Preeclampsia and Fetal Loss in Women With a History of Venous Thromboembolism

Abstract

Abstract-A higher prevalence of risk factors for venous thromboembolism (VTE) has been found in women with preeclampsia and fetal loss. We investigated whether women with a history of VTE have a higher prevalence of pregnancy-associated complications compared with control subjects. In 395 patients with a history of VTE and in 313 control women, the prevalence of complications during pregnancy and the mean birth weight of viable infants were evaluated. The prevalence of pregnancy-induced hypertension and preeclampsia was higher in patients (5.1% and 3.0%, respectively) compared with control subjects (1.3% each). The odds ratio was 4.13 for pregnancyinduced hypertension (95% CI 1.4 to 12.22, Pϭ0.0058) and 2.43 for preeclampsia (95% CI 0.78 to 7.6, Pϭ0.133). Stillbirth was slightly more frequent in patients (4.3%) than in control subjects (3.2%); the difference was not statistically significant. Miscarriage was equally frequent in patients (21.8%) and control subjects (21.3%). The birth weight of viable infants born to patients was, on average, 109 g lower than that of the infants born to the control subjects (Pϭ0.014) after adjustment for the mother's body mass index. Our study demonstrates that women with a predisposition to VTE have, overall, a good chance for a successful pregnancy outcome. However, the findings from our study support the assumption that a predisposition to venous thrombosis is associated with a higher risk for complications during pregnancy and lower infant birth weight. Key Words: venous thromboembolism Ⅲ pregnancy Ⅲ preeclampsia Ⅲ fetal loss Ⅲ birth weight C omplications of pregnancy, such as preeclampsia and fetal loss, are considered to result from underperfusion of the placenta due to structural and occlusive changes, including thrombosis of the placental vessels. 1 Recently, a number of studies were published in which a higher prevalence of genetic or acquired risk factors for thrombosis was found in women with preeclampsia and/or fetal loss compared with control subjects. [2][3][4][5][6][7] Preeclampsia is a pregnancy-related disorder characterized by increased blood pressure and proteinuria occurring in the second or third trimester of pregnancy and is one of the main causes of maternal and fetal morbidity and mortality. The cause of preeclampsia itself is most probably multifactorial. Genetic factors seem to play an important role, inasmuch as studies have demonstrated a certain familial predisposition. 8 Among other causes, thrombophilia has gained major attention as a risk factor for preeclampsia in recent years. In several case-control studies, 2,5,9,10 a higher prevalence of risk factors for thrombosis, especially the factor V Leiden mutation 11 and the G20210A prothrombin gene variation, 12 has been demonstrated in cases. Other authors 13 do not confirm these data. If the pathogeneses of venous thromboembolism (VTE) and preeclampsia share similar mechanisms, it may be expected that women with a history of VTE are at an increased risk for these complications during pregnancy.Data ...

Hypertensive Pregnancy Disorders and Subsequent Cardiovascular Morbidity and Type 2 Diabetes Mellitus in the Mother

“…Importantly, controlling for type 2 diabetes mellitus in the risk of subsequent thromboembolism did not substantially alter the estimates. Previous studies have shown that thromboembolism preceding a pregnancy is associated with a higher risk of preeclampsia, 30 and preeclampsia, likewise, is a strong risk factor for postpartum thromboembolism. 31,32 Our study adds epidemiological evidence of the association between preeclampsia and a thrombophilic tendency; whether this is because of underlying genetic thrombophilia 33 or other mechanisms 34,35 cannot be ascertained from this study.…”

High Concentrations of Soluble P-Selectin Are Associated with Risk of Venous Thromboembolism and the P-Selectin Thr715 Variant

“…We routinely evaluated risk factors for VTE (protein C, protein S, and antithrombin deficiency; lupus anticoagulant; homocysteine concentration; factor V Leiden; prothrombin G20210A variation) in every patient and control individual as previously described (30 ). Factor VIII activity (upper limit of the reference interval, 230%) and high-sensitivity C-reactive protein (hs-CRP) were measured as described elsewhere (31 ).…”

Venous thromboembolism a manifestation of the metabolic syndrome

“…27 Factor VIII activity was measured on a Sysmex CA 7000 analyzer using factor VIII-deficient plasma (Hyland Baxter Immuno, Vienna, Austria) and Dade ® Actin ® -FS (Dade Behring, Marburg, Germany). The cut-off point for elevated factor VIII activity was set at 229%, which represents the 95 th percentile of factor VIII activity in our controls (n=129).…”