The impact of low molecular weight heparin on obstetric outcomes among unexplained recurrent miscarriages complicated with methylenetetrahydrofolate reductase gene polymorphism

Abstract

Objectives:The association between methylenetetrahydrofolate reductase gene polymorphisms and unexplained recurrent miscarriage is elusive. The recommendations for improving pregnancy outcomes in these patients keep changing based on the available evidence. The aim of this study is to analyze the impact of low molecular weight heparin on obstetric outcomes of recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphism. Material and methods:We reviewed medical records of 121 patients with a history of recurrent miscarriage complicated by methylenetetrahydrofolate reductase gene polymorphisms, retrospectively. From among them, 68 patients were treated only with folic acid and iron. The remaining 53 patients were treated with folic acid, iron and prophylactic doses of low molecular weight heparin. The subsequent pregnancy outcomes of these patients were noted. Results:The live birth rate was higher in patients with anticoagulant therapy than in patients without anticoagulant therapy (48.5% vs. 69.8%, respectively, p: 0.015) and the congenital anomaly rate was lower in anticoagulant therapy group (17.6% vs. 3.8%, respectively, p: 0.022). The other obstetric outcomes were found to be similar between the two groups. Conclusions:The current study demonstrated that low molecular weight heparin improved the live birth rates among unexplained recurrent miscarriage patients complicated with methylenetetrahydrofolate reductase gene polymorphisms. However, the routine use of low molecular weight heparin did not improve the late pregnancy complications in these selected patients in the eastern region of our country. Further studies are needed to discriminate the effect of anticoagulation on the live birth rate of each of methylenetetrahydrofolate reductase gene polymorphism type.

The role of lymphocytes in fetal development and recurrent pregnancy loss

“…LMWH group had higher live birth rate (69.8% vs. 48.5%, p = 0.015) and lower congenital anomalies rate (3.3% vs. 17.6%, p = 0.022). Treatment group delivered two weeks later (34.88 vs. 32.75) comparing with supplementation only group but this result did not reach statistical significance (p = 0.060) [30].…”

Role of Low Molecular Weight Heparin in the Management of Unexplained Recurrent Pregnancy Loss: A Review of Literature

“…Studies revealed that placental thrombosis, vascular endothelial growth factor dysfunction, and maternal-fetal immunology play a role in women with URPL [3,4]. Proinflammatory changes such as increased Th1 to Th2 cytokine ratio and complement activation has been repeatedly demonstrated in these women [3,4,5]. There is also increasing knowledge of the association between methylenetetrahydrofolate reductase gene polymorphisms and URPL [5].…”

“…Proinflammatory changes such as increased Th1 to Th2 cytokine ratio and complement activation has been repeatedly demonstrated in these women [3,4,5]. There is also increasing knowledge of the association between methylenetetrahydrofolate reductase gene polymorphisms and URPL [5].…”

“…Developing guidelines for managing URPL is complicated, as the exact etiology is unknown [5,6]. Thus, empirical treatment with immunomodulators and drugs has been in practice with varying degrees of success [2,6].…”

“…However, it has the same efficacy in preventing and treating various coagulation disorders [4,7]. Because LMWH has both anticoagulative and anti-inflammatory effects, it is now widely used to treat recurrent pregnancy losses due to thrombophilia and nonthrombophilia, either alone or with other agents such as acetylsalicylic acid [4,5,[8][9][10][11][12]. Outcomes such as live birth rate and the occurrence of pregnancy complications were some of the variables reported in some studies, with varying degrees of success [4,5,[8][9][10][11][12].…”