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DOI: 10.1160/TH09-07-0476
Altered reference ranges for protein C and protein S during early pregnancy: Implications for the diagnosis of protein C and protein S deficiency during pregnancy
Financial support: We thank Bayer Diagnostics (Australia) and Diagnostica Stago (France) for supplying the reagents used in this study at discounted rates. This project has been supported by grants from the Kings Jubilee Fund (City of Melbourne), The Royal Women’s Hospital and The University of Melbourne (Australian Postgraduate Award and Felix Meyer Scholarship).
Publication History
Received:
25 July 2009
Accepted after major revision:
05 January 2010
Publication Date:
22 November 2017 (online)
Summary
Protein S, protein C and antithrombin are important regulators of coagulation. While deficiencies of these proteins have been linked to adverse pregnancy outcomes, testing for these deficiencies during pregnancy is limited by the use of non-pregnant reference ranges and a limited understanding of the changes that occur during pregnancy. Although several small studies have previously reported on the activity of these proteins during pregnancy, potentially important changes have been overlooked by continuing to compare the activity during pregnancy with non-pregnant reference ranges. In the current study, we investigated the activity of protein S, protein C and antithrombin during the first half of pregnancy in 440 otherwise asymptomatic women who went on to have uncomplicated singleton pregnancies. Consistent with previous studies, we found that antithrombin activity remained unchanged, while protein S activity decreased significantly to a mean level of 46%. We did not observe a progressive decrease in protein S during the second trimester as several studies have suggested previously. In contrast, we observed a potentially biologically significant increase in protein C activity throughout the first 22 weeks of pregnancy. Given the physiological role of protein C, we postulate that this increase may play a role in maintaining early pregnancy through both an anticoagulant and an inflammatory regulation pathway.
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