Management of a pregnancy complicated by classical homocysteinaemia

Pregnancy itself increases the risk of venous thrombosis by 4-5 fold. Homocystinaemia increases this risk as well as the risk of arterial thrombosis which in turn increases the incidence of stroke and myocardial infarction. Therefore, the reduction of thrombotic risk is vital. Therapeutic doses of low-molecular weight heparin (LMWH) may be necessary to prevent thrombosis during and 6 weeks after the pregnancy. The mainstay of controlling homocysteinaemia is dietary management to decrease the amount of methionine, which in turn leads to a decreased amount of homocysteine in the blood. If any interventions during pregnancy becomes necessary, care should be taken to select ones which are associated with lesser risk of thrombosis. Patient should be appropriately counselled about potential implications of future pregnancy and reliable non-hormonal contraception or sterilisation should be offered.