Adverse pregnancy outcomes and inherited thrombophilia

Dominik Dłuski; Radzisław Mierzyński; Elżbieta Poniedziałek-Czajkowska; Bożena Leszczyńska-Gorzelak

doi:10.1515/jpm-2017-0059

Artikel

Adverse pregnancy outcomes and inherited thrombophilia

Dominik Dłuski , Radzisław Mierzyński , Elżbieta Poniedziałek-Czajkowska und Bożena Leszczyńska-Gorzelak

Veröffentlicht/Copyright: 9. August 2017

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Aus der Zeitschrift Journal of Perinatal Medicine Band 46 Heft 4

Abstract

Aim:

(1) To evaluate the prevalence of inherited thrombophilia in pregnant women with adverse pregnancy outcomes: intrauterine growth retardation (IUGR), preeclampsia (PE) and placental abruption. (2) To assess the impact of inherited thrombophilia on the nature of obstetric complications. (3) To assess levels of protein S, protein C, antithrombin III and homocysteine in pregnant women with adverse pregnancy outcomes.

Subjects and methods:

The study comprised 162 pregnant women. The patients were divided into three test groups and one control group. In all 162 patients the following tests were completed: activated protein C resistance (APC-R), the level of free protein S, activity of protein C, antithrombin III and the level of homocysteine. The data were statistically analyzed via χ² of independence or homogeneity test.

Results:

In 32 of 162 patients participating in clinical research thrombophilia was diagnosed (10 patients with APC-R, 21 patients with protein S deficiency, one patient with hyperhomocysteinemia): seven patients belonged to the control group and 25 patients had diagnosed adverse pregnancy outcomes (P=0.04). In 32 patients with diagnosed thrombophilia, level of protein S was decreased (P=0.04). Protein S deficiency was diagnosed, when level of protein S was lower than 30% in the second trimester and lower than 24% in the third trimester. The incidence of activated protein C resistance caused by the mutation of factor V Leiden was in six patients (5.9%) with adverse pregnancy outcomes, and in four patients (6.6%) from the control group. Results were not statistically significant. No protein C deficiency was diagnosed (diagnosis: level<60%), but in 50% of patients with thrombophilia level of protein C was over the norm (P=0.02). The level of antithrombin III was often decreased in patients with preeclampsia – (32.4%), then in the other patients – (17.2%) (P=0.04), but no patient was diagnosed with antithrombin III deficiency (diagnosis: level<60%).

Conclusions:

Tests for thrombophilia should be carried out in women with adverse pregnancy outcomes in their history, who are planning pregnancy, to start anticoagulant prophylaxis. Our study supports the thesis that tests for thrombophilia should be carried out in women with a history of adverse pregnancy outcomes and who are planning a pregnancy to start anticoagulant prophylaxis.

Keywords: Activated protein C resistance; adverse pregnancy outcomes; antithrombin III; inherited thrombophilia; intrauterine growth retardation; placental abruption; preeclampsia; pregnancy; protein C; protein S

Author’s statement
Conflict of interest: Authors state no conflict of interest.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.

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Received: 2017-2-23

Accepted: 2017-6-30

Published Online: 2017-8-9

Published in Print: 2018-5-24

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Artikel in diesem Heft

https://doi.org/10.1515/jpm-2017-0059

Schlagwörter für diesen Artikel

Activated protein C resistance; adverse pregnancy outcomes; antithrombin III; inherited thrombophilia; intrauterine growth retardation; placental abruption; preeclampsia; pregnancy; protein C; protein S