Thrombophilia testing in pregnancy: should we agree to disagree?
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Laudelino Lopes
Abstract
The value of testing for inherited thrombophilia in pregnancy has been debated in literature with regard to its utility in preventing adverse obstetrical outcomes or identifying women at risk for it. In this commentary, an evidence based approach is used to investigate the strength of association between thrombophilias and recurrent pregnancy loss and stillbirth. Several studies and meta-analyses have shown that there is only a weak association with recurrent pregnancy loss. However, many of these studies were underpowered, and there was significant heterogeneity-issues that are addressed in this paper. The evidence for association with stillbirth is lacking, but the few studies that are available seem to suggest a stronger correlation than for recurrent pregnancy loss. Further, the benefit of treating thrombophilias with anticoagulation in order to prevent these outcomes is discussed. While there is a lack of evidence looking at whether anticoagulation prevents stillbirth, there is strong evidence to show that anticoagulation does not prevent recurrent pregnancy loss. Finally, guidelines put out by various obstetrical and hematological societies regarding this topic are summarized.
References
[1] American College of Obstetricians and Gynecologists. Management of stillbirth. ACOG Practice Bulletin no. 102. Obstet Gynecol. 2009;113:748–61.Suche in Google Scholar
[2] American College of Obstetricians and Gynecologists. Inherited Thrombophilias in Pregnancy. Practice Bulletin. Obstet Gynecol. 2011;118:730–40.Suche in Google Scholar
[3] Bates S, Greer I, Middledorp S, Veenstra DL, Prabulos AM, Vandvik PO. VTE, Thrombophilia, antithrombotic therapy, and pregnancy. Chest. 2012;141(suppl): e691S–736S.10.1378/chest.11-2300Suche in Google Scholar PubMed PubMed Central
[4] Berg C, Callaghan W, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998–2005. Obstet Gynecol. 2010;116:1302–9.10.1097/AOG.0b013e3181fdfb11Suche in Google Scholar PubMed
[5] Clark P, Walker I, Langhorne P, Crichton L, Thomas A, Greaves M, et al. SPIN (Scottish Pregnancy Intervention) study: a multicenter, randomized control trial of low-molecular-weight heparin and low-dose aspirin in women with recurrent miscarriage. Blood. 2010;115:4162–7.10.1182/blood-2010-01-267252Suche in Google Scholar PubMed
[6] Cunningham F, Leveno K, Bloom S, Hauth J, Rouse D, Spong C. Williams Obstetrics. 23rd ed. New York: McGraw-Hill Medical; 2010.Suche in Google Scholar
[7] Dizon-Townsen D, Miller C, Sibai B, Spong CY, Thom E, Wendel G, et al. The relationship of factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol. 2005;106:517–24.10.1097/01.AOG.0000173986.32528.caSuche in Google Scholar PubMed
[8] Greer I, Nelson-Piercy C. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood. 2005;106:401–7.10.1182/blood-2005-02-0626Suche in Google Scholar PubMed
[9] James A, Jamison M, Brancazio L, Myers E. Venous thromboembolism during pregnancy and the postpartum period: Incidence, risk factors, and mortality. Am J Obstet Gynecol. 2006;194:1311–5.10.1016/j.ajog.2005.11.008Suche in Google Scholar PubMed
[10] Kaandorp S, Di Nisio M, Goddjin M, Middledorp S. Aspirin or anticoagulants for treating recurrent miscarriage in women without antiphospholipid syndrome. The Cochrane Library. 2009.10.1002/14651858.CD004734.pub3Suche in Google Scholar PubMed
[11] Kaandorp S, Goddijn M, van der Post J, Hutten BA, Verhoeve HR, Hamulyak K, et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. New Engl J Med. 2010;362:1586–96.10.1056/NEJMoa1000641Suche in Google Scholar PubMed
[12] Leduc L, Farine D, Anthony AB, Brunner M, Crane J, Delisie MF, et al. Stillbirth and bereavement: guidelines for stillbirth investigations. J Obstet Gynecol Can. 2007;29:560–7.Suche in Google Scholar
[13] Lockwood C. Thrombosis, thrombophilia, and thromboembolism: Clinical updates in women’s health care. Am Coll Obstet Gynecol. Vol. VI, No. 4, 2007;6:1–95.Suche in Google Scholar
[14] Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe G, et al. Thrombophilia in pregnancy: a systematic review. Br J Haematol. 2006;132:171–96.10.1111/j.1365-2141.2005.05847.xSuche in Google Scholar PubMed
[15] Rodger M, Betancourt M, Clark P, Lindqvist P, Dizon-Townsen D, Said J, et al. The association of factor V Leiden and prothrombin gene mutation and placenta-mediated pregnancy complications: a systematic review and meta-analysis of prospective cohort studies. PLoS Med. 2010;7:e1000292.10.1371/journal.pmed.1000292Suche in Google Scholar PubMed PubMed Central
[16] Roque H, Paidas MJ, Funai EF, Kuczynski E, Lockwood CJ. Maternal thrombophilias are not associated with early pregnancy loss. J Thromb Haemost. 2004;91:290–5.10.1160/TH03-09-0596Suche in Google Scholar PubMed
[17] Royal College of Obstetricians and Gynaecologists. Green Top Guidelines. Reducing the risk of thrombosis and embolism in pregnancy and the peurperium. 2009.Suche in Google Scholar
[18] Silver R, Zhao Y, Spong C, Sibai B, Wendel G, Wenstrom K, et al. Prothrombin gene G20210A mutation and obstetric complications. Obstet Gynecol. 2010;115:14–20.10.1097/AOG.0b013e3181c88918Suche in Google Scholar PubMed PubMed Central
[19] Stefano V, Martinelli I, Mannucci P, Paciaroni K, Chiusolo P, Casorelli I, et al. The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation. New Engl J Med. 1999;341:801–6.10.1056/NEJM199909093411104Suche in Google Scholar PubMed
[20] Tormene D, Simioni P, Prandoni P, Lunis S, Zerbinati P, Sartor D, et al. Factor V Leiden mutation and the risk of venous thromboembolism in pregnant women. Haematologica. 2001;86:1305–9.Suche in Google Scholar
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2015 by De Gruyter
Artikel in diesem Heft
- Frontmatter
- Academy’s Corner
- Obstetrical Doppler: the evidence today
- Review article
- Fetal complications due to intrahepatic cholestasis of pregnancy
- Original articles – Obstetrics
- Pre-pregnancy obesity compromises obstetric and neonatal outcomes
- Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester
- Placental gene expression of inflammatory markers and growth factors – a case control study of obese and normal weight women
- Haemorrhagic and thrombotic complications in pregnant women with acquired and congenital cardiac disease
- Intrapartum ultrasound prior to Kristeller maneuver: an observational study
- Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals
- Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days
- Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen
- Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births
- Original articles – Fetus
- MR imaging of the fetal brain at 1.5T and 3.0T field strengths: comparing specific absorption rate (SAR) and image quality
- Sex differences in the fetal heart rate variability indices of twins
- Original articles – Newborn
- Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study
- Antenatal testing in uncomplicated pregnancies: should testing be initiated after 40 or 41 weeks?
- Low total IgM values and high cytomegalovirus loads in the blood of newborns with symptomatic congenital cytomegalovirus infection
- Associated anomalies in congenital diaphragmatic hernia: perinatal characteristics and impact on postnatal survival
- The value of lipopolysaccharide binding protein for diagnosis of late-onset neonatal sepsis in very low birth weight infants
- Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery
- Commentary
- Thrombophilia testing in pregnancy: should we agree to disagree?
- Congress Calendar
- Congress Calendar
Artikel in diesem Heft
- Frontmatter
- Academy’s Corner
- Obstetrical Doppler: the evidence today
- Review article
- Fetal complications due to intrahepatic cholestasis of pregnancy
- Original articles – Obstetrics
- Pre-pregnancy obesity compromises obstetric and neonatal outcomes
- Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester
- Placental gene expression of inflammatory markers and growth factors – a case control study of obese and normal weight women
- Haemorrhagic and thrombotic complications in pregnant women with acquired and congenital cardiac disease
- Intrapartum ultrasound prior to Kristeller maneuver: an observational study
- Interinstitutional variations in mode of birth after a previous caesarean section: a cross-sectional study in six German hospitals
- Use of the angle of progression on ultrasonography to predict spontaneous onset of labor within 7 days
- Study of the relationship in pregnant women between hepatitis B markers and a placenta positive for hepatitis B surface antigen
- Sarcoidosis and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 7 million births
- Original articles – Fetus
- MR imaging of the fetal brain at 1.5T and 3.0T field strengths: comparing specific absorption rate (SAR) and image quality
- Sex differences in the fetal heart rate variability indices of twins
- Original articles – Newborn
- Correlation of neonatal weight with maternal serum levels of pregnancy-associated plasma protein-A during the first trimester of pregnancy: a retrospective study
- Antenatal testing in uncomplicated pregnancies: should testing be initiated after 40 or 41 weeks?
- Low total IgM values and high cytomegalovirus loads in the blood of newborns with symptomatic congenital cytomegalovirus infection
- Associated anomalies in congenital diaphragmatic hernia: perinatal characteristics and impact on postnatal survival
- The value of lipopolysaccharide binding protein for diagnosis of late-onset neonatal sepsis in very low birth weight infants
- Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery
- Commentary
- Thrombophilia testing in pregnancy: should we agree to disagree?
- Congress Calendar
- Congress Calendar
