Advertisement

Maternal thrombophilia and the risk of recurrence of preeclampsia

Published:October 10, 2008DOI:https://doi.org/10.1016/j.ajog.2008.07.032

      Objective

      The aim of this prospective study was to determine the impact of thrombophilia on the recurrence of preeclampsia.

      Study Design

      In a multicenter, observational, cohort design, 172 white patients with a previous pregnancy complicated by preeclampsia were observed in the next pregnancy. They were evaluated for heritable thrombophilia (factor V Leiden and factor II G20210A mutations, protein S, protein C, and antithrombin deficiency), hyperhomocystinemia, lupus anticoagulant, and anticardiolipin antibodies. Development of preeclampsia and maternal complications and both gestational age at delivery and birthweight were recorded.

      Results

      Sixty women (34.9%) showed the presence of a thrombophilic defect. They had a higher risk for the recurrence of preeclampsia (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.2-5.1), compared to patients without thrombophilia. Similar findings were observed considering only heritable thrombophilia. Thrombophilic patients were at increased risk for the occurrence of very early preterm delivery (< 32 weeks; OR, 11.6; 95% CI, 3.4-43.2).

      Conclusion

      When counseling white women with a history of preeclampsia, screening for thrombophilia can be useful for preconceptional counseling and pregnancy management.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alfirevic Z.
        • Roberts D.
        • Martlew V.
        How strong is the association between maternal thrombophilia and adverse pregnancy outcome?.
        Eur J Obstet Gynecol Reprod Biol. 2002; 101: 6-14
        • Lin J.
        • August P.
        Genetic thrombophilia and preeclampsia: a meta-analysis.
        Obstet Gynecol. 2005; 105: 182-192
        • Mello G.
        • Parretti E.
        • Marozio L.
        • et al.
        Thrombophilia is significantly associated with severe preeclampsia.
        Hypertension. 2005; 46: 1270-1274
        • Duckitt K.
        • Harrington D.
        Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies.
        BMJ. 2005; 330: 565-568
        • De Groot P.G.
        • Derksen H.V.M.
        Pathophysiology of the antiphospholipid syndrome.
        J Thromb Haemost. 2005; 3: 1854-1860
        • van Rijn B.B.
        • Hoeks L.B.
        • Bots M.L.
        • Franx A.
        • Bruinse H.W.
        Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia.
        Am J Obstet Gynecol. 2006; 195: 723-728
        • American College of Obstetricians and Gynecologists Committee on Obstetric Practice
        ACOG practice bulletin, number 33, January 2002.
        Int J Gynecol Obstet. 2002; 77: 67-75
        • Parazzini F.
        • Cortinovis I.
        • Bortolus R.
        • Fedele L.
        • Recarli A.
        Weight at birth by gestational age in Italy.
        Hum Reprod. 1995; 10: 1862-1863
        • Sibai B.M.
        • El-Nazer A.
        • Gonzalez-Ruiz A.
        Severe preeclampsia-eclampsia in young primigravid women: subsequent pregnancy outcome and remote prognosis.
        Am J Obstet Gynecol. 1986; 155: 1011-1016
        • Rees D.C.
        • Cox M.
        • Clegg J.B.
        World distribution of factor V Leiden.
        Lancet. 1995; 346: 1133-1134
        • Sibai B.M.
        • Lindheimer M.
        • Hauth J.
        • et al.
        Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension.
        N Engl J Med. 1998; 339: 667-671
        • Knight M.
        • Duley L.
        • Henderson-Smart D.J.
        • King J.F.
        Antiplatelet agents for preventing and treating preeclampsia.
        Cochrane Database Syst Rev. 2002; 2 (CD000492)
        • Gris J.C.
        • Lissalde-Lavigne G.
        • Qhéré I.
        • Dauzat M.
        • Marés P.
        Prophylaxis and treatment of thrombophilia in pregnancy.
        Curr Opin Hematol. 2006; 13: 376-381
        • van Walraven C.
        • Mamdani M.
        • Cohn A.
        • Katib Y.
        • Walker M.
        • Rodger M.A.
        Risk of subsequent thromboembolism for patients with pre-eclampsia.
        BMJ. 2003; 326: 791-792
        • Wilson B.J.
        • Watson M.S.
        • Prescott G.J.
        • et al.
        Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study.
        BMJ. 2003; 326: 845-849
        • Pabinger I.
        • Grafenhofer H.
        • Kaider A.
        • et al.
        Risk of pregnancy-associated recurrent venous thromboembolism in women with a history of venous thrombosis.
        J Thromb Haemost. 2005; 3: 949-954