ABSTRACT
A recent review of the literature on thrombophilia and adverse pregnancy outcome reveals
contradictory findings. There are retrospective and prospective studies that recommend
testing for genetic and acquired markers of thrombophilia for those with the enumerated
adverse pregnancy outcome. Based on our review, routine screening for thrombophilias
in women with a history of adverse pregnancy outcome (preeclampsia, abruptio placenta,
intrauterine growth restriction, and fetal loss) is not justified. Based on data from
observational studies and few randomized trials with inadequate number of subjects,
there is consensus that women with true antiphospholipid antibody syndrome should
receive low-dose aspirin plus adjusted-dose heparin in subsequent pregnancies. Some
authors also recommend heparin prophylaxis in subsequent pregnancies in women with
genetic thrombophilia with previous adverse pregnancy outcome. However, this recommendation
is not based on randomized trials. Hence, a randomized double-blind, controlled trial
is urgently needed to evaluate the benefit of heparin during pregnancy in women with
a history of adverse pregnancy outcome in association with genetic thrombophilia.
KEYWORDS
Thrombophilia - adverse pregnancy outcome
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Caroline L StellaM.D.
Maternal-Fetal Medicine Fellow, Clinical Instructor, Division of Maternal-Fetal Medicine,
University of Cincinnati
231 Albert Sabin Way, Room 5052, Medical Sciences Building, P.O. Box 670526, Cincinnati,
OH 45267-0526
