Calhoun Byron, Hoover Elizabeth, Seybold Dara, Broce Mike, Hill Ashley, Schaible Burk, Bracero Luis A
a Department of Obstetrics and Gynecology , West Virginia University Charleston Campus , Charleston , WV , USA.
b Center for Health Services and Outcomes Research , Charleston Area Medical Center Health Education and Research Institute , Charleston , WV , USA.
J Matern Fetal Neonatal Med. 2018 May;31(10):1267-1271. doi: 10.1080/14767058.2017.1313829. Epub 2017 Apr 20.
The purpose of this study was to examine birth outcomes in women treated or untreated for thrombophilia during pregnancies affected or not by tobacco exposure.
This was a retrospective cohort study of consecutive women from a single maternal fetal medicine clinic who delivered between January 2009 and December 2013. We compared birth outcomes by four groups of thrombophilia and smoking combinations and then by treated or untreated groups.
Of the 8889 pregnant women in this study, 113 had thrombophilia and 97 received treatment. Thromboprophylaxis included: low molecular weight heparin, aspirin, unfractionated heparin, folic acid, and combinations of these. Smokers with thrombophilia had significantly higher rates of preeclampsia, intrauterine growth restriction, preterm birth (<37 weeks gestation) and low birth weight (all p ≤ .001). Conversely, this group had significantly lower rates of hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) and placental abruption. Women with thrombophilia who received thromboprophylaxis had lower rates of adverse birth outcomes, reaching significance for preterm birth <32 weeks gestation (4.3% versus 21.1%, p = .026).
Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.
本研究旨在调查在受或未受烟草暴露影响的孕期中，接受或未接受血栓形成倾向治疗的女性的分娩结局。
这是一项对来自单一母胎医学诊所的连续女性进行的回顾性队列研究，这些女性在2009年1月至2013年12月期间分娩。我们按四组血栓形成倾向与吸烟组合情况，然后再按治疗组或未治疗组比较分娩结局。
本研究的8889名孕妇中，113人有血栓形成倾向，97人接受了治疗。血栓预防措施包括：低分子量肝素、阿司匹林、普通肝素、叶酸以及这些药物的组合。有血栓形成倾向的吸烟者患先兆子痫、子宫内生长受限、早产（妊娠<37周）和低出生体重的发生率显著更高（所有p≤0.001）。相反，该组患溶血、肝酶升高、血小板计数低（HELLP综合征）和胎盘早剥的发生率显著更低。接受血栓预防的有血栓形成倾向的女性不良分娩结局发生率更低，对于妊娠<32周的早产达到显著水平（4.3%对21.1%，p = 0.026）。
吸烟且有血栓形成倾向的孕妇可能比不吸烟的孕妇更易出现不良分娩结局，且从血栓预防中获益更多。
