Thrombophilia and Adverse Pregnancy Outcome

Results obtained in the last 15 years from a number of retrospective trials provide evidence that there is an association between adverse pregnancy outcomes (APO) such as early/late (recurrent) abortion, preeclampsia, intrauterine fetal growth retardation, or abruptio placentae and the presence of inherited or acquired thrombophilic defects. Although revised international recommendations (American College of Chest Physicians, Pregnancy and Thrombosis Working Group, Royal College of Obstetricians and Gynaecologists) for the investigation and management of thrombophilia in patients with APO apart from thrombosis have been published recently, they are inconsistent and based on limited evidence due to the lack of prospective trials performed in homogeneous groups of patients using multivariate analysis and uniform terminologies for APO. However, according to a recent British survey, 75% of participating prenatal units perform routine thrombophilia screening in women with APO, and the results guide the decision to administer anticoagulant medication to prevent APO in subsequent pregnancies. A summary of current study results of thrombophilia-associated APO and the prevention of APO (apart from thrombosis) using anticoagulants was carried out, and more recent prospective trials are considered. Recommendations for thrombophilia screening in APO as well as the use of anticoagulants for the prevention of APO are discussed.