Low Molecular Weight Heparins (LMWH) and Implications along Pregnancy: a Focus on the Placenta

Zullino, Sara; Clemenza, Sara; Mecacci, Federico

doi:10.1007/s43032-021-00678-0

Cited by 8 publications

(8 citation statements)

References 101 publications

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“…They may synergistically modulate the immune response, inhibit maternal immune rejection of the embryo, and promote embryo implantation. 29,30 In agreement with our expected results, combining the two drugs can significantly increase clinical pregnancy and live birth rates and decrease the spontaneous miscarriage rate. Bahrami-Asl et al 31 confirmed that TAC could result in an implantation rate of 40%, a clinical pregnancy rate of 50%, and a live birth rate of 35% in RIF patients.…”

Section: Discussionsupporting

confidence: 91%

“…The rationale for co‐administration is based on their effect on embryo implantation, placentation processes, and immune balance at the mother‐fetus interface. They may synergistically modulate the immune response, inhibit maternal immune rejection of the embryo, and promote embryo implantation 29,30 . In agreement with our expected results, combining the two drugs can significantly increase clinical pregnancy and live birth rates and decrease the spontaneous miscarriage rate.…”

Section: Discussionsupporting

confidence: 90%

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Co‐administration of tacrolimus and low molecular weight heparin in patients with a history of implantation failure and elevated peripheral blood natural killer cell proportion

Shen

Zhang

Han

et al. 2022

J of Obstet and Gynaecol

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Aim To investigate the therapeutic effect of co‐administration of tacrolimus (TAC) and low‐molecular‐weight heparin (LMWH) or LMWH only on pregnancy outcomes in the female with a history of implantation failure and elevated peripheral blood natural killer (pNK) cell proportion in frozen‐thawed embryo transfer cycles. Methods To evaluate the pregnancy parameters for 249 patients with ≥2 implantation failures and pNK cell proportion ≥12% by analyzing a retrospective observational cohort study. Sixty patients had received the co‐administration TAC and LMWH (TAC & LMWH group), 85 others had only taken LMWH (LWMH group), and the rest did not take any particular drugs (control group). Results The experimental finding indicated that the TAC & LMWH group and the LMWH group showed higher clinical pregnancy rates than the control group (p < 0.05), and TAC & LMWH group had a much higher live birth rate. According to the binary logistic regression analysis, the combination of TAC and LMWH was conducive to clinical pregnancy and live birth rate and reduced the possibility of miscarriage. It would not affect the result of spontaneous abortion and live birth, although the LMWH was only beneficial to clinical pregnancy. In addition, these findings were similar for these three groups' obstetrical and neonatal outcomes. Conclusions The combination of TAC and LMWH can improve clinical pregnancy and live birth rates and reduce the risk of spontaneous miscarriage in patients with a history of implantation failure and elevated pNK ratio. LMWH is also beneficial to clinical pregnancy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Co‐administration of tacrolimus and low molecular weight heparin in patients with a history of implantation failure and elevated peripheral blood natural killer cell proportion

Shen

Zhang

Han

et al. 2022

J of Obstet and Gynaecol

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“…As an unbalanced inflammatory activation seems to play a key role in determining placental insufficiency, LMWH may be useful because of its anti-inflammatory activity [56]. However, standardised, trials investigating the potential role of LMWH for prevention of placenta-mediated disorders in women at the highest risk of these conditions are needed to confirm our hypothesis [53].…”

Section: Discussionmentioning

confidence: 80%

“…The effect of LMWH in these conditions does not seem related to its anti-coagulant action. It is well known that LMWH exerts beneficial actions on maternal vascular system, and has anti-inflammatory and immunomodulant effects, playing a potential role in embryo implantation and placentation [53]. In fact, LMWH seems to induce cytotrophoblast proliferation causing an ameliorated syncytial fusion in the syncytiotrophoblast layer that in turn secretes pro-angiogenic growth factors in the intervillous space [54].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes Subsequent to Stillbirth—A Single Tertiary-Care Center Experience

Clemenza¹,

Serena²,

Vannuccini³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: Currently, there is little evidence to guide clinical management of pregnancies after stillbirth. Our study aims to evaluate the pregnancy outcome in pregnant women with a previous stillbirth, by applying a standardized protocol for etiologic investigations and subsequent treatment of the underlying etiology. Methods: A retrospective cohort study on a group of 100 women with history of stillbirth, occurred in single pregnancy between 2005 and 2021, was performed. All patients were followed up in their subsequent pregnancies (n = 153) in a tertiary university hospital. During the preconception period causes of stillbirth were investigated and a correction of modifiable risk factors was encouraged with a multidisciplinary approach. Data about pregnancy management, obstetric complications, gestational age at delivery, mode of delivery and neonatal outcomes were collected. Results: The analysis of previous stillbirth revealed that, by using the ReCoDe classification, the most common identifiable causes of death were fetal growth restriction (21%), placental abruption (11%) and "other placenta insufficiencies" (26.7%), whereas 15.8% of stillbirth was unexplained. Out of 153 subsequent pregnancies, 131 (85.62%) resulted in live births, 15 (9.8%) in a first trimester miscarriage, and 7 (4.57%) in second trimester miscarriage; no cases of stillbirth recurrence occurred. Obstetric complications in subsequent pregnancies included gestational diabetes (21.4%), gestational hypertensive disorders (6.1%), intrahepatic cholestasis of pregnancy (3.8%), fetal growth restriction (7.6%) and preterm birth (19.8%). The mean gestational age at delivery was 38 weeks with a mean birth weight of 2886.63 g. Conclusions: Our experience is encouraging as reflecting good outcomes in terms of live birth rate in the subsequent pregnancies, with no cases of recurrence. These results are probably due to extensive preconception investigations with a multidisciplinary approach. A preconception evaluation is, thus, essential to improve maternal and fetal outcome in case of history of stillbirth, aiming to minimize the risk of recurrence.

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“…LMWH have been traditionally administered for its anticoagulant activity. However, it also has anti-inflammatory and immunomodulant properties, which may support embryo implantation and placentation ( Zullino, 2021 ). Current guidelines recommend antepartum LMWH and aspirin prophylaxis for pregnant women with APS—whether obstetric or thrombotic—to improve pregnancy outcomes and/or reduce risk of thrombosis ( Sammaritano et al, 2020 ).…”

Section: Should Aspirin and Low Molecular Weight Heparin Play A Role To Improve Pregnancy Outcomes?mentioning

confidence: 99%

Undifferentiated Connective Tissue Disease in Pregnancy: A Topic Yet to be Explored

et al. 2022

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Undifferentiated connective tissue disease (UCTD) is characterized by signs and symptoms suggestive of a connective tissue disease (CTD), but not fulfilling criteria for a specific CTD. Although UCTD is probably the most common rheumatic disease diagnosed in pregnant women, data about disease course during pregnancy and perinatal outcomes are very limited. Compared to other CTDs, UCTD seems to have milder clinical manifestations in pregnancy. Its natural history is related to disease activity at conception. In fact, if the disease is in a state of remission or minimal activity at conception, pregnancy outcomes are generally good. On the contrary, patients who become pregnant in a moment of high disease activity and/or who have multiple antibodies positivity show an increased risk of disease flares, evolution to a definite CTD and obstetric complications, such as fetal growth restriction, preeclampsia and preterm birth. Therefore, a preconception assessment is essential in women with UCTD to evaluate maternal and fetal risks, to initiate interventions to optimize disease activity, and to adjust medications to those that are least harmful to the fetus. The aim of the present study was to review the available literature about pregnancy course, maternal and fetal outcomes and therapeutic approaches of pregnant women with UCTD.

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Low Molecular Weight Heparins (LMWH) and Implications along Pregnancy: a Focus on the Placenta

Cited by 8 publications

References 101 publications

Co‐administration of tacrolimus and low molecular weight heparin in patients with a history of implantation failure and elevated peripheral blood natural killer cell proportion

Co‐administration of tacrolimus and low molecular weight heparin in patients with a history of implantation failure and elevated peripheral blood natural killer cell proportion

Pregnancy Outcomes Subsequent to Stillbirth—A Single Tertiary-Care Center Experience

Undifferentiated Connective Tissue Disease in Pregnancy: A Topic Yet to be Explored

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