Page 45 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

2.2 Associations between phenotypes of preeclampsia and thrombophilia| 43 INTRODUCTION
Preeclampsia complicates 2-8% of all pregnancies4. The cause of preeclampsia has not yet been elucidated and is most probably heterogenic4. One possible cause is a maternal pro-thrombogenic state, leading to mal- adaptation of the spiral arteries in early pregnancy and placental thrombosis and infarction in mid- and late pregnancy4. A pro-thrombogenic state can be caused by inherited or acquired thrombophilia98-100. Maternal thrombophilia seems to be associated with preeclampsia in cohort studies. However, these results cannot be reproduced in larger prospective studies4.
An explanation of these conflicting results might be that preeclampsia is a heterogenic disease with different phenotypes. Not only can preeclampsia be classified as mild or severe, it may also be complicated by hemolysis, elevated liver enzymes or low platelets (HELLP-syndrome) and/or intrauterine growth restriction (IUGR) and/or early onset preeclampsia. Histological examination of placentas of pregnancies complicated by preeclampsia may show extensive infarction, but also no abnormal findings at all99. Some authors suggest that early preeclampsia has another pathophysiological basis than late preeclampsia101. It might be that these different phenotypes of preeclampsia are differently associated with thrombophilia. If this is true, future research should be focused on the pathophysiology, prediction and ultimately prevention of preeclampsia in combination with these thrombophilia factors.
This retrospective cohort study addresses the question which phenotypes of preeclampsia are associated with thrombophilia.