Page 56 - Pro-active Management of Women’s Health after Cardiometabolic Complicated Pregnancies

54 | Part 2 Cardiovascular Health
Our study found no association between any of the preeclampsia phenotypes and factor V Leiden. Previous cohort and case-control studies showed conflicting results on the association between the occurrence of preeclampsia and factor V Leiden105 107 113 115 116 118-120 123 125-128. However, reported prevalence range widely from 2% to 28%. Ethnicity may explain some of this variance, next to small study groups and bias due to study design. In larger studies110 121 as well as in prospective cohort studies (systematically review by Rodger et al129) prevalence ranged from 3-7%, showing no association with preeclampsia and are in line with our findings. This leaves factor V Leiden only a possible associated factor in Ashkenazi-Jews, but not in Caucasians.
We found no associations with Prothrombin gene mutations. Previous cohort and case-control studies showed conflicting results105 113 115 116 119 122 123 125 126 128. However, a systematic reviews of only prospective cohort studies129, showed no associations.
We found no associations with Protein-C deficiency and (non-factor V Leiden) APC-resistance. Although the incidence in our population was very low, it confirms the findings in other studies107 116 120 123 124 133.
This study has several limitations. Firstly, bias in patient inclusion before 2006 could not be excluded. Until 2006 mainly severe cases of preeclampsia were being screened for thrombophilia. Since 2006 screening for thrombophilia is offered to all women with preeclampsia. Secondly, placental infarction was not scored using a standardized protocol, lowering the power of the findings with regard to placental infarction. Thirdly, the tests of association we performed were numerous, causing multiple-testing. Forth, abnormality of some factors of thrombophilia had a low prevalence in this population (Protein-C), leading to a probable power-problem. On the other hand, the low prevalence indicates a low clinical value, sustaining our conclusion.