Perinatal outcome in women with severe pregnancy complications and multiple thrombophilias

Thrombophilia mediates lowering cardiovascular risk factors in women with a history of preeclampsia

OBJECTIVE

Preeclampsia is associated with increased risk of cardiovascular disease. The aim of this pilot study was to assess whether the presence of thrombophilia results in a greater tendency to develop endothelial dysfunction and cardiovascular diseases.

METHODS

Ten women with thrombophilia were matched with 10 women without thrombophilia for a history of hypertensive disorders during pregnancy. Laboratory measurements: blood pressure, insulin sensitivity, and micro- and macrovascular function were determined.

RESULTS

Women with thrombophilia had significant lower total- and low-density cholesterol, were more insulin sensitive, and had better microvascular function.

CONCLUSION

This study suggests that thrombophilia "mediates" in lowering of cardiovascular risk factors in women with a history of preeclampsia.

Low birthweight in relation to placental abruption and maternal thrombophilia status

OBJECTIVE

The objective of the study was to evaluate whether the association between low birthweight and placental abruption is mediated through preterm birth or restricted fetal growth and whether these associations were influenced by maternal thrombophilia status.

STUDY DESIGN

Data were derived from the New Jersey-Placental Abruption Study, an ongoing, multicenter, case-control study conducted in New Jersey since August 2002. Abruption cases (n = 156) were identified based on a clinical diagnosis, and controls (n = 170) were matched to cases based on parity and maternal race. Low birthweight (<2500 g) was stratified based on preterm birth (<37 weeks' gestation) and small for gestational age (birthweight < the 10th percentile for gestational age). Maternal thrombophilia assessment was based on serum evaluation (protein C and S deficiency, activated protein C resistance ratio, and anticardiolipin antibodies) as well as genetic polymorphisms (methylenetetrahydrofolate reductase, prothrombin gene, and factor V Leiden). Associations were expressed based on odds ratios (ORs) with 95% confidence interval (CI).

RESULTS

Among abruption cases, 60.3% (n = 94) were low birthweight in comparison with 11.2% (n = 19) of controls (OR, 13.7; 95% CI, 7.4-25.2). Furthermore, placental abruption had a significantly increased association with preterm birth in both small for gestational age (OR, 17.4; 95% CI, 4.6-64.9) and appropriately grown fetuses (OR, 15.8; 95% CI, 8.4-29.8). However, the association between abruption and low birthweight were similar between women with and without thrombophilia.

CONCLUSION

The association between placental abruption and low birthweight is chiefly mediated through preterm birth, and this association does not appear to be modified by maternal thrombophilia status.

Placenta and fetal growth restriction

The placenta, as the vector for all maternal-fetal oxygen and nutrient exchange, is a principal influence on birthweight. Placental weight summarizes laterally expanding growth of the chorionic disc, and villous arborization yielding the nutrient exchange surface. These different growth dimensions alter fetoplacental weight ratio and ponderal index, and thus may modify placental functional efficiency. The placenta may show a range of histopathologies, some of which are also associated with fetal growth restriction. Different fetal intrinsic abilities to compensate for gross and histo-pathology may clarify the imperfect relationships between fetal growth and both intrauterine pathology, and the long-term health risks associated with poor fetal growth.

Fetal growth restriction and subsequent pregnancy risks

Fetal growth restriction can result from a variety of intrinsic or extrinsic insults, resulting from maternal, fetal, and placental factors. Determining the underlying cause of poor fetal growth can be difficult but is essential for assessing potential risks for future pregnancies. Importantly, recurrence risks greatly depend on these underlying conditions. Understanding these risks can allow more appropriate patient counseling and may influence management strategies to optimize future pregnancies.

Placental histopathologic features in patients with thrombophilic mutations

The purpose of this article is to review the histopathologic findings in the placenta of women with a known thrombophilic mutation. The findings range from normal to severe pathologic features including decidual vasculopathy, placental infarctions, syncytial knotting, maternal floor infarction, fetal thrombotic vasculopathy, vasculitis, and chronic villitis. They are, however, not pathognomonic of thrombophilic states, nor are necessarily markers of perinatal damage. The prospective evaluation of cases with known thrombophilic mutations and the application of tissue microarray examination of the placenta may allow identification of major histopathologic features and molecular parameters associated with maternal and/or fetal thrombophilic states. This may assist clinicians in their consultation with patients and optimize management in future pregnancies.