ArticleBMC pregnancy and childbirth2026
Hyperhomocysteinemia as a potential risk factor for unexplained recurrent pregnancy loss: an exploratory case-control study at Damascus University Maternity Hospital.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe association between hyperhomocysteinemia and unexplained recurrent pregnancy loss (RPL) remains controversial, with existing studies reporting inconsistent conclusions.
objectiveThis exploratory study aimed to investigate the relationship between elevated serum homocysteine (Hcy) levels and unexplained RPL in a Syrian population.
methodsA hospital-based case-control study was conducted from August 2024 to December 2025 at Damascus University Maternity Hospital. Ninety-six non-pregnant women were enrolled: 70 with a history of ≥ 2 unexplained miscarriages (case group) and 26 with prior successful pregnancies and no history of miscarriage (control group). Serum homocysteine concentrations were measured using an enzymatic assay on a BS-800 M Mindray analyzer. Statistical analyses included group comparisons, correlation testing, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression to adjust for potential confounders.
resultsThe median serum homocysteine level was significantly higher in the RPL group (28.8 µmol/L, IQR 17–43) compared with controls (10.54 µmol/L, IQR 7.23–14.21; p < 0.001). Elevated homocysteine (> 15 µmol/L) was observed in 54.3% of cases versus none of the controls. A positive correlation was found between homocysteine concentration and the number of pregnancy losses (r = 0.318, p = 0.007). homocysteine remained significantly associated with RPL after adjustment for BMI (adjusted OR = 1.40, 95% CI: 1.11–1.75, p = 0.003). A positive correlation was found between homocysteine concentration and the number of prior pregnancy losses (r = 0.318, p = 0.007). ROC analysis suggested an exploratory optimal cutoff of 11.57 µmol/L, yielding 88.6% sensitivity and 70.0% specificity for predicting RPL in this study population.
conclusionThis exploratory study shows a significant association between hyperhomocysteinemia and unexplained recurrent pregnancy loss (adjusted for BMI) and a positive correlation with number of miscarriages. However, due to selection bias and quasi‑complete separation, findings are hypothesis‑generating. Future prospective studies with comprehensive confounder assessment are essential to validate these results.
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