Pregnancy and thrombophilia

Mrinal M. Patnaik, Tufia Haddad, Colleen T. Morton

Research output: Contribution to journalReview articlepeer-review

26 Scopus citations

Abstract

The physiological changes that occur during pregnancy create a hypercoagulable milleu. This hypercoagulable state is thought to be protective, especially at the time of labor, preventing excessive hemorrhage. The presence of hereditary or acquired causes of thrombophilia during pregnancy tilts the balance in favor of unwanted venous thromboembolism and adverse pregnancy outcomes due to vascular uteroplacental insufficiency. These adverse pregnancy outcomes include recurrent pregnancy losses, intrauterine fetal death, intrauterine growth retardation, preeclampsia and placental abruption. Much of the current data with regards to the association of the different thrombophilias and pregnancy-related complications are based on retrospectively designed studies. This lack of randomization, in-homogeneity of patient populations, varying case definitions, selection biases and inadequately matched control populations, have given rise to conflicting data with regard to screening for, and treatment of, pregnant women with suspected thrombophilias. The limited data that we have support the use of anticoagulant drugs for the prevention of pregnancy-related complications in the setting of thrombophilia. Heparin and low-molecular-weight heparins are the anticoagulant drugs of choice as they do not cross the placental barrier and, hence, do not cause fetal anticoagulation or teratogenicity. Warfarin can be used from the 12th week of gestation onwards but is preferably reserved for the postpartum period.

Original languageEnglish (US)
Pages (from-to)753-765
Number of pages13
JournalExpert Review of Cardiovascular Therapy
Volume5
Issue number4
DOIs
StatePublished - Jul 1 2007

Keywords

  • Adverse pregnancy outcome
  • Anticoagulation
  • Antiphospholipid antibody syndrome
  • Intrauterine growth retardation
  • Placental abruption
  • Preeclampsia
  • Pregnancy
  • Recurrent pregnancy loss
  • Thrombophilia
  • Venous thromboembolism

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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