Thrombophilia in pregnancy: a systematic review

Abstract

Summary Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0·74–34·40); early pregnancy loss (ORs, 1·40–6·25); late pregnancy loss (ORs, 1·31–20·09); pre‐eclampsia (ORs, 1·37–3·49); placental abruption (ORs, 1·42–7·71) and intrauterine growth restriction (ORs, 1·24–2·92). Low‐dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1·62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.

Is there any relationship between ABO/Rh blood group and patients with pre-eclampsia?

“…The disease mechanisms are thought to be multifactorial involving immunological, genetic factors, and may be related to blood clotting cascade [6][7][8][9], and associated with thrombosis of the placental vasculature and thrombophilia [10].…”

Plasma homocysteine and vitamin B12 serum levels, red blood cell folate concentrations, C677T methylenetetrahydrofolate reductase gene mutation and risk of recurrent miscarriage: a case-control study in Spain

“…Several published reports regarding the prevalence of hyperhomocysteinemia and MTHFR gene mutation in women with recurrent miscarriage (RM), have shown dissenting and inconclusive results as evidenced in a systematic review and meta-analysis of the literature [7] . The most common and studied MTHFR gene mutation is produced by the substitution of cytosine (C) (normal) by thymine (T) (mutated) at nucleotide 677 (677C > T), which converts an alanine residue to a valine.…”

Conhecimento de Gestantes a Respeito de Fatores de Risco e Prevenção de Complicações Vasculares na Gestação

“…Em estudo de caso-controle, realizado com 110 gestantes, em que apresentaram complicações obstétricas, 52% apresentaram trombofilia hereditária (KUPFERMINC et al, 1999). Segundo revisão sistemática, com metanálise, realizada por Robertson et al (2006), os desfechos que ocorrem com maior frequência foram o parto prematuro, pré-eclâmpsia e a restrição de crescimento fetal. As complicações condizem com os resultados obtidos no presente estudo, em que 50% das gestantes acreditaram haver risco de prematuridade e mais de 32% consideraram a possibilidade de ocorrência de pré-eclâmpsia e de aborto (Tabela 4).…”