Page 52 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

50 | Part 2 Cardiovascular Health
total volume) was significantly associated with more prevalent anti-phospholipid antibodies (p<0.01) compared to normal placental infarction (< 10% of total volume). A low placental weight (≤ 5th percentile) was significantly associated with more prevalent hyperhomocysteineamia (p=0.03) compared to normal placental weight (> 5th percentile). HELLP was not associated with any thrombophilia. The following thrombophilia factors were not associated with any phenotype of preeclampsia: Protein-C deficiency, APC-resistance, factor V Leiden mutation and Prothrombin gene mutation.
Table 2.2.3 shows adjusted odds-ratios for thrombophilia factors if only HELLP or only IUGR is present. After adjusting for gestational age at onset of preeclampsia, correlations with IUGR disappear for Protein-S deficiency.
The factor analysis with fixed 2-axis model performed poorly, only explaining 34% of the variance in the results of thrombophilia factors.
DISCUSSION
Thrombophilia was more present if the preeclampsia was severe, combined with IUGR, a delivery before the 34th week of gestation, placental infarction was more than 10% or placental weight was lower than the 5th centile. To our knowledge this is the largest cohort-study so far, testing for the association between different phenotypes of preeclampsia and thrombophilia.
Previous studies show wide ranges in the prevalence of thrombophilia factors as shown in table 2.2.4. This is probably caused by differences in known confounders103 like laboratory methods, chosen cut-off points to define abnormal results, definition of the presence of thrombophilia factors (one or two positive tests), timing of the testing and heterogeneity of the cases race, gestational age at delivery and preeclampsia severity.