2006;136:1731S-1740S.
24. Ananth CV, Elsasser D, kinzler WL, Peltier MR, Getahun D, Leclerc D, et al. Polymorphisms in
methionine synthase reductase and betaine-homocystein s-methyltransferase genes: risk of placental
abruption. Mol Genet Metab 2007;91(1):104-10.
25. Kartal Durmaziar SP, Akgul A, Eskioglu F. Hyperhomocysteinemia in patients with stasis dermatitis and
ulcer ; A novel finding with important therapeutic implications. J Dermatol Treat 2009;1:1-4.
26. Steegers-Theunissen RP, Van Iersel CA, Peer PG, Nelen WL, Steegers EA. Hyperhomocysteinemia,
pregnancy complications, and the timing of investigation. Obstet Gynecol 2004;104:336-43.
27. Karakula H, Opolska A, Kowal A, Domanski M, Plotka A, Perzynski J. Does diet affect our mood? The
significance of folic acid and homocystiein. Pol Merkur Lekarski 2009;26(152):136-41.
28. Igbal MP, Lindbiad BS, Mehboobali N, Yusuf FA, Khan AH, Igbal SP. Folic acid and vitamin B6
deficiencies related hyperhomocysteinemia in apparently healthy Pakistani adults: is mass micronutrient
supplementation indicated in this population? J Coll Physicians Surg Pak 2009;19(5):308-12.
29. Goddijn- wessel TA, Wouters MG, Van de Molen EF, Spuijbroe Steegers- Theunissen RP, Blom HJ,
Boers GH, et al. Hyperhomocysteinemia: a risk factor for placental abruption or infarction.
Eur J Obstet Gynecol Reprod Biol 1996;66(1):23-9.
30. Velzing- Aarts FV, Holm PI, Fokkema MR, VaA der Dijs FP, Ueland PM, Muskiet FA. Plasma coline and
betaine and their relation to plasma homocysteine in normal pregnancy. Am J Clin Nutr 2005;81(6):1383-9.
31. Walker Mc, Smith GN, Perkins SL, Keely EJ, Garner PR. Changes in homocysteine levels during normal
pregnancy. Am J Obstet Gynecol 1999;180(3 pt 1):660-4.
32. Eskes Tk. Homocysteine and human reproduction. Clin Exp Obstet Gynecol 2000;27(3-4):157-67.
33. Jacques PF, Selhub J, Bostom AG. The effect of folic acid fortification on plasma folate and total
homocysteine concentrations. N Engl J Med 1999;340:1449.
34. De Leo V, La Marca A, Morgante G, Ciani F, Zammarchi E, Setacci C. Low- dose folic acid
supplementation reduces plasma levels of the cardiovascular risk factor homocysteine in post-menoposal
women. Am J Obstet Gynecol 2000;183(4):945-7.
35. Villa P, Perri C, Suriano R, Cucinelli F, Panunzi S, Ranieri M, et al. L- folic acid supplementation in
healthy postmenopausal women: effect on homocysteine and glycolipid metabolism. J Clin Endocrinol Metab
2005;90(8):4622- 9.
36. Selhub J, Jqcaues PF, Wilson PW. Vitamin status and intake as primary determinants of homocysteinemia
in an elderly population. JAMA 1999;270:2693.
37. Ubbink JR, Vermaak WJ, van der Merwe A. Vitamin B-12, vitamin B-6, and folate nutritional status in
men with hyperhomocysteinemia. Am J Clin Nutr 2000;57:47.
38. Bonnette RE, Caudill MA, Boddie AM, Huston AD, Kauwell GP, Bailey LB. Plasma homocyst(e)ine
concentrations in pregnant and nonpregnant women with controlled folate intake. Obstet Gynecol
1998;92(2):167-70. 
مجله زنان، مامایی و نازایی ایران
دوره 12، شماره 4 - شماره پیاپی 4
زمستان 1388
دی 1388
صفحه 1-6

فایل ها

هم رسانی

ارجاع به این مقاله

آمار