Thrombophilia in Pregnancy

Thrombophilia in pregnancy increases the risk of developing  numerous complications, but there are exceptions   to this case.  A large number of women with FV Leiden, MTHFR mutation, etc. have had   several successful deliveries without problems and without even knowing that they have a thrombophiliac mutation. So the risks of thrombosis caused by thrombophilia in pregnancy are relative. Your doctor will evaluate your medical history and consider what is the best prevention of complications in your case.

Thrombosis in Pregnancy

Pregnancy is a physiological hypercoagulable state = a condition where the blood is more likely to clot due to increase of pregnancy hormones (especially estrogen), fibrinogen and other coagulation factors – V, VII, VIII and Von Willebrand factors.

Decrease in protein S, secondary resistance to activated protein C and increased levels of inhibitors of fibrinolysis are also factors contributing to thrombophilia state.

If you have inherited thrombophilia in pregnancy, the risk of thrombosis increases.

Risks of thrombophilia in pregnancy

Currently, a number of studies are focused on the relationship between thrombophilia and occurrence of serious complications in pregnancy. Thrombophilia is usually linked to recurrent spontaneous abortions, intrauterine fetal death, fetal growth restriction and preeclampsia. These complications have made a significant contribution to total maternal and neonatal morbidity and mortality. Therefore an intensive research is carried out in the field of thrombotic complications of fetoplacental circulation.

It is not yet clear to what extent thrombophilia impacts on the emergence of preeclampsia, placental abruption, ante-partum fetal death, repeated abortions and fetal growth retardation. Diverse individual results of epidemiological studies are due mostly to the small samples examined from among the population. The cause of further discrepancies is probably due to genetic diversity in different countries. The risk of some obstetric complications related to thrombophilic mutations vary among different populations. Most of the studies, which showed statistically significant differences between thrombophilic and the control group, were conducted in southern and eastern Europe. In contrast, the work of Scandinavian, the Dutch and the British did not show statistically significant differences.

Based on current knowledge it has been observed that there is an association between the presence of thrombophilia and late abortions, the risk of preeclampsia and fetal growth restriction. Pathophysiology of thrombophilia that leads   to the   development of these complications is far from known. Probably other congenital and acquired factors also influence the external environment and cause the development of complications in pregnancy. With the development of laboratory techniques, new insights and new thrombophilia mutations are being discovered. It is likely that many mutations are still unknown. Detecting etiology is complicated by the fact that serious complications such as preeclampsia, can be found even in women with no known risk factors and without thrombophilia mutation. Apparently not all etiologic agents are known today.

Prevention of Pregnancy Complications

Medication

  • If you are in higher risk of thrombosis your doctor might recommend injections of LMWH (Low molecular weight heparin) during pregnancy.
  • If you are on Warfarin remember that Warfarin harms the fetus and cause warfarin embryopathy.
  • Ideally, prior to beginning of pregnancy you should switch to the heparin injections, at the latest as soon as pregnancy is discovered.

Stockings

  • For a prevention of leg swelling and varicose veins.

Healthy lifestyle

  • Exercise: Pay attention to proper water intake and choose a diet rich in folic acid.
  • The prohibition of alcohol and smoking cigarettes is obvious.
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