Berks Durk, Duvekot Johannes J, Basalan Hillal, De Maat Moniek P M, Steegers Eric A P, Visser Willy
Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2015 Nov;194:199-205. doi: 10.1016/j.ejogrb.2015.09.021. Epub 2015 Sep 28.
Preeclampsia complicates 2-8% of all pregnancies. Studies on the association of preeclampsia with thrombophilia are conflicting. Clinical heterogeneity of the disease may be one of the explanations. The present study addresses the question whether different phenotypes of preeclampsia are associated with thrombophilia factors. Study design We planned a retrospective cohort study. From 1985 until 2010 women with preeclampsia were offered postpartum screening for the following thrombophilia factors: anti-phospholipid antibodies, APC-resistance, protein C deficiency and protein S deficiency, hyperhomocysteineamia, factor V Leiden and Prothrombin gene mutation. Hospital records were used to obtain information on phenotypes of the preeclampsia and placental histology.
We identified 844 women with singleton pregnancies who were screened for thrombophilia factors. HELLP complicated 49% of pregnancies; Fetal growth restriction complicated 61% of pregnancies. Early delivery (<34th week) occurred in 71% of pregnancies. Any thrombophilia factor was present in 29% of the women. Severe preeclampsia was associated with protein S deficiency (p=0.01). Fetal growth restriction was associated with anti-phospholipid antibodies (p<0.01). Early onset preeclampsia was associated with anti-phospholipid antibodies (p=0.01). Extensive placental infarction (>10%) was associated with anti-phospholipid antibodies (p<0.01). Low placental weight (<5th percentile) was associated with hyperhomocysteineamia (p=0.03). No other associations were observed.
Early onset preeclampsia, especially if complicated by fetal growth restriction, are associated with anti-phospholipid antibodies. Other phenotypes of preeclampsia, especially HELLP syndrome, were not associated with thrombophilia. We advise only to test for anti-phospholipid antibodies after early onset preeclampsia, especially if complicated by fetal growth restriction. We suggest enough evidence is presented to justify no further studies are needed.
子痫前期在所有妊娠中占比2%-8%。关于子痫前期与易栓症之间关联的研究结果相互矛盾。该疾病的临床异质性可能是原因之一。本研究旨在探讨子痫前期的不同表型是否与易栓症因素相关。
我们计划进行一项回顾性队列研究。从1985年至2010年，为患有子痫前期的女性提供产后以下易栓症因素筛查：抗磷脂抗体、活化蛋白C抵抗、蛋白C缺乏、蛋白S缺乏、高同型半胱氨酸血症、凝血因子V Leiden突变和凝血酶原基因突变。利用医院记录获取子痫前期表型和胎盘组织学信息。
我们确定了844名单胎妊娠且接受易栓症因素筛查的女性。49%的妊娠并发HELLP综合征；61%的妊娠并发胎儿生长受限。71%的妊娠发生早产（<34周）。29%的女性存在任何易栓症因素。重度子痫前期与蛋白S缺乏相关（p=0.01）。胎儿生长受限与抗磷脂抗体相关（p<0.01）。早发型子痫前期与抗磷脂抗体相关（p=0.01）。广泛胎盘梗死（>10%）与抗磷脂抗体相关（p<0.01）。低胎盘重量（<第5百分位数）与高同型半胱氨酸血症相关（p=0.03）。未观察到其他关联。
早发型子痫前期，尤其是并发胎儿生长受限时，与抗磷脂抗体相关。子痫前期的其他表型，尤其是HELLP综合征，与易栓症无关。我们建议仅在早发型子痫前期，尤其是并发胎儿生长受限时检测抗磷脂抗体。我们认为已有足够证据表明无需进一步研究。
