Lubbers M F, Aarnoudse J G, van Doormaal J J
Rijksuniversiteit, faculteit der Medische Wetenschappen, Groningen.
Ned Tijdschr Geneeskd. 1999 Apr 3;143(14):705-8.
Obstetrical problems sometimes portend manifestations of atherosclerosis, as illustrated by two case reports. The first patient had the combination of hyperhomocysteinaemia due to chronic vitamin deficiencies in the diet, and smoking. The second was also a smoker and had a genetically determined mild hyperhomocysteinaemia, aggravated by chronic vitamin deficiencies resulting from poor dietary habits; she also had an increased folic acid requirement because of use of anti-epileptic drugs in combination with a familial predisposition for premature atherosclerotic manifestations. The first patient had four pregnancies, two of which ended in intrauterine foetal death due to placental infarction, and one in the birth of a dysmature boy. The second patient's four pregnancies ended twice in abortion and twice in the birth of a dysmature child; in one of the latter cases placental infarction was observed. Both women subsequently suffered cerebrovascular accidents while in addition, older cerebral infarctions were found to be present. Women with recurrent abortion, pre-eclampsia, placental infarction, placental detachment and foetal growth retardation should be examined, even if other risk factors are also present, for (mild) hyperhomocysteinaemia, and treated for it with vitamin suppletion (folic acid, vitamins B6 and B12), even although admittedly more research is necessary to make certain that such treatment has a preventive effect on the manifestations of this disorder.
产科问题有时预示着动脉粥样硬化的表现，两个病例报告说明了这一点。第一位患者因饮食中慢性维生素缺乏和吸烟而合并高同型半胱氨酸血症。第二位患者也是吸烟者，有基因决定的轻度高同型半胱氨酸血症，因饮食习惯不良导致的慢性维生素缺乏而加重；由于使用抗癫痫药物以及家族性过早出现动脉粥样硬化表现的倾向，她对叶酸的需求量也增加。第一位患者怀孕四次，其中两次因胎盘梗死导致宫内胎儿死亡，一次分娩出发育不成熟的男孩。第二位患者的四次怀孕两次以流产告终，两次分娩出发育不成熟的孩子；在后一种情况中，有一次观察到胎盘梗死。两名女性随后都发生了脑血管意外，此外，还发现存在陈旧性脑梗死。即使存在其他危险因素，对于反复流产、先兆子痫、胎盘梗死、胎盘早剥和胎儿生长受限的女性，也应检查是否存在（轻度）高同型半胱氨酸血症，并给予维生素补充剂（叶酸、维生素B6和B12）进行治疗，尽管诚然还需要更多研究来确定这种治疗对该疾病表现是否具有预防作用。
