Pabinger Ingrid
Department of Internal Medicine I, Medical University of Vienna, Austria.
Thromb Res. 2009;123 Suppl 3:S16-21. doi: 10.1016/S0049-3848(09)70128-8.
In recent years thrombophilia has gained much attention as a risk factor for pregnancy complications. Whereas there is an established correlation between antiphospholipid antibodies and pregnancy loss, data for other risk factors of thrombosis are less well established. Data suggest associations with antithrombin deficiency, hyperhomocysteinemia and also with factor V Leiden, prothrombin G20210A variation and protein S-deficiency. The association of thrombophilia with pre-eclampsia is still under discussion. A limited number of prospective studies did not reveal an increased risk for pregnancy complications in unselected women with thrombosis risk factors. In a single study low molecular weight heparin seemed to have a positive effect on pregnancy outcome after previous single or recurrent abortions. Experience in prevention of pre-eclampsia by administration of prophylactic heparin is very limited. Data on pregnancy complications in women with known heritable thrombophilia or a history of thrombosis are inconsistent as well. These women usually have a favourable pregnancy outcome. In conclusion, thrombophilia screening might be justified in women with pregnancy loss, and treatment with low molecular weight heparin might be considered for those with pregnancy loss and thrombophilia. Further prospective studies and controlled interventional trials are urgently needed.
近年来，血栓形成倾向作为妊娠并发症的一个风险因素受到了广泛关注。虽然抗磷脂抗体与妊娠丢失之间已确立相关性，但关于其他血栓形成风险因素的数据尚不充分。数据表明，抗凝血酶缺乏、高同型半胱氨酸血症以及因子V Leiden、凝血酶原G20210A变异和蛋白S缺乏与之相关。血栓形成倾向与子痫前期的关联仍在讨论中。少数前瞻性研究未发现有血栓形成风险因素的未筛选女性发生妊娠并发症的风险增加。在一项研究中，低分子量肝素似乎对既往有单次或复发性流产史的女性的妊娠结局有积极影响。通过预防性使用肝素预防子痫前期的经验非常有限。关于已知遗传性血栓形成倾向或有血栓形成病史的女性发生妊娠并发症的数据也不一致。这些女性通常有良好的妊娠结局。总之，对于有妊娠丢失的女性，进行血栓形成倾向筛查可能是合理的，对于有妊娠丢失且有血栓形成倾向的女性，可考虑使用低分子量肝素进行治疗。迫切需要进一步的前瞻性研究和对照干预试验。
