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We aimed to investigate the correlation between blood homocysteine (Hcy) levels and pre-eclampsia (PE) risk in pregnant women. Related articles were searched using PubMed, Embase, and Web of Science databases. Methodological quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Cochran's Q and I 2  tests were used to evaluate heterogeneity. Egger’s test was used to evaluate publication bias. A sensitivity analysis was performed to test stability of the results using a one-by-one elimination method. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess certainty of evidence. Nine studies (4384 PE and 26021 non-PE patients) were included in the meta-analysis. The methodology of them was of good quality, with NOS scores of 5–8. However, there was a significant heterogeneity among included studies. Therefore, the random effect model was generated and combined results suggested a significant association between increased level of Hcy in pregnant women and PE risk. Although a significant publication bias was found in the current study with a P value of 0.006 in the Egger test, sensitivity analysis showed that the combined results were stable and did not vary significantly from any single study. However, the GRADE evidence quality was very low, which may lower the recommendation of pooled results. Increased levels of Hcy in maternal blood were significantly associated with the risk of PE, but low certainty of evidence need to be improved by more high-quality studies.

High level of homocysteine is associated with pre-eclampsia risk in pregnant woman: a meta-analysis