Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials

Rodger, Marc; Gris, Jean‐Christophe; Vries, J.I.P. de; Martinelli, Ida; Rey, Évelyne; Schleußner, E; Middeldorp, Saskia; Kaaja, Risto; Langlois, Nicole; Ramsay, Tim; Mallick, Ranjeeta; Bates, Shannon M.; Abheiden, Carolien N H; Perna, Annalisa; Petroff, David; Jong, Paulien de; Hoorn, Marion E. van; Bezemer, P.D.; Mayhew, Alain

doi:10.1016/s0140-6736(16)31139-4

Cited by 190 publications

(184 citation statements)

References 39 publications

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“…60 Further research evaluating the role of LMWH for the subgroup of women with past placenta abruption is still needed. 59 In summary, the absolute venous thrombotic risk is increased to 1% to 3% during the antepartum period and .3% in the postpartum period among women with ET. LMWH prophylaxis is suggested in the postpartum period.…”

Section: Discussionmentioning

confidence: 92%

Risk of venous thromboembolism in pregnant women with essential thrombocythemia: a systematic review and meta-analysis

Skeith

Carrier

Robinson

et al. 2017

Blood

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We performed a meta-analysis to evaluate the risk of venous thromboembolism (VTE) in pregnant women with essential thrombocythemia. Twenty-one trials and 756 pregnancies met inclusion criteria. The absolute VTE risk in the antepartum period is not above a threshold where low-molecular-weight heparin (LMWH) prophylaxis is clearly indicated or below a threshold where LMWH should be withheld (2.5%; 95% CI, 1.3-4.3). Postpartum, the absolute VTE risk is above a threshold where postpartum LMWH prophylaxis should be considered (4.4%; 95% CI, 1.2-9.5).

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Section: Discussionmentioning

confidence: 92%

Risk of venous thromboembolism in pregnant women with essential thrombocythemia: a systematic review and meta-analysis

Skeith

Carrier

Robinson

et al. 2017

Blood

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“…It has been known that the placenta plays important roles in pathophysiology of a number of APO. Pre‐eclampsia, stillbirth, fetal growth restriction and preterm birth are currently considered as placenta‐mediated disorders . A number of studies revealed that placental barrier dysfunction might occur in these disorders .…”

Section: Discussionmentioning

confidence: 99%

A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

Zhang

Chan

et al. 2019

J of Obstet and Gynaecol

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Aim It has been reported in numerous studies that elevated maternal serum alpha‐fetoprotein (MS‐AFP) is associated with adverse pregnancy outcomes (APO), such as pre‐eclampsia, stillbirth, preterm birth and fetal growth restriction. However, the mechanism linking elevated MS‐AFP and APO is obscure. In this study, we tried to explore the mechanism by using pregnant rats. Methods Lipopolysaccharide (LPS) was used to induce placental inflammation in pregnant rats. Maternal serum and placental inflammatory cytokines and placental morphology were used to assess the level of placental inflammation. The incidences of APO and the levels of MS‐AFP were evaluated. The expressions of alpha‐fetoprotein (AFP) in the related organs and fetal serum AFP levels were detected. Results Compared to saline‐treated pregnant rats, LPS led to elevated maternal serum and placental inflammatory cytokines and a higher rate of placental inflammation. Lipopolysaccharide resulted in the features of APO and at the same time elevated MS‐AFP. Maternal serum alpha‐fetoprotein levels were significantly correlated to the evaluation parameters of APO. Lipopolysaccharide did not increase the expressions of AFP in fetal liver, maternal liver and placenta, but reduced the fetal serum AFP levels. Conclusion The phenomenon that elevated MS‐AFP is associated with APO, which has been reported in human pregnancies, is observed in our rat model. Placental inflammation can be the potential cause linking the two manifestations together. Although the source of elevated MS‐AFP is not identified, fetal blood circulation is suspected. Our study may provide an animal model for the future studies on this subject.

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“…A recent meta-analysis of trials using low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications found no benefit. 69 …”

Section: Potential Targets To Prevent Obstetric Apsmentioning

confidence: 99%

Emerging Treatment Models in Rheumatology: Antiphospholipid Syndrome and Pregnancy: Pathogenesis to Translation

Abrahams

Chamley

Salmon

2017

Arthritis & Rheumatology

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Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials

Cited by 190 publications

References 39 publications

Risk of venous thromboembolism in pregnant women with essential thrombocythemia: a systematic review and meta-analysis

Risk of venous thromboembolism in pregnant women with essential thrombocythemia: a systematic review and meta-analysis

A rat model of placental inflammation explains the unexplained elevated maternal serum alpha‐fetoprotein associated with adverse pregnancy outcomes

Emerging Treatment Models in Rheumatology: Antiphospholipid Syndrome and Pregnancy: Pathogenesis to Translation

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