Thrombophilia in pregnancy

a systematic review

L Robertson, O Wu, P Langhorne, S Twaddle, P Clark, G D O Lowe, I D Walker, M Greaves, I Brenkel, L Regan, I A Greer, Thrombosis Screening Study

Research output: Contribution to journalArticle

570 Citations (Scopus)

Abstract

Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0.74-34.40); early pregnancy loss (ORs, 1.40-6.25); late pregnancy loss (ORs, 1.31-20.09); pre-eclampsia (ORs, 1.37-3.49); placental abruption (ORs, 1.42-7.71) and intrauterine growth restriction (ORs, 1.24-2.92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1.62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.

Original languageEnglish
Pages (from-to)171-196
Number of pages26
JournalBritish Journal of Haematology
Volume132
Issue number2
Early online date15 Nov 2005
DOIs
Publication statusPublished - Jan 2006

Fingerprint

Thrombophilia
Odds Ratio
Venous Thromboembolism
Pregnancy
Pregnancy Complications
Pregnancy Outcome
Abruptio Placentae
Pre-Eclampsia
Aspirin
Heparin
Databases
Growth

Keywords

  • thrombophilia
  • pregnancy outcomes
  • systematic review
  • factor-v-leiden
  • protein-C resistance
  • methylenetetrahydrofolate reductase gene
  • recurrent miscarriage population
  • randomized controlled-trial
  • molecular-weight heparin
  • low-dose aspirin
  • late fetal loss
  • antiphospholipid antibodies
  • risk-factor

Cite this

Robertson, L., Wu, O., Langhorne, P., Twaddle, S., Clark, P., Lowe, G. D. O., ... Thrombosis Screening Study (2006). Thrombophilia in pregnancy: a systematic review. British Journal of Haematology, 132(2), 171-196. https://doi.org/10.1111/j.1365-2141.2005.05847.x

Thrombophilia in pregnancy : a systematic review. / Robertson, L ; Wu, O ; Langhorne, P ; Twaddle, S ; Clark, P ; Lowe, G D O ; Walker, I D ; Greaves, M ; Brenkel, I ; Regan, L ; Greer, I A ; Thrombosis Screening Study.

In: British Journal of Haematology, Vol. 132, No. 2, 01.2006, p. 171-196.

Research output: Contribution to journalArticle

Robertson, L, Wu, O, Langhorne, P, Twaddle, S, Clark, P, Lowe, GDO, Walker, ID, Greaves, M, Brenkel, I, Regan, L, Greer, IA & Thrombosis Screening Study 2006, 'Thrombophilia in pregnancy: a systematic review', British Journal of Haematology, vol. 132, no. 2, pp. 171-196. https://doi.org/10.1111/j.1365-2141.2005.05847.x
Robertson L, Wu O, Langhorne P, Twaddle S, Clark P, Lowe GDO et al. Thrombophilia in pregnancy: a systematic review. British Journal of Haematology. 2006 Jan;132(2):171-196. https://doi.org/10.1111/j.1365-2141.2005.05847.x
Robertson, L ; Wu, O ; Langhorne, P ; Twaddle, S ; Clark, P ; Lowe, G D O ; Walker, I D ; Greaves, M ; Brenkel, I ; Regan, L ; Greer, I A ; Thrombosis Screening Study. / Thrombophilia in pregnancy : a systematic review. In: British Journal of Haematology. 2006 ; Vol. 132, No. 2. pp. 171-196.
@article{147617337f5c4459a050952000d04351,
title = "Thrombophilia in pregnancy: a systematic review",
abstract = "Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0.74-34.40); early pregnancy loss (ORs, 1.40-6.25); late pregnancy loss (ORs, 1.31-20.09); pre-eclampsia (ORs, 1.37-3.49); placental abruption (ORs, 1.42-7.71) and intrauterine growth restriction (ORs, 1.24-2.92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1.62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.",
keywords = "thrombophilia, pregnancy outcomes, systematic review, factor-v-leiden, protein-C resistance, methylenetetrahydrofolate reductase gene, recurrent miscarriage population, randomized controlled-trial, molecular-weight heparin, low-dose aspirin, late fetal loss, antiphospholipid antibodies, risk-factor",
author = "L Robertson and O Wu and P Langhorne and S Twaddle and P Clark and Lowe, {G D O} and Walker, {I D} and M Greaves and I Brenkel and L Regan and Greer, {I A} and {Thrombosis Screening Study}",
year = "2006",
month = "1",
doi = "10.1111/j.1365-2141.2005.05847.x",
language = "English",
volume = "132",
pages = "171--196",
journal = "British Journal of Haematology",
issn = "0007-1048",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Thrombophilia in pregnancy

T2 - a systematic review

AU - Robertson, L

AU - Wu, O

AU - Langhorne, P

AU - Twaddle, S

AU - Clark, P

AU - Lowe, G D O

AU - Walker, I D

AU - Greaves, M

AU - Brenkel, I

AU - Regan, L

AU - Greer, I A

AU - Thrombosis Screening Study

PY - 2006/1

Y1 - 2006/1

N2 - Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0.74-34.40); early pregnancy loss (ORs, 1.40-6.25); late pregnancy loss (ORs, 1.31-20.09); pre-eclampsia (ORs, 1.37-3.49); placental abruption (ORs, 1.42-7.71) and intrauterine growth restriction (ORs, 1.24-2.92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1.62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.

AB - Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0.74-34.40); early pregnancy loss (ORs, 1.40-6.25); late pregnancy loss (ORs, 1.31-20.09); pre-eclampsia (ORs, 1.37-3.49); placental abruption (ORs, 1.42-7.71) and intrauterine growth restriction (ORs, 1.24-2.92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1.62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.

KW - thrombophilia

KW - pregnancy outcomes

KW - systematic review

KW - factor-v-leiden

KW - protein-C resistance

KW - methylenetetrahydrofolate reductase gene

KW - recurrent miscarriage population

KW - randomized controlled-trial

KW - molecular-weight heparin

KW - low-dose aspirin

KW - late fetal loss

KW - antiphospholipid antibodies

KW - risk-factor

U2 - 10.1111/j.1365-2141.2005.05847.x

DO - 10.1111/j.1365-2141.2005.05847.x

M3 - Article

VL - 132

SP - 171

EP - 196

JO - British Journal of Haematology

JF - British Journal of Haematology

SN - 0007-1048

IS - 2

ER -