Key result
Pregnancy-induced antithrombin deficiency affects ~40% of triplet pregnancies and is linked to liver dysfunction.
Why the study?
The clinical features of pregnancy-induced antithrombin deficiency (PIATD) and its recognition in obstetrical practice are not well understood.
Should antithrombin activity be determined in pregnant women with multifetal pregnancies, hypertension, isolated proteinuria, and/or edema?
Should antithrombin activity be determined in pregnant women with multifetal pregnancies, hypertension, isolated proteinuria, and/or edema?
Determining antithrombin activity in high-risk pregnant women may help identify pregnancy-induced antithrombin deficiency and improve clinical management.
May prompt targeted antithrombin testing in multifetal pregnancies; leaves open prospective validation before practice change.
BACKGROUND: Some women exhibit a gradual decrease in antithrombin activity until the time of delivery, with antithrombin activity reaching <65% of the normal level (pregnancy-induced antithrombin deficiency, PIATD). However, the clinical features of such women are not well understood and are unfamiliar to many obstetricians. FINDINGS: PIATD is more likely to occur as the number of fetuses increases (approx. 1.0%, 10%, and 40% for singleton, twin, and triplet pregnancies, respectively) and in women with hypertension, isolated proteinuria and/or edema. However, normotensive women account for 60% of women with PIATD. Antithrombin can escape from the blood into the interstitial space. Women with PIATD suffer from a decreased plasma volume and are more likely to develop liver dysfunction, irrespective of the presence or absence of hypertension. Because antithrombin activity continues to decrease until the time of delivery in women with PIATD, women with unrecognized PIATD may be identified as patients with so-called "acute fatty liver of pregnancy" if delivery is delayed. CONCLUSION: Knowledge of AT activity in obstetrical practice may improve management of pregnant women. The determination of AT activity should be considered in women with multifetal pregnancies, hypertension, isolated proteinuria and/or edema.
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Minakami et al. (2011) conducted a review in Pregnancy-induced antithrombin deficiency (PIATD). Multifetal pregnancy vs. Singleton pregnancy was evaluated on Pregnancy-induced antithrombin deficiency (PIATD). Pregnancy-induced antithrombin deficiency occurs in approximately 1.0%, 10%, and 40% of singleton, twin, and triplet pregnancies, respectively, and is associated with liver dysfunction.
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