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WITH MATERNAL THROMBOPHILIA AND ADVERSE PREGNANCY OUTCOMES TRISHNA GOSWAMI, MADHURIMA UPPALAPATI, HOLLY MASEL, NISHA VYAS, HELAIN LANDY, CRAIG KESSLER, RUBY ANNE DEVERAS, Georgetown University, Hematology/Oncology, Washington, District of Columbia, Georgetown University, Hematology/Oncology, Marrietta, Georgia, Georgetown University, Obstetrics and Gynecology, Washington, District of Columbia, Georgetown University, Hematology, Washington, District of Columbia OBJECTIVE: Plasminogen activator inhibitor 1 (PAI-1) polymorphisms are associated with thrombotic disease. Prior studies have shown a possible link with gestational diabetes, preeclampsia, and recurrent miscarriages. Our objective was to determine the prevalence of PAI-1 polymorphisms (4G/4G, 4G/5G, 5G/5G) in pregnant women with a history of thrombophilia, to investigate if women with PAI-1 polymorphisms are at risk for other thrombophilic risk factors, and whether treatment with Lovenox improves obstetrical outcomes in these women. STUDY DESIGN: Demographic characteristics and obstetrical outcomes were gathered prospectively on high risk patients with a history of thrombophilia who were referred to hematology clinic from January 2002 to December 2005. A thrombophilia panel was done including PAI genotype by PCR, Factor V Leiden PCR, Prothrombin Gene mutation, Antithrombin III levels, MTHFR C677T mutation, serum homocysteine level, anticardiolipin (ACA), protein C and protein S levels, antiphospholipid (APA) and b-2 microglobulin antibodies (B2M), and lupus anticoagulant levels (LAC). Data was stratified by PAI-1 gene mutations and Lovenox therapy. Data analysis was performed using JMP software. RESULTS: Of the 72 patients collected, the PAI gene phenotypes were 4G/ 4G (39%), 4G/5G (35%) and 5G/5G (26%). Obstetrical complications did not significantly vary between the two treatment groups (preeclampsia; p = .09, abruption; p = 1, DVT; p = .73, gestational diabetes; p = .6). Correlation analysis indicated that PAI 4G/4G mutation was not an independent risk factor for recurrent miscarriage, but was associated with MTHFR C677T mutation. Women with MTHFR C677T mutation had a trend for more recurrent miscarriages (p = 0.07). There was an association between PAI 4G/ 4G and MTHFR (p = .08). No relationship was found between antibodies: ACA/APA/B2MG/LAC and recurrent miscarriage. CONCLUSION: Patients with the PAI 4G/4G mutation are not independently at increased risk for miscarriage and lovenox therapy did not significantly decrease obstetrical complications. |
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