{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:12:42Z","timestamp":1788451962003,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adverse pregnancy outcomes such as preeclampsia (PE), preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth are major contributors to maternal and neonatal morbidity and mortality. Elevated maternal homocysteine (Hcy) levels, influenced by genetic, dietary, and lifestyle factors, have been increasingly associated with placental dysfunction and adverse pregnancy outcomes. This review aims to evaluate the link between hyperhomocysteinemia and pregnancy complications to inform clinical practice. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Library was conducted up to December 2024. Observational studies assessing maternal Hcy levels in relation to pregnancy complications were included. Heterogeneity was measured using the I2 statistic, and a random-effects model using the DerSimonian\u2013Laird method was applied to account for study variability. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. Elevated maternal Hcy was significantly associated with: PE (OR: 2.49; 95% CI: 1.41\u20134.40; I2 = 96.03%; n = 9), preterm birth (OR: 4.01; 95% CI: 1.84\u20138.72; I2 = 91.08%; n = 6), fetal loss (OR: 1.76; 95% CI: 1.22\u20132.52; I2 = 41.47%; n = 6), SGA (OR: 1.69; 95% CI: 1.35\u20132.11; I2 = 0.00%; n = 3), and LBW (OR: 2.46; 95% CI: 1.37\u20134.43; I2 = 77.71%; n = 3). Conclusions: This review highlights a significant association between elevated maternal Hcy levels and various pregnancy complications. However, given the substantial heterogeneity and reliance on observational evidence, these findings should be interpreted with caution. Future well-designed prospective cohort studies with standardized definitions of hyperhomocysteinemia, consistent timing of exposure assessment across pregnancy trimesters, and adjustment for key confounders are needed to better clarify these associations and underlying mechanisms.<\/jats:p>","DOI":"10.3390\/jcm15093216","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T17:04:59Z","timestamp":1776963899000},"page":"3216","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Role of Maternal Homocysteine Concentration in Pregnancy Complications: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Ahmed","family":"Abu-Zaid","sequence":"first","affiliation":[{"name":"Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0427-8758","authenticated-orcid":false,"given":"Saeed","family":"Baradwan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah 23433, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9718-6371","authenticated-orcid":false,"given":"Majed Saeed","family":"Alshahrani","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran 66462, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Khadawardi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8550-7251","authenticated-orcid":false,"given":"Neveen","family":"Awadh","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Rabigh 25732, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedaya","family":"Albelwi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, College of Medicine, Tabuk University, Tabuk 47512, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9222-9149","authenticated-orcid":false,"given":"Heba M.","family":"Adly","sequence":"additional","affiliation":[{"name":"Department of Community Medicine and Pilgrims Healthcare, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9522-9198","authenticated-orcid":false,"given":"Saleh A. K.","family":"Saleh","sequence":"additional","affiliation":[{"name":"Directorate of Institutional Excellence, Batterjee Medical College, Jeddah 21442, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Abuzaid","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Al Birk General Hospital, Al Birk 63525, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9529-9791","authenticated-orcid":false,"given":"Maha","family":"Tulbah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Alomar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia"},{"name":"Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ornoy, A., Becker, M., Weinstein-Fudim, L., and Ergaz, Z. (2021). Diabetes during pregnancy: A maternal disease complicating the course of pregnancy with long-term deleterious effects on the offspring. a clinical review. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22062965"},{"key":"ref_2","first-page":"53","article-title":"Maternal sleep and related pregnancy outcomes: A Multicenter cross-sectional study in 11 provinces of Iran","volume":"15","author":"Hajipour","year":"2021","journal-title":"J. Fam. Reprod. Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e651","DOI":"10.1002\/hsr2.651","article-title":"Effects of maternal age on the mode of delivery following induction of labor in nulliparous term pregnancies: A retrospective cohort study","volume":"5","author":"Sharami","year":"2022","journal-title":"Health Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Muglia, L.J., Benhalima, K., Tong, S., and Ozanne, S. (2022). Maternal factors during pregnancy influencing maternal, fetal, and childhood outcomes. BMC Med., 20.","DOI":"10.1186\/s12916-022-02632-6"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Chang, K.-J., Seow, K.-M., and Chen, K.-H. (2023). Preeclampsia: Recent advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20042994"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Malha, L., Podymow, T., and August, P. (2024). Hypertension in Pregnancy. Hypertension, Elsevier.","DOI":"10.1016\/B978-0-323-88369-6.00044-X"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: A systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e13380","DOI":"10.1111\/obr.13380","article-title":"Low birth weight and small for gestational age are associated with complications of childhood and adolescence obesity: Systematic review and meta-analysis","volume":"23","author":"Goni","year":"2022","journal-title":"Obes. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"54","DOI":"10.4258\/hir.2023.29.1.54","article-title":"Machine learning-based classifiers for the prediction of low birth weight","volume":"29","author":"Arayeshgari","year":"2023","journal-title":"Healthc. Inform. Res."},{"key":"ref_10","first-page":"329","article-title":"The psychological effects of stillbirth on parents: A qualitative evidence synthesis of psychoanalytic literature","volume":"67","author":"Cena","year":"2021","journal-title":"Z. F\u00fcr Psychosom. Med. Und Psychother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5672","DOI":"10.1080\/14767058.2021.1888923","article-title":"Clinical manifestation and maternal complications and neonatal outcomes in pregnant women with COVID-19: A comprehensive evidence synthesis and meta-analysis","volume":"35","author":"Soheili","year":"2022","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1373\/clinchem.2007.097469","article-title":"Effect of homocysteine concentration in early pregnancy on gestational hypertensive disorders and other pregnancy outcomes","volume":"54","author":"Dodds","year":"2008","journal-title":"Clin. Chem."},{"key":"ref_13","first-page":"167","article-title":"Hyperhomocysteinemia and pregnancy outcomes in women with polycystic ovary syndrome: A case-control study","volume":"21","author":"Asanidze","year":"2023","journal-title":"Int. J. Reprod. Biomed."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s12272-018-1016-4","article-title":"Causes of hyperhomocysteinemia and its pathological significance","volume":"41","author":"Kim","year":"2018","journal-title":"Arch. Pharmacal Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Yuan, D., Chu, J., Lin, H., Zhu, G., Qian, J., Yu, Y., Yao, T., Ping, F., Chen, F., and Liu, X. (2023). Mechanism of homocysteine-mediated endothelial injury and its consequences for atherosclerosis. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1109445"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e13589","DOI":"10.1111\/aji.13589","article-title":"Fetal hyperhomocysteinemia is associated with placental inflammation and early breakdown of maternal-fetal tolerance in pre-term birth","volume":"88","author":"Bala","year":"2022","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3945\/ajcn.111.016212","article-title":"Maternal homocysteine and small-for-gestational-age offspring: Systematic review and meta-analysis","volume":"95","author":"Hogeveen","year":"2012","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.1080\/14767058.2019.1567705","article-title":"The relationship between maternal plasma homocysteine in early pregnancy and birth weight","volume":"33","author":"Cawley","year":"2020","journal-title":"J. Matern.-Fetal Neonatal Med."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rubini, E., Snoek, K.M., Schoenmakers, S., Willemsen, S.P., Sinclair, K.D., Rousian, M., and Steegers-Theunissen, R.P. (2022). First trimester maternal homocysteine and embryonic and fetal growth: The Rotterdam Periconception Cohort. Nutrients, 14.","DOI":"10.3390\/nu14061129"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"572","DOI":"10.12669\/pjms.40.4.8988","article-title":"Effects of glycated serum protein, homocysteine, and cystatin-C levels on pregnancy outcomes in patients with gestational diabetes mellitus","volume":"40","author":"Chen","year":"2024","journal-title":"Pak. J. Med. Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1080\/09513590.2021.1967314","article-title":"Homocysteine level and gestational diabetes mellitus: A systematic review and meta-analysis","volume":"37","author":"Zheng","year":"2021","journal-title":"Gynecol. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/jdi.12460","article-title":"Serum homocysteine level and gestational diabetes mellitus: A meta-analysis","volume":"7","author":"Gong","year":"2016","journal-title":"J. Diabetes Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.cbi.2018.07.021","article-title":"Effect of homocysteine on pregnancy: A systematic review","volume":"293","author":"Gaiday","year":"2018","journal-title":"Chem. Biol. Interact."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jclinepi.2021.02.003","article-title":"Updating guidance for reporting systematic reviews: Development of the PRISMA 2020 statement","volume":"134","author":"Page","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1001\/jamasurg.2021.0522","article-title":"MOOSE Reporting Guidelines for Meta-analyses of Observational Studies","volume":"156","author":"Brooke","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_26","first-page":"1","article-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses","volume":"2","author":"Peterson","year":"2011","journal-title":"Ott. Hosp. Res. Inst."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.jclinepi.2020.09.018","article-title":"GRADE Guidelines 30: The GRADE approach to assessing the certainty of modeled evidence-An overview in the context of health decision-making","volume":"129","author":"Brozek","year":"2021","journal-title":"J. Clin. Epidemiol."},{"key":"ref_28","unstructured":"Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V. (2019). Cochrane Handbook for Systematic Reviews of Interventions, John Wiley and Sons."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"Br. Med. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/j.1471-0528.2012.03321.x","article-title":"Homocysteine and folate concentrations in early pregnancy and the risk of adverse pregnancy outcomes: The Generation R Study","volume":"119","author":"Bergen","year":"2012","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.rbmo.2018.12.046","article-title":"Effects of hyperhomocysteinaemia and metabolic syndrome on reproduction in women with polycystic ovary syndrome: A secondary analysis","volume":"38","author":"Chang","year":"2019","journal-title":"Reprod. Biomed. Online"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chaudhry, S.H., Taljaard, M., MacFarlane, A.J., Gaudet, L.M., Smith, G.N., Rodger, M., Rennicks White, R., Walker, M.C., and Wen, S.W. (2019). The role of maternal homocysteine concentration in placenta-mediated complications: Findings from the Ottawa and Kingston birth cohort. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2219-5"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Liu, C., Luo, D., Wang, Q., Ma, Y., Ping, L., Wu, T., Tang, J., Peng, D., and Zhao, P. (2020). Serum homocysteine and folate concentrations in early pregnancy and subsequent events of adverse pregnancy outcome: The Sichuan Homocysteine study. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-02860-9"},{"key":"ref_34","first-page":"e37461","article-title":"Maternal Hyperhomocysteinemia as a Predictor of Placenta-Mediated Pregnancy Complications: A Two-Year Novel Study","volume":"15","author":"Memon","year":"2023","journal-title":"Cureus"},{"key":"ref_35","first-page":"2","article-title":"Hyperhomocysteinemia and folate deficiency in preterm premature rupture of membranes: A hospital based case control study (India)","volume":"4","author":"Mishra","year":"2018","journal-title":"J. Womens Health Issues Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4103\/aam.aam_41_19","article-title":"Association between maternal serum homocysteine concentrations in early pregnancy and adverse pregnancy outcomes","volume":"19","author":"Nwogu","year":"2020","journal-title":"Ann. Afr. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"45","DOI":"10.47489\/p000s351z7831-6mc","article-title":"Association of Maternal Hyperhomocysteinemia with Preeclampsia: A Hospital Based Case-Control Study","volume":"35","author":"Qureshi","year":"2021","journal-title":"Proceedings"},{"key":"ref_38","first-page":"5396","article-title":"Correlation of maternal serum homocysteine in the first trimester with the development of gestational hypertension and preeclampsia","volume":"23","author":"Sun","year":"2017","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_39","first-page":"e40423","article-title":"Raised Maternal Homocysteine Levels in Antenatal Women at 10 to 14 Weeks of Gestation and Placenta-Mediated Complications: A Cohort Study","volume":"15","author":"Thakur","year":"2023","journal-title":"Cureus"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1093\/ajcn\/71.4.962","article-title":"Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: The Hordaland Homocysteine study","volume":"71","author":"Vollset","year":"2000","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.15562\/bmj.v11i3.3701","article-title":"High maternal homocysteine (Hcy) levels as a risk factor of preterm labor: A case-control study","volume":"11","author":"Wiradnyana","year":"2022","journal-title":"Bali Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"520","DOI":"10.3109\/01443615.2012.693984","article-title":"Homocysteine, folate and pregnancy outcomes","volume":"32","author":"Kim","year":"2012","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e23388","DOI":"10.1002\/ajhb.23388","article-title":"Trends of folate, vitamin B12, and homocysteine levels in different trimesters of pregnancy and pregnancy outcomes","volume":"32","author":"Mishra","year":"2020","journal-title":"Am. J. Hum. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"D\u2019Souza, S.W., and Glazier, J.D. (2022). Homocysteine metabolism in pregnancy and developmental impacts. Front. Cell Dev. Biol., 10.","DOI":"10.3389\/fcell.2022.802285"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.nutres.2021.05.002","article-title":"Hyperhomocysteinemia and low vitamin B12 are associated with the risk of early pregnancy loss: A clinical study and meta-analyses","volume":"91","author":"Bala","year":"2021","journal-title":"Nutr. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1080\/09513590.2022.2110233","article-title":"High level of homocysteine is associated with pre-eclampsia risk in pregnant woman: A meta-analysis","volume":"38","author":"Zhang","year":"2022","journal-title":"Gynecol. Endocrinol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"197","DOI":"10.14715\/cmb\/2024.70.2.28","article-title":"Homocysteine modulates CXCL10\/CXCR3 axis activity to induce endothelial dysfunction","volume":"70","author":"Xu","year":"2024","journal-title":"Cell. Mol. Biol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Dymara-Konopka, W., and Laskowska, M. (2019). The role of nitric oxide, ADMA, and homocysteine in the etiopathogenesis of preeclampsia. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20112757"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00424-016-1849-y","article-title":"Hyperhomocysteinemia impairs regional blood flow: Involvements of endothelial and neuronal nitric oxide","volume":"468","author":"Toda","year":"2016","journal-title":"Pfl\u00fcgers Arch.-Eur. J. Physiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e01851","DOI":"10.1002\/brb3.1851","article-title":"Elevated homocysteine, as a biomarker of cardiac injury, in panic disorder patients due to oxidative stress","volume":"10","author":"Aghayan","year":"2020","journal-title":"Brain Behav."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e19911","DOI":"10.1016\/j.heliyon.2023.e19911","article-title":"Association of baseline and changes in adiponectin, homocysteine, high-sensitivity C-reactive protein, interleukin-6, and interleukin-10 levels and metabolic syndrome incidence: Tehran lipid and glucose study","volume":"9","author":"Zahedi","year":"2023","journal-title":"Heliyon"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e23996","DOI":"10.1002\/jcla.23996","article-title":"Exploring potential serum levels of Homocysteine, interleukin-1 beta, and apolipoprotein B 48 as new biomarkers for patients with ischemic stroke","volume":"35","author":"Shademan","year":"2021","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_53","first-page":"e35244","article-title":"High homocysteine levels during pregnancy and its Association with placenta-mediated complications: A scoping review","volume":"15","author":"Thakur","year":"2023","journal-title":"Cureus"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/j.1538-7836.2005.01708.x","article-title":"Activation of p38 MAPKinase\/cPLA2 pathway in homocysteine-treated platelets","volume":"4","author":"Leoncini","year":"2006","journal-title":"J. Thromb. Haemost."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Litvinov, R.I., Peshkova, A.D., Le Minh, G., Khaertdinov, N.N., Evtugina, N.G., Sitdikova, G.F., and Weisel, J.W. (2021). Effects of hyperhomocysteinemia on the platelet-driven contraction of blood clots. Metabolites, 11.","DOI":"10.3390\/metabo11060354"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e15467","DOI":"10.14814\/phy2.15467","article-title":"Elevated homocysteine activates unfolded protein responses and causes aberrant trophoblast differentiation and mouse blastocyst development","volume":"10","author":"Capatina","year":"2022","journal-title":"Physiol. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Wan, C., Zong, R.-Y., and Chen, X.-S. (2022). The new mechanism of cognitive decline induced by hypertension: High homocysteine-mediated aberrant DNA methylation. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.928701"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"101322","DOI":"10.1016\/j.redox.2019.101322","article-title":"Homocysteine-methionine cycle is a metabolic sensor system controlling methylation-regulated pathological signaling","volume":"28","author":"Shen","year":"2020","journal-title":"Redox Biol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3216\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T17:14:49Z","timestamp":1776964489000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":58,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093216"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093216","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}