Clavijo María Manuela, Mahuad Carolina Valeria, Reparaz María de Los Angeles Vicente, Aizpurua María Florencia, Ventura Adriana, Casali Claudia Erica
Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.
Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.
Hematol Transfus Cell Ther. 2019 Oct-Dec;41(4):303-309. doi: 10.1016/j.htct.2019.03.003. Epub 2019 Jun 20.
Although there is a vast literature regarding the association between inherited thrombophilia, obstetric complications and the effect of low molecular weight heparin (LMWH), these are controversial and we have not found publications related to additional risk factors other than thrombophilia. Our objectives were to assess the prevalence of miscarriage, placenta-mediated pregnancy complications and fetal loss in pregnant women with IT, establishing associated risk factors and the effect of LMWH.
A retrospective cohort of pregnant women with IT was formed. Risk factors considered were: high-risk IT, age ≥35 years, body mass index ≥25 and ≥30, assisted reproductive technology, antiphospholipid antibodies, autoimmune disease, first-degree family history of obstetric complications and personal history of venous or arterial thromboembolic disease, the outcomes being M, FL and PMPC.
Data from 250 pregnancies in 88 women were obtained. There were 112 (45%) Ms, 13 (5.2%) FLs and 25 (10%) PMPCs. High-risk IT was associated with FL (OR=4.96; 95% CI, 1.42-17.3). Antiphospholipid antibodies and family history of obstetric complications were associated with PMPC (OR=7.12; 95% CI, 1.89-26.74, OR=3.88; 95% CI, 1.18-12.78, respectively). The LMWH presented a benefit in the combined outcome (any obstetric complication, OR=0.25; 95% CI, 0.12-0.54) and M (OR=0.41; 95% CI, 0.20-0.82). We conclude that obstetric complications are common in women with IT. Antiphospholipid antibodies, family history of obstetric complications and high-risk IT might be additional risk factors. The LMWH has an apparent protective effect against obstetric complications, which is consistent with some previous studies.
尽管有大量关于遗传性易栓症、产科并发症以及低分子肝素（LMWH）作用之间关联的文献，但这些存在争议，并且我们尚未发现除易栓症之外与其他危险因素相关的出版物。我们的目标是评估患有遗传性易栓症（IT）的孕妇中流产、胎盘介导的妊娠并发症和胎儿丢失的患病率，确定相关危险因素以及低分子肝素的作用。
组建了一个患有IT的孕妇回顾性队列。考虑的危险因素有：高危IT、年龄≥35岁、体重指数≥25和≥30、辅助生殖技术、抗磷脂抗体、自身免疫性疾病、产科并发症的一级家族史以及静脉或动脉血栓栓塞性疾病的个人史，结局为流产（M）、胎儿丢失（FL）和胎盘介导的妊娠并发症（PMPC）。
获得了88名女性250次妊娠的数据。有112例（45%）流产，13例（5.2%）胎儿丢失，25例（10%）胎盘介导的妊娠并发症。高危IT与胎儿丢失相关（比值比[OR]=4.96；95%置信区间[CI]，1.42 - 17.3）。抗磷脂抗体和产科并发症家族史与胎盘介导的妊娠并发症相关（分别为OR = 7.12；95% CI，1.89 - 26.74，OR = 3.88；95% CI，1.18 - 12.78）。低分子肝素在综合结局（任何产科并发症，OR = 0.25；95% CI，0.12 - 0.54）和流产方面显示出益处（OR = 0.41；95% CI，0.20 - 0.82）。我们得出结论，产科并发症在患有IT的女性中很常见。抗磷脂抗体、产科并发症家族史和高危IT可能是额外的危险因素。低分子肝素对产科并发症有明显的保护作用，这与一些先前的研究一致。
