The association between IUGR and maternal inherited thrombophilias

Abstract

One of the risk factors for vascular obstetric complications, such as intrauterine growth restriction (IUGR), is inherited thrombophilias. Nevertheless, routine screening for thrombophilias is not endorsed in pregnant women due to their low prevalence and conflicting results of published studies regarding the usefulness of screening in these patients. The cause of IUGR remains unknown in almost 1 quarter of cases. There are no published studies evaluating the association of inherited thrombophilias and IUGR in patients with IUGR of unknown origin. Understanding and preventing IUGR is an important public health concern, as IUGR has been associated with fetal mortality and neonatal morbidity, as well as adverse long-standing consequences. This study aimed to evaluate the prevalence of inherited thrombophilias in IUGR of unknown cause and to test the association between the inherited thrombophilias and IUGR of unknown cause.This study included 33 cases of IUGR of unknown cause tested for inherited thrombophilias and 66 controls individually matched for age, ethnicity, and smoking status.Patients with plasminogen activator inhibitor 1 (PAI-1) and methylenetetrahydrofolate reductase (MTHFR) had significantly higher odds for IUGR of unknown cause (P < .001 and P = .002, respectively) with OR 13.546 (CI 95% 3.79–48.37) and 8.139 (CI 95% 2.20–30.10), respectively. A positive association between other inherited thrombophilias (homozygous 20210 prothrombin gene mutation and homozygous factor V Leiden) and IUGR of unknown cause was also found, P = .096, OR 6.106 (CI 95% 0.72–51.30), although it was not statistically significant (P = .096, OR = 6.106, CI 95% 0.72–51.30).Our results indicate that PAI-1 and MTHFR thrombophilias represent risk factors for IUGR of otherwise unidentified cause.

Comparison of 2 approaches in management of pregnant women with inherited trombophilias

“…[20,21,22] Additionally, a case-controlled study that compared the incidence of FGR between healthy women and women with inherited thrombophilias without LMWH therapy revealed that LMWH untreated inherited thrombophilias represents risk factors for FGR. [4]…”

“…For many decades inherited thrombophilias have been linked with venous thromboembolism (VTE) in pregnancy and the puerperium [1] and recurrent miscarriages. [2] However, since recently they have also been recognized as risk factors for numerous adverse pregnancy outcomes (APO), such as preeclampsia, [3] intrauterine growth restriction, [4] placental abruption, [5] and stillbirth. [6] Kupfermink et al showed that as much as 65% of women with preeclampsia, unexpected still birth, placental abruption, and fetal growth restriction (FGR) had some form of inherited thrombophilias.…”

Thrombophilia as a Risk Factor for Thrombosis

“…The 10 th week and the 3 rd trimester of preg-nancy are considered as critical periods for manifestation of thrombophilia since the complication such as recurrent miscarriages, stillbirth in the third trimester, placental abruption with massive bleeding, retardation of fetal development may occur [10]. The presence of thrombophilia determines the risk of developing the first episode of VT; however, it is not recognized as a risk factor for its recurrence [18].…”

Analysis of the State of Platelet Aggregation in Pregnant Women With Thrombophilia and Burdened Obstetric History

“…Вчені при-пускають взаємозв'язок тромбозу з дефіцитом антитромбіну, гіпергомоцистеїнемією та фактором V Лейдена й варіаціями протромбіну G20210A і дефіцитом білка S [1]. За припущеннями науковців, близько 65,0 % усіх випадків негативних наслідків вагітності у вигляді затримки внутрішньоутробного розвитку плоду, прееклампсій і відшарувань плаценти провокуються ТФ [4,10], а 60,0 % таких наслідків спровоковані спадковою ТФ і викликаними нею ідеопатичними тромбоемболічними випадками [6], через що при наявності у вагітних ТФ їх відносять до групи підвищеного ризику [11].…”