Page 44 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

42 | Part 2 Cardiovascular Health ABSTRACT
Background Preeclampsia (PE) complicates 2-8% of all pregnancies. Studies on the association of PE with thrombophilia (TP) are conflicting. Clinical heterogeneity of the disease may be one of the explanations. The present study addresses the question whether different phenotypes of PE are associated with TP factors.
Materials and Methods We planned a retrospective cohort study. From 1985 until 2010 women with PE were offered postpartum screening for the following TP factors: anti-phospholipid antibodies (APA), APC-resistance (APC- r), protein C deficiency (PCD) and protein S deficiency (PSD), hyperhomocysteineamia (HHC), factor V Leiden (FVL) and Prothrombin gene mutation (F2M). Hospital records were used to obtain information on phenotypes of the PE and placental histology.
Results We identified 844 women with singleton pregnancies who were screened for TP factors. HELLP complicated 49% of pregnancies; IUGR complicated 61% of pregnancies. Early delivery (<34th week) occurred in 71% of pregnancies. Any TP factor was present in 29% of the women. Severe PE was associated with PSD (p=0.01). IUGR was associated with APA (p<0.01). Early onset PE was associated with APA (P=0.01). Extensive placental infarction (>10%) was associated with APA (p<0.01). Low placental weight (<5th percentile) was associated with HHC (p=0.03).
Discussion Severe and early onset PE, especially if complicated by IUGR, are associated with APA. Other phenotypes of PE, especially HELLP syndrome, were not associated with TP. We advise only to test for APA after severe, early onset PE, especially if complicated by IUGR. We suggest enough evidence is presented to justify no further studies are needed.