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Inherited and Acquired Thrombophilias and Adverse Pregnancy Outcomes

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Recurrent Pregnancy Loss

Abstract

Historically, much controversy has existed regarding the association of inherited thrombophilias with adverse pregnancy outcomes. Current guidelines recommend screening when there is a personal history of venous thromboembolism (VTE) or when there is a strong family history of thromboembolic disease, but our up to 40 % of physicians may screen contrary to current guidelines. This chapter summarizes the existing evidence for each inherited thrombophilia, and reviews current guidelines.

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References

  1. Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am J Obstet Gynecol. 1996;174(5):1584–9.

    Article  CAS  PubMed  Google Scholar 

  2. Rai R et al. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ. 1997;314(7076):253–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Rodger MA et al. Inherited thrombophilia and pregnancy complications revisited. Obstet Gynecol. 2008;112(2 Pt 1):320–4.

    Article  PubMed  Google Scholar 

  4. Davenport WB, Kutteh WH. Inherited thrombophilias and adverse pregnancy outcomes: a review of screening patterns and recommendations. Obstet Gynecol Clin N Am. 2014;41:133–44.

    Google Scholar 

  5. Lockwood C, Wendel G. Practice bulletin no. 124: inherited thrombophilias in pregnancy. Obstet Gynecol. 2011;118(3):730–40.

    Article  PubMed  Google Scholar 

  6. Wichers IM et al. Assessment of coagulation and fibrinolysis in families with unexplained thrombophilia. Thromb Haemost. 2009;101(3):465–70.

    CAS  PubMed  Google Scholar 

  7. Villani M et al. Risk of obstetric and thromboembolic complications in family members of women with previous adverse obstetric outcomes carrying common inherited thombophilias. J Thromb Haemost. 2012;10(2):223–8.

    Article  CAS  PubMed  Google Scholar 

  8. Lussana F et al. Pregnancy-related venous thromboembolism: risk and the effect of thromboprophylaxis. Thromb Res. 2012;129(6):673–80.

    Article  CAS  PubMed  Google Scholar 

  9. Horton AL et al. Family history of venous thromboembolism and identifying factor V Leiden carriers during pregnancy. Obstet Gynecol. 2010;115(3):521–5.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Branch DW. The truth about inherited thrombophilias and pregnancy. Obstet Gynecol. 2010;115(1):2–4.

    Article  PubMed  Google Scholar 

  11. Bates SM et al. Venous thromboembolism, thrombophilia, antithrombotic therapy, and pregnancy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edn). Chest. 2008;133(6 Suppl):844S–86.

    Article  CAS  PubMed  Google Scholar 

  12. Dizon-Townson DS et al. Fetal carriers of the factor V Leiden mutation are prone to miscarriage and placental infarction. Am J Obstet Gynecol. 1997;177(2):402–5.

    Article  CAS  PubMed  Google Scholar 

  13. Rey E et al. Thrombophilic disorders and fetal loss: a meta-analysis. Lancet. 2003;361(9361):901–8.

    Article  PubMed  Google Scholar 

  14. Bradley LA et al. Can factor V Leiden and prothrombin G20210A testing in women with recurrent pregnancy loss result in improved pregnancy outcomes? Results from a targeted evidence-based review. Genet Med. 2012;14(1):39–50.

    Article  CAS  PubMed  Google Scholar 

  15. Rodger MA et al. The association of factor V leiden and prothrombin gene mutation and placenta-mediated pregnancy complications: a systematic review and meta-analysis of prospective cohort studies. PLoS Med. 2010;7(6), e1000292.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Howley HE, Walker M, Rodger MA. A systematic review of the association between factor V Leiden or prothrombin gene variant and intrauterine growth restriction. Am J Obstet Gynecol. 2005;192(3):694–708.

    Article  CAS  PubMed  Google Scholar 

  17. Dizon-Townson D et al. The relationship of the factor V Leiden mutation and pregnancy outcomes for mother and fetus. Obstet Gynecol. 2005;106(3):517–24.

    Article  CAS  PubMed  Google Scholar 

  18. Jaaskelainen E et al. M385T polymorphism in the factor V gene, but not Leiden mutation, is associated with placental abruption in Finnish women. Placenta. 2004;25(8-9):730–4.

    Article  CAS  PubMed  Google Scholar 

  19. Prochazka M et al. Factor V Leiden in pregnancies complicated by placental abruption. BJOG. 2003;110(5):462–6.

    Article  CAS  PubMed  Google Scholar 

  20. Rogers BB et al. Avascular villi, increased syncytial knots, and hypervascular villi are associated with pregnancies complicated by factor V Leiden mutation. Pediatr Dev Pathol. 2010;13(5):341–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Silver RM et al. Prothrombin gene G20210A mutation and obstetric complications. Obstet Gynecol. 2010;115(1):14–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Infante-Rivard C et al. Absence of association of thrombophilia polymorphisms with intrauterine growth restriction. N Engl J Med. 2002;347(1):19–25.

    Article  CAS  PubMed  Google Scholar 

  23. Alfirevic Z, Roberts D, Martlew V. How strong is the association between maternal thrombophilia and adverse pregnancy outcome? A systematic review. Eur J Obstet Gynecol Reprod Biol. 2002;101(1):6–14.

    Article  PubMed  Google Scholar 

  24. Di Nisio M, Middeldorp S, Buller HR. Direct thrombin inhibitors. N Engl J Med. 2005;353(10):1028–40.

    Article  PubMed  Google Scholar 

  25. Blumenfeld Z, Brenner B. Thrombophilia-associated pregnancy wastage. Fertil Steril. 1999;72(5):765–74.

    Article  CAS  PubMed  Google Scholar 

  26. Preston FE et al. Increased fetal loss in women with heritable thrombophilia. Lancet. 1996;348(9032):913–6.

    Article  CAS  PubMed  Google Scholar 

  27. Sanson BJ et al. The risk of abortion and stillbirth in antithrombin-, protein C-, and protein S-deficient women. Thromb Haemost. 1996;75(3):387–8.

    CAS  PubMed  Google Scholar 

  28. Peng F et al. Single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene are common in US Caucasian and Hispanic American populations. Int J Mol Med. 2001;8(5):509–11.

    CAS  PubMed  Google Scholar 

  29. Krabbendam I, Dekker GA. Pregnancy outcome in patients with a history of recurrent spontaneous miscarriages and documented thrombophilias. Gynecol Obstet Invest. 2004;57(3):127–31.

    Article  PubMed  Google Scholar 

  30. den Heijer M et al. Hyperhomocysteinemia and venous thrombosis: a meta-analysis. Thromb Haemost. 1998;80(6):874–7.

    Google Scholar 

  31. Eichinger S. Homocysteine, vitamin B6 and the risk of recurrent venous thromboembolism. Pathophysiol Haemost Thromb. 2003;33(5-6):342–4.

    Article  PubMed  Google Scholar 

  32. den Heijer M et al. Homocysteine lowering by B vitamins and the secondary prevention of deep vein thrombosis and pulmonary embolism: a randomized, placebo-controlled, double-blind trial. Blood. 2007;109(1):139–44.

    Article  Google Scholar 

  33. Bezemer ID et al. No association between the common MTHFR 677C → T polymorphism and venous thrombosis: results from the MEGA study. Arch Intern Med. 2007;167(5):497–501.

    Article  CAS  PubMed  Google Scholar 

  34. Nurk E et al. Associations between maternal methylenetetrahydrofolate reductase polymorphisms and adverse outcomes of pregnancy: the Hordaland Homocysteine Study. Am J Med. 2004;117(1):26–31.

    Article  CAS  PubMed  Google Scholar 

  35. Molloy AM et al. Folate status and neural tube defects. Biofactors. 1999;10(2-3):291–4.

    Article  CAS  PubMed  Google Scholar 

  36. Ceyhan ST et al. Thrombophilia-associated gene mutations in women with pregnancies complicated by fetal neural tube defects. Int J Gynaecol Obstet. 2008;101(2):188–9.

    Article  PubMed  Google Scholar 

  37. Akar N et al. Spina bifida and common mutations at the homocysteine metabolism pathway. Clin Genet. 2000;57(3):230–1.

    Article  CAS  PubMed  Google Scholar 

  38. Molloy AM, Weir DG, Scott JM. Homocysteine, folate enzymes and neural tube defects. Haematologica. 1999;84(Suppl EHA-4):53–6.

    PubMed  Google Scholar 

  39. Coulam CB et al. Multiple thrombophilic gene mutations rather than specific gene mutations are risk factors for recurrent miscarriage. Am J Reprod Immunol. 2006;55(5):360–8.

    Article  CAS  PubMed  Google Scholar 

  40. Kutteh WH, Triplett DA. Thrombophilias and recurrent pregnancy loss. Semin Reprod Med. 2006;24(1):54–66.

    Article  CAS  PubMed  Google Scholar 

  41. Brenner B et al. Thrombophilic polymorphisms are common in women with fetal loss without apparent cause. Thromb Haemost. 1999;82(1):6–9.

    CAS  PubMed  Google Scholar 

  42. Sarig G et al. Thrombophilia is common in women with idiopathic pregnancy loss and is associated with late pregnancy wastage. Fertil Steril. 2002;77(2):342–7.

    Article  PubMed  Google Scholar 

  43. Kupferminc MJ et al. Increased frequency of genetic thrombophilia in women with complications of pregnancy. N Engl J Med. 1999;340(1):9–13.

    Article  CAS  PubMed  Google Scholar 

  44. Castoldi E et al. Combinations of 4 mutations (FV R506Q, FV H1299R, FV Y1702C, PT 20210G/A) affecting the prothrombinase complex in a thrombophilic family. Blood. 2000;96(4):1443–8.

    CAS  PubMed  Google Scholar 

  45. Infante-Rivard C et al. Lupus anticoagulants, anticardiolipin antibodies, and fetal loss. A case-control study. N Engl J Med. 1991;325(15):1063–6.

    Article  CAS  PubMed  Google Scholar 

  46. Lockshin MD. Pregnancy loss in the antiphospholipid syndrome. Thromb Haemost. 1999;82(2):641–8.

    CAS  PubMed  Google Scholar 

  47. Lockwood C, Wendel G, Silverman N. ACOG Practice Bulletin no. 138. Thromboembolism in Pregnancy. Obstet Gynecol 2013;122(3);706–16.

    Google Scholar 

  48. Lonn E et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006;354(15):1567–77.

    Article  CAS  PubMed  Google Scholar 

  49. Kutteh WH. Novel strategies for the management of recurrent pregnancy loss. Semin Reprod Med. 2015;33:159–66.

    Article  Google Scholar 

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Correspondence to William H. Kutteh MD, PhD, HCLD .

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Kutteh, W.H. (2016). Inherited and Acquired Thrombophilias and Adverse Pregnancy Outcomes. In: Bashiri, A., Harlev, A., Agarwal, A. (eds) Recurrent Pregnancy Loss. Springer, Cham. https://doi.org/10.1007/978-3-319-27452-2_5

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  • DOI: https://doi.org/10.1007/978-3-319-27452-2_5

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-27452-2

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