血栓形成倾向与胎盘介导的妊娠并发症有关吗？一项前瞻性队列研究。

Is thrombophilia associated with placenta-mediated pregnancy complications? A prospective cohort study.

机构信息

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Hematology, The Ottawa Hospital, Ottawa, ON, Canada; Department of Medicine, The University of Ottawa, Ottawa, ON, Canada.

出版信息

J Thromb Haemost. 2014 Apr;12(4):469-78. doi: 10.1111/jth.12509.

DOI:10.1111/jth.12509

PMID:24447367

Abstract

BACKGROUND

Case control studies suggest that genetic thrombophilias increase the risk of placenta-mediated pregnancy complications (pregnancy loss, small for gestational age (SGA), preeclampsia and/or placental abruption). Cohort studies have not supported this association but were underpowered to detect small effects.

OBJECTIVE

To determine if factor V Leiden (FVL) or the prothrombin gene mutation (PGM) were associated with placenta-mediated pregnancy complications.

PATIENTS/METHODS: A prospective cohort of unselected, consenting pregnant women at three Canadian tertiary care hospitals had blood drawn in the early second trimester and were genotyped for FVL and PGM after delivery. The main outcome measure was a composite of pregnancy loss, SGA < 10th percentile, preeclampsia or placental abruption.

RESULTS

Complete primary outcome and genetic data were available for 7343 women. Most were Caucasian (77.7%, n = 5707), mean age was 30.4 (± 5.1) years, and half were nulliparous. There were 507 (6.9%) women with FVL and/or PGM; 11.64% had a placenta-mediated pregnancy complication. Of the remaining 6836 women, 11.23% experienced a complication. FVL and/or PGM was associated with a relative risk of 1.04 (95% CI, 0.81-1.33) for the composite outcome, with similar results after adjustment for important covariates.

CONCLUSIONS

Carriers of FVL or PGM are not at significantly increased risk of these pregnancy complications.

摘要

背景

病例对照研究表明，遗传性血栓形成倾向会增加胎盘介导的妊娠并发症（妊娠丢失、小于胎龄儿（SGA）、子痫前期和/或胎盘早剥）的风险。队列研究并未支持这种关联，但检测小效应的能力不足。

目的

确定因子 V Leiden（FVL）或凝血酶原基因突变（PGM）是否与胎盘介导的妊娠并发症相关。

患者/方法：在加拿大三家三级保健医院，对未选择的、同意参与的孕妇进行前瞻性队列研究，在孕早期采集血样，并在分娩后对 FVL 和 PGM 进行基因分型。主要结局指标是妊娠丢失、SGA<第 10 百分位数、子痫前期或胎盘早剥的复合结局。

结果

共有 7343 名女性的完整主要结局和遗传数据可用。大多数为白种人（77.7%，n=5707），平均年龄为 30.4（±5.1）岁，一半为初产妇。有 507（6.9%）名女性携带 FVL 和/或 PGM；11.64%发生胎盘介导的妊娠并发症。在其余 6836 名女性中，11.23%出现并发症。FVL 和/或 PGM 与复合结局的相对风险为 1.04（95%CI，0.81-1.33），在调整重要协变量后也得到了类似的结果。