Key result
Low molecular weight heparin treatment reduced the incidence of intrauterine fetal death (P=0.011) in Conventional thrombophilia, and FGR, IUFD, and PTB in Novel thrombophilia.
Why the study?
Does LMWH treatment reduce pregnancy complications in women with inherited thrombophilias and previous adverse pregnancy outcomes?
Cohort (n=50)
Does LMWH treatment reduce pregnancy complications in women with inherited thrombophilias and previous adverse pregnancy outcomes?
p-value: p=0.011
LMWH therapy reduces severe pregnancy complications such as intrauterine fetal death, fetal growth restriction, and preterm birth in women with inherited thrombophilias and prior adverse outcomes, with notable benefits in those with 'novel' thrombophilia mutations.
Supports LMWH consideration in thrombophilia with prior adverse outcomes; leaves open need for RCTs to confirm benefit.
PURPOSE: To assess the distribution of births and spontaneous abortions, first-trimester abortion (FTA) and mid-trimester abortion (MTA), in untreated (n=128) and low molecular weight heparin (LMWH) treated pregnancies (n=50) of the same women with inherited thrombophilias and adverse pregnancy outcome (APO) in previous pregnancies. We particularly investigated the impact of LMWH on reducing the pregnancy complications in two thrombophilia types, "Conventional" and "Novel". MATERIALS AND METHODS: 50 women with inherited thrombophilia (26 Conventional and 24 Novel) and APO in previous pregnancies were included in the study. Conventional group included factor V Leiden (FVL), prothrombin G20210A (PT) mutations and antithrombin (AT), protein S (PS), and protein C (PC) deficiency, while the Novel group included methylentetrahydrofolate-reductase (MTHFR), plasminogen activator inhibitor-1 (PAI-1), and angiotensin converting enzyme (ACE) polymorphism. APO was defined as one of the following: preterm birth (PTB), fetal growth restriction (FGR), preeclampsia (PE), intrauterine fetal death (IUFD), placental abruption (PA) and deep venous thrombosis (DVT). RESULTS: There was no difference in distribution of births and spontaneous abortions between Conventional and Novel thrombophilia in untreated pregnancies (χ²=2.7; p=0.100) and LMWH treated pregnancies (χ²=0.442; p=0.506). In untreaed pregnancies thrombophilia type did not have any impact on the frequency of FTA and MTA (χ²=0.14; p=0.711). In birth-ended pregnancies LMWH treatement reduced the incidence of IUFD (p=0.011) in Conventional and FGR, IUFD, and PTB in Novel thrombophilia group. CONCLUSION: The equal impact of two thrombophilia types on the pregnancy outcomes and a more favorable effect of LMWH therapy on pregnancy complications in Novel thrombophilia group point the need for Novel thrombophilias screening and the future studies on this issue should be recommended.
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Aračić et al. (2016) conducted a cohort in Inherited thrombophilia and previous adverse pregnancy outcome (n=50). Low molecular weight heparin (LMWH) vs. Untreated pregnancies was evaluated on Incidence of pregnancy complications including intrauterine fetal death (IUFD), fetal growth restriction (FGR), and preterm birth (PTB) (p=0.011). Low molecular weight heparin treatment reduced the incidence of intrauterine fetal death (P=0.011) in Conventional thrombophilia, and FGR, IUFD, and PTB in Novel thrombophilia.
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