The association between inherited thrombophilia, antiphospholipid antibodies and lipoprotein A levels with obstetrical complications in pregnancy.

OBJECTIVES

To evaluate the association between obstetrical complications in pregnancy and thrombophilic factors.

STUDY

DESIGN

75 pregnant women with obstetrical complications and 66 controls with live births without obstetrical complications were tested for thrombophilia. All subjects were negative for thromboembolic disease.

RESULTS

The obstetrical complications in the study group were unexplained oligohydramnios = 16 (21%), IUGR = 17 (23%), preeclampsia <32 weeks = 15 (20%), recurrent abortions = 42 (56%), fetal demise = 14 (19%), abruption = 8 (11%). Comparing women with obstetrical complications versus controls, factor V Leiden mutation was present in 7 (10%) versus 1 (2%) P =.064, odds ratio (OR) = 7, 95%, CI = 0.8-58.5, antiphospholipid antibody syndrome in 14 (19%) versus 2 (3%) P =.003, OR = 7, 95% CI = 1.7-35, high lipoprotein A levels 13 (30%) versus 6 (10%) P =.019, OR = 3.8, 95% CI = 1.3-11. In the study group, there was a case each of prothrombin gene mutation, elevated homocysteine level, antithrombin III, protein S&C deficiencies. Major thrombophilia diagnosis was present in 24 (32%) versus 3 (5%) of controls p =.001, OR = 9.8. No association was found with the methylenetetrahydrofolate reductase gene mutation. In 22 women who subsequently became pregnant, prophylactic anticoagulant therapy compared to pretreatment control pregnancies showed 22 versus 11 live births P =.001, 95% CI = 0.3-0.7 and obstetrical complications of 2 (9%) versus 22 (100%) P =.001, OR = 11, 95% CI = 2.9-41.2.

CONCLUSION

An association is suggested between non-thromboembolic pregnancy complications and hypercoagulable disorders. Prophylactic anticoagulant therapy may be associated with improved pregnancy outcome.