Hyperhomocysteinemia and recurrent early pregnancy loss: a meta-analysis

Objective: To quantify the risk of recurrent early pregnancy loss in the presence of elevated fasting or afterload homocysteine concentrations or homozygosity for the 677C-->T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene (T/T genotype). Design: Case-control studies published between January 1992 and November 1999 were identified with a MEDLINE-search. These studies were combined with a recent case-control study performed by our own research group. Setting: Academic research environment. Patient(s): Studies published in the English language, concerning two or more pregnancy losses before 16 weeks' menstrual age were included. Intervention(s): Meta-analysis of all of the studies included. Main Outcome Measure(s): The number of subjects with and without hyperhomocysteinemia or with the T/T genotype were derived, if necessary the study was supplemented by personal communication with the original authors. Result(s): Pooled risk estimates of 2.7 (1.4 to 5.2) and 4.2 (2.0 to 8.8) were calculated for fasting and afterload plasma homocysteine concentrations, respectively. For the MTHFR T/T genotype a pooled risk estimate of 1.4 (1.0 to 2.0) was found. Conclusion(s): These data support hyperhomocysteinemia as a risk factor for recurrent early pregnancy loss. Further research should be focused on the pathophysiology of this relationship and on the clinical efficacy of B vitamin supplementation. (Fertil Steril(R) 2000;74:1196-9. (C) 2000 by American Society for Reproductive Medicine).