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Lambert JR, Ueno J, Fernandes CE, Pompei LM. Prophylactic low-molecular-weight heparin in women with thrombophilia undergoing in vitro fertilization. Int J Gynaecol Obstet 2024; 164:242-248. [PMID: 37491876 DOI: 10.1002/ijgo.15005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To verify whether low-molecular-weight heparin (LMWH) could increase pregnancy rates and/or decrease abortion rates in women with thrombophilia undergoing assisted reproduction cycles. METHODS Cross-sectional study with patients undergoing in vitro fertilization (IVF) (N = 104). Women without thrombophilia (control group, n = 20), women with thrombophilia who did not receive LMWH (untreated group, n = 30), and women with thrombophilia, treated with daily enoxaparin from the day of embryo transfer until week 36 of gestation (treated group, n = 54). All women underwent controlled ovarian hyperstimulation. IVF was performed by intracytoplasmic sperm injection, and embryos were transferred on day 3. Pregnancy was detected by β-human chorionic gonadotropin (biochemical pregnancy) and fetal heartbeat at week 5 to 6. Ongoing pregnancy was determined by ultrasound on week 12. RESULTS Patients in the untreated thrombophilia group presented with significantly lower ongoing pregnancy rates and live birth rates and significantly higher early pregnancy loss and abortion rates when compared with the control and the treated thrombophilia groups. CONCLUSIONS In women with diagnosed coagulation disorders, use of LMWH is important to avoid miscarriages.
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Affiliation(s)
- José Roberto Lambert
- Faculdade de Medicina do ABC, Santo Andre, Brazil
- Ami Lambert Clinic, Santo Andre, Brazil
| | - Joji Ueno
- Instituto GERA de Medicina Reprodutiva, São Paulo, Brazil
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Chen J, Bie J, Jiang F, Wu Y, Pan Z, Meng Y, Song J, Liu Y. Low-molecular-weight heparin in thrombophilic women receiving in vitro fertilization/intracytoplasmic sperm injection: A meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1431-1439. [PMID: 37475190 PMCID: PMC10577622 DOI: 10.1111/aogs.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION This meta-analysis aimed to evaluate the efficacy and safety of low-molecular-weight heparin (LMWH) on pregnancy outcomes in thrombophilic women receiving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). MATERIAL AND METHODS A systematic literature search of PubMed, EMBASE, the Cochrane Library, and China National Knowledge Infrastructure was performed to identify randomized controlled trials (RCTs) comparing LMWH with no treatment or placebo published from database inception until February 19, 2023. Primary outcomes were the clinical pregnancy rate and implantation rate, and secondary outcomes were the live birth rate, miscarriage rate, and the risk of bleeding events. The certainty of the evidence was rated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system. Meta-analysis was conducted using STATA 14.0. RESULTS Five RCTs involving 1094 thrombophilic women receiving IVF/ICSI were finally included. Administration of LMWH was associated with statistically higher clinical pregnancy rate (4 RCTs, risk ratio [RR] 1.50, 95% confidence interval [CI] 1.23-1.82, p < 0.001, low certainty evidence), implantation rate (5 RCTs, RR 1.49, 95% CI 1.25-1.78, p < 0.001, very low certainty evidence), and live birth rate (2 RCTs, RR 2.15, 95% CI 1.60-2.89, p < 0.001, very low certainty evidence), but with statistically lower miscarriage rate (2 RCTs, RR 0.36, 95% CI 0.15-0.86, p = 0.021, very low certainty evidence). However, using LMWH was linked to a higher risk of bleeding events (2 RCTs, RR 2.36, 95% CI 1.49-3.74, p < 0.001, very low certainty evidence). CONCLUSIONS Very low certainty evidence suggests that administration of LMWH may benefit pregnancy outcomes in thrombophilic women receiving IVF/ICSI treatment, although it may also increase the risk of bleeding events. However, before putting our findings into practice, healthcare professionals should conduct an in-depth evaluation of the available evidence and specific patient situations. Furthermore, due to the low methodological quality of the included studies, more high-quality studies are needed to validate our findings in the future.
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Affiliation(s)
- Jingsi Chen
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Jia Bie
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Fangjie Jiang
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Yanzhi Wu
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Zhengmei Pan
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Yushi Meng
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Jiamei Song
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Yang Liu
- Department of Reproductionthe Second Affiliated Hospital of Kunming Medical UniversityKunmingChina
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Ding Z, Pan H, Yang Z, Yang C, Shi H. Beyond the classics: The emerging value of anti-phosphatidylserine/prothrombin antibodies in antiphospholipid syndrome. Clin Immunol 2023; 256:109804. [PMID: 37838215 DOI: 10.1016/j.clim.2023.109804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by the presence of antiphospholipid antibodies (aPLs), which can lead to thrombosis and pregnancy complications. Within the diverse range of aPLs, anti-phosphatidylserine/prothrombin antibodies (aPS/PT) have gained significance in clinical practice. The detection of aPS/PT has proven valuable in identifying APS patients and stratifying their risk, especially when combined with other aPL tests like lupus anticoagulant (LA) and anti-β2-glycoprotein I (aβ2GPI). Multivariate analyses have confirmed aPS/PT as an independent risk factor for vascular thrombosis and obstetric complications, with its inclusion in the aPL score and the Global Anti-Phospholipid Syndrome Score (GAPSS) aiding in risk evaluation. However, challenges remain in the laboratory testing of aPS/PT, including the need for assay standardization and its lower sensitivity in certain patient populations. Further research is necessary to validate the clinical utility of aPS/PT antibodies in APS diagnosis, risk stratification, and management.
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Affiliation(s)
- Zetao Ding
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyu Pan
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhixia Yang
- Department of Rheumatology and Immunology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Nasich LL, Hoffman R, Keren-Politansky A, Jabareen A, Kalish Y, Schliamser L, Brenner B, Nadir Y. Effects of anti-Xa activity monitoring on the outcome of high-risk pregnancies treated with a prophylactic dose of low-molecular-weight heparin. Eur J Haematol 2023; 111:655-661. [PMID: 37533300 DOI: 10.1111/ejh.14060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVE To evaluate if anti-Xa level monitoring and dose adjustment in women using a prophylactic dose of enoxaparin can decrease placenta-mediated pregnancy complications. METHODS This retrospective observational cohort study included pregnant women receiving enoxaparin prophylaxis, who were followed at the Thrombosis and Hemostasis Outpatient clinic between 2010 and 2017. The dose was adjusted according to enoxaparin anti-Xa levels in the study group or the weight of individuals in the control group. RESULTS Of 585 women surveyed, 110 met the inclusion criteria; 63 of them were included in the study group and 47 in the control group. Mean starting dose was 46 versus 43 mg (p = .25), mean final dose was 52 mg versus 45 mg (p = .03) and dose adjustment was required in 37% versus 11% (p = .002) in the study and control groups, respectively. Twenty-eight percent of anti-Xa measurements in the second trimester were beneath the prophylactic threshold, compared to 11% and 16% in the first and third trimesters, respectively (p = .02). Labors ended with live birth in 91% versus 94% of cases (p = .5), 85% versus 68% of pregnancies were term (p = .05), 11% versus 23% of newborns were low birth weight (p = .1) and placenta-mediated pregnancy complications were documented in 9% versus 19%, (p = .17) in the study group relative to controls, respectively. CONCLUSIONS The most prominent decrease in anti-Xa levels was observed in the second trimester. Monitored women had significantly more term deliveries and demonstrated a trend toward higher birth weight and fewer placenta-mediated pregnancy complications. Larger studies are needed to confirm improved pregnancy outcome in monitored women.
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Affiliation(s)
- Lea Liat Nasich
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
| | - Ron Hoffman
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
| | | | - Amal Jabareen
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yosef Kalish
- Thrombosis and Hemostasis Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Benjamin Brenner
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel
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Dusek J, Nedvedova L, Scheinost O, Hanzl M, Kantorova E, Fendrstatova E, Sram RJ, Kotouckova H, Voracek J. Frequency of Leiden Mutation in Newborns with Birth Weight below 1500 g. Healthcare (Basel) 2022; 10:healthcare10050865. [PMID: 35628002 PMCID: PMC9140989 DOI: 10.3390/healthcare10050865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023] Open
Abstract
It has been hypothesized that fetal prematurity or Intrauterine Growth Restriction (IUGR) could be related to the presence of factor V of Leiden mutation. This mutation is associated with a higher incidence of pregnancy difficulties that can result in preterm birth. The frequency of Leiden mutation was investigated in the group of newborns with a low birth weight below 1500 g over a six-year period from 2015 to 2020. During this period, 339 newborns were tested, of which 42 newborns with V Leiden mutation (12.4%) were detected. The average of its occurrence frequency in the Czech population was determined as 5.0% based on published studies. In our research, the occurrence of the V Leiden mutation was found significantly higher in newborns under 1500 g. At the same time, we did not demonstrate an increased frequency of births at lower gestational weeks, lower birth weight, or an association with sex in newborns with a positive diagnosis of the Leiden V factor.
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Affiliation(s)
- Jiri Dusek
- Neonatology Department, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic; (L.N.); (M.H.); (E.F.)
- Faculty of Health and Social Sciences, University of South Bohemia, J. Boreckeho 1167, 37011 Ceske Budejovice, Czech Republic
- Correspondence:
| | - Lenka Nedvedova
- Neonatology Department, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic; (L.N.); (M.H.); (E.F.)
| | - Ondrej Scheinost
- Laboratory of Molecular Biology and Genetics, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic;
| | - Milan Hanzl
- Neonatology Department, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic; (L.N.); (M.H.); (E.F.)
| | - Eva Kantorova
- Department of Genetics, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic;
| | - Eva Fendrstatova
- Neonatology Department, Hospital Ceske Budejovice, Bozeny Nemcove 54, 37001 Ceske Budejovice, Czech Republic; (L.N.); (M.H.); (E.F.)
| | - Radim J. Sram
- Institute of Experimental Medicine AS CR, Videnska 1083, 14220 Prague, Czech Republic;
| | - Hana Kotouckova
- Department of Mathematics, College of Polytechnics, Tolsteho 16, 58601 Jihlava, Czech Republic;
| | - Jan Voracek
- Department of Technical Studies, College of Polytechnics, Tolsteho 16, 58601 Jihlava, Czech Republic;
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Küçüktürkmen B, Baskaya Y, Özdemir K. A qualitative study of Turkish midwives' experience of providing care to pregnant women infected with COVID-19. Midwifery 2021; 105:103206. [PMID: 34864325 PMCID: PMC8595251 DOI: 10.1016/j.midw.2021.103206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 11/03/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Abstract
Objective To determine the experiences of Turkish midwives who provided care to pregnant women diagnosed with COVID-19 or suspected of having it, during labour and delivery. Methods A phenomenological approach was used. In-depth individual interviews were conducted with 15 midwives from 15 different hospitals in various Turkish cities through video-conferencing. Data analysis was based on Graneheim and Lundman's techniques for extracting themes from qualitative data. Findings Four themes emerged: “Measures against pandemic uncertainty,” “Impairment in postpartum care,” “Emotional burden of the pandemic,” and “Adaptation to the results of the pandemic.” Midwives stated that they tried to reduce the risk of contamination by taking self-protection measures and creating isolated areas. They carried out practices such as separating the mother and baby postpartum and not allowing breastfeeding. They experienced emotional confusion with the difficulties faced in this process, and they became professional in the management of the process. Implications for practice The results of this study reveal the challenges faced by Turkish midwives during the COVID-19 pandemic and the importance of the publication of evidence-based guidelines. Provision of emotional support for midwives is essential in order to sustain the continuity of the quality maintenance of midwifery care.
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Affiliation(s)
- Büşra Küçüktürkmen
- Sakarya University, Faculty of Health Sciences, Department of Midwifery, Sakarya, Turkey.
| | - Yasemin Baskaya
- Sakarya University, Faculty of Health Sciences, Department of Midwifery, Sakarya, Turkey
| | - Kevser Özdemir
- Sakarya University, Faculty of Health Sciences, Department of Nursing, Sakarya, Turkey
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Padda J, Khalid K, Mohan A, Pokhriyal S, Batra N, Hitawala G, Cooper AC, Jean-Charles G. Factor V Leiden G1691A and Prothrombin Gene G20210A Mutations on Pregnancy Outcome. Cureus 2021; 13:e17185. [PMID: 34540419 PMCID: PMC8439407 DOI: 10.7759/cureus.17185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2021] [Indexed: 12/12/2022] Open
Abstract
Factor V Leiden (FVL) G1619A mutation and prothrombin gene (PTG) G20210A are the most common inherited thrombophilias. They have been associated with various obstetric complications such as venous thromboembolism, recurrent pregnancy loss, preeclampsia, abruptio placentae, and small for gestational age fetus. The prevalence of these two mutations is 3-15% in Caucasians and is assumed to be far less common in other ethnic populations. However, there have been several controversies regarding advising routine screening of these thrombophilias because of a widely variable strength of association between different ethnic groups, as well as contradictory conclusions by different studies in regards to the association. In this study, the literature was analyzed thoroughly for the effect of FVL G1619A and PTG G20210A mutations on various obstetric outcomes. A review of multiple case-control and prospective studies suggests that despite the availability of robust data on this subject the results remain inconclusive and insubstantial. Further superior quality research, preferably prospective studies, is warranted to conclusively establish this relationship and to enable practitioners to follow a definitive protocol in the screening of various populations for these mutations to achieve an improved pregnancy outcome.
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Affiliation(s)
- Jaskamal Padda
- Internal Medicine, JC Medical Center, Orlando, USA
- Internal Medicine, Avalon University School of Medicine, Willemstad, CUW
| | | | - Ayushi Mohan
- Internal Medicine, JC Medical Center, Orlando, USA
| | | | - Nitya Batra
- Internal Medicine, JC Medical Center, Orlando, USA
| | | | | | - Gutteridge Jean-Charles
- Internal Medicine, JC Medical Center, Orlando, USA
- Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA
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Schonewille NN, Abheiden CNH, Bokslag A, Thijs A, De Groot CJM, De Vries JIP, De Boer MA. Cardiovascular risk after hypertensive disorders of pregnancy in women with and without inheritable Thrombophilia. Hypertens Pregnancy 2020; 39:203-210. [PMID: 32297536 DOI: 10.1080/10641955.2020.1753767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim of this study was to compare cardiovascular risk in women with and without inheritable thrombophilia after hypertensive disorders of pregnancy (HDP). Blood pressure, anthropometrics and blood samples were measured 9-13 years after early-onset (<34 weeks) HDP. Amongst the 114 women included, no differences in hypertension (31.1% vs. 33.7%, OR 0.90 95% CI (0.29-2.79)), body mass index > 25 kg/m2 (43.8% vs. 53.1%, OR 0.69 95% CI (0.24-2.00)) or metabolic syndrome (18.8% vs. 13.3%, OR 1.51 95% CI (0.38-6.02)) were found. These data show similar cardiovascular risk profile in women with and without inheritable thrombophilia.
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Affiliation(s)
- N N Schonewille
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C N H Abheiden
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - A Bokslag
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - A Thijs
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - C J M De Groot
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - J I P De Vries
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
| | - M A De Boer
- Department of Obstetrics and Gynaecology, UMC, Institute for Cardiovascular Research, Amsterdam, The Netherlands
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High Prevalence of Sticky Platelet Syndrome in Patients with Infertility and Pregnancy Loss. J Clin Med 2019; 8:jcm8091328. [PMID: 31466364 PMCID: PMC6780264 DOI: 10.3390/jcm8091328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022] Open
Abstract
Platelet hyperaggregability, known as sticky platelet syndrome (SPS), is a prothrombotic disorder that has been increasingly associated with pregnancy loss. In this retrospective study, we aimed to investigate the clinical and diagnostic relevance of SPS in 208 patients with infertility and unexplained pregnancy loss history. We studied 208 patients that had been referred to undergo a dose-dependent platelet aggregation response to adenosine diphosphate and epinephrine using light transmission aggregometry modified by Mammen during an 11-year period. Patients’ platelet aggregation response was compared with platelet function in 29 female healthy controls of fertile age with no previous history of pregnancy loss. We found a prevalence of SPS type II (33.2%) in 208 female patients with infertility and pregnancy loss. ∆-epinephrine-induced platelet aggregation in patients with SPS was significantly decreased (median 7% and range −21 to 43%) compared to patients without SPS (median 59%, range 7–88% and p < 0.0001) and healthy controls (median 57%, range 8–106% and p < 0.0001). The optimum SPS-diagnostic cutoff value for ∆-epinephrine aggregation was ≤32% (sensitivity 95.7%, specificity 95.2%). SPS patients with low-dose acetylsalicylic acid (ASA) therapy (n = 56) showed improved pregnancy outcome (32 pregnancies; live births n = 18 (56%)) compared to SPS patients without low-dose ASA (n = 13) (3 pregnancies; live births n = 1 (33%)). Our study demonstrates the clinical and diagnostic relevance of platelet hyperaggregation in women with infertility and pregnancy loss history. Further studies should investigate the potential of SPS as a novel decisional tool with both diagnostic and clinical implications in infertility and pregnancy loss.
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Sencan H, Keskin N, Khatib G. The role of neopterin and anti-Mullerian hormone in unexplained recurrent pregnancy loss - a case-control study. J OBSTET GYNAECOL 2019; 39:996-999. [PMID: 31064238 DOI: 10.1080/01443615.2019.1586850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This case-control study was conducted to assess whether neopterin (NP) and anti-Mullerian hormone (AMH) can be used as markers in the condition of unexplained recurrent pregnancy loss (RPL). To the best of our knowledge, this is the first work which has studied the association between AMH, NP and RPL. A total of 110 patients were included; 53 women who had at least two consecutive unexplained miscarriages (<12 weeks) made up the study group. The control group was established from 57 women who never had a miscarriage and had at least one healthy birth history. Peripheral blood samples were collected from each patient to analyse the AMH and NP concentrations. The results suggested that mean level of AMH (1.38 ± 0.683 ng/ml) in the patient's group was significantly lower than the control group (1.84 ± 0.718 ng/ml). The mean levels of NP were significantly higher in the patient group (1.69 ± 0.486 vs. 1.38 ± 0.431 ng/ml). IMPACT STATEMENT What is already known about this subject? To the best of our knowledge, no previous studies about the association among AMH, NP and RPL were found in the literature. What do the results of this study add? This pioneer study demonstrates the significant relationship between the unexplained RPL with the increased levels of NP and decreased AMH. What are the implications of these findings for clinical practice and/or further research? NP and AMH may play an effective role in illuminating the condition of unexplained RPL. High levels of NP and low values of AMH in patients with RPL can be used as predictive markers for this clinical situation. If the causes of high levels of NP and low levels of AMH can be better illuminated, new treatments towards these causes can be developed to help such patients become childbearing.
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Affiliation(s)
- Halime Sencan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dumlupınar University , Kütahya , Turkey
| | - Nadi Keskin
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dumlupınar University , Kütahya , Turkey
| | - Ghanim Khatib
- Department of Obstetrics and Gynecology, Gynecologic Oncology Division, Balcalı Hospital, School of Medicine, Çukurova University , Adana , Turkey
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11
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Genetic profiling revealed an increased risk of venous thrombosis in the Hungarian Roma population. Thromb Res 2019; 179:37-44. [PMID: 31078119 DOI: 10.1016/j.thromres.2019.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/15/2019] [Accepted: 04/30/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Besides modifiable risk factors, genetic susceptibility may also explain the high cardiovascular disease burden of the Roma population. OBJECTIVES Aim of this study was to define the genetic susceptibility of Hungarian Roma to venous thrombosis (VT) and comparing it to that of the general population. METHODS Fifty-two SNPs associated with VT (in F2, F5, F9, F11, F15, FGA, FGB, FGG, CYP4V2, KLKB1 and vWF) were selected and analyzed in the group of Roma (N = 962) and general (N = 1492) subjects collected by cross-sectional studies. Allele frequencies and genetic risk scores (GRS, unweighted and weighted) were computed for the study groups and compared to estimate the joint effects of SNPs. RESULTS The majority of the susceptible alleles were more prevalent in the Roma population, and both GRS and wGRS were found to be significantly higher in Roma than in the general population (GRS: 41.83 ± 5.78 vs. 41.04 ± 6.04; wGRS: 7.78 ± 1.28 vs. 7.46 ± 1.33, p = .001). Only 2.39% of subjects in the Roma population were in the bottom fifth of the wGRS (wGRS≤0.19) compared with 3.62% of those in the general population (p = .080); 2.88% of the general subjects were in the top fifth of the wGRS (wGRS≥10.02), while 4.26% of the Roma population were (p = .066). CONCLUSION In conclusion, the Roma population seems to have increased genetic susceptibility to VT. This might have important implications in the future in identifying possible new opportunities for targeted prevention and treatment for those subgroups in the populations who are at greater risk for VT development.
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12
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Chen GC, Gao H, Zhang L, Tong T. Evaluation of therapeutic efficacy of anticoagulant drugs for patients with venous thromboembolism during pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2019; 238:7-11. [PMID: 31082745 DOI: 10.1016/j.ejogrb.2019.04.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/15/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
Abstract
A meta-analysis based on published literature was undertaken to evaluate the efficacy of anticoagulant drugs for the treatment of venous thromboembolism during pregnancy. PubMed, Cochrane and Embase databases were searched from inception to September 2018 for relevant studies using indexed words, including qualified case-control and cohort studies. The meta-analysis used odds ratios (OR) and 95% confidence intervals (95% CI) to analyse the primary results. Nine studies were included in this meta-analysis, with a total of 834 cases and 3424 controls. There were no significant differences in the incidence of prenatal haemorrhage (OR 1.08, 95% CI 0.84-1.40), venous thromboembolism (OR 1.30, 95% CI 0.72-2.33) or caesarean section (OR 1.16, 95% CI 0.69-1.98) between the case group and the control group. The incidence of pulmonary embolism was significantly higher in the case group than in the control group (OR 3.90, 95% CI 1.23-12.34). However, there were a few limitations that may have influenced the results, so more randomized double-blind controlled studies of high quality are warranted to confirm the efficacy of anticoagulant therapy for venous thromboembolism in pregnancy.
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Affiliation(s)
- Guo-Chang Chen
- Department of Medicine, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China.
| | - Hong Gao
- Department of Medicine, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Lin Zhang
- Department of Medicine, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
| | - Tong Tong
- Department of Medicine, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, Beijing, China
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Safe childbirth for a type 1 antithrombin-deficient woman with novel mutation in the SERPINC1 gene undergoing antithrombin concentrate therapy. Blood Coagul Fibrinolysis 2019; 30:47-51. [PMID: 30431449 DOI: 10.1097/mbc.0000000000000785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Inherited antithrombin (AT) deficiency is an autosomal dominant thrombotic disorder. We encountered a case of inherited type I AT deficiency and identified the causative mutation; a novel c.7430A>G missense mutation in the SERPINC1 gene in which tyrosine was substituted for cysteine at the 292nd amino acid. A recombinant AT protein with the 7430A>G mutation was not detected in cell lysates or culture supernatants. And then, our patient without personal or family history of thrombosis was pregnant woman with asymptomatic AT deficiency. Our patient treated with only AT concentrate therapy during pregnancy and she was able to safely give birth naturally and avoid thrombosis. We believe that this therapy for pregnant woman with asymptomatic AT deficiency is effective and safety as anticoagulant therapy during pregnancy.
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Sokol J, Skerenova M, Biringer K, Simurda T, Kubisz P, Stasko J. Glycoprotein VI Gene Variants Affect Pregnancy Loss in Patients With Platelet Hyperaggregability. Clin Appl Thromb Hemost 2018; 24:202S-208S. [PMID: 30278775 PMCID: PMC6714835 DOI: 10.1177/1076029618802358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to evaluate GP6 gene in patients with sticky platelet
syndrome (SPS) and fetal loss. Platelet aggregability was tested with
platelet-rich plasma using PACKS-4 aggregometer (Helena Laboratories).
High-resolution melting analysis on LightCycler 480 II (Roche Diagnostics) was
used for single-nucleotide polymorphism (SNP) genotyping. We examined 64
patients with SPS and 54 control participants. We found significantly higher
occurrence of 5 SNPs in patients with SPS versus controls (rs1671152, rs1654433,
rs1613662, rs1654416, and rs2304167). Moreover, the haplotype analysis showed a
significantly higher occurrence of 7 haplotypes in patients with SPS compared to
controls (acgg and aagg in GP6_5reg haplotype; ccgt in GP6_3reg haplotype; gg
and ta in GP6_REG haplotype; SKTH and PEAN in GP6_PEAN haplotype). Our results,
especially higher occurrence of 4 nonsynonymous variants within the coding
region, support the idea that GP6 polymorphisms are associated with the platelet
hyperaggregability accompanied by fetal loss.
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Affiliation(s)
- Juraj Sokol
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Maria Skerenova
- Department of Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Kamil Biringer
- Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomas Simurda
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubisz
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jan Stasko
- Department of Hematology and Transfusion Medicine, National Center of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Gumus E. Güneydoğu Anadolu Bölgesi’ndeki Tekrarlayan Abortus Olgularında Protrombin, MTHFR, FV Leiden ve PAI-1 Polimorfizmlerinin Retrospektif Olarak İncelenmesi. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.457243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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16
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Giannakou K, Evangelou E, Papatheodorou SI. Genetic and non-genetic risk factors for pre-eclampsia: umbrella review of systematic reviews and meta-analyses of observational studies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:720-730. [PMID: 29143991 DOI: 10.1002/uog.18959] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To summarize evidence from the literature on genetic and non-genetic risk factors associated with pre-eclampsia (PE), assess the presence of statistical bias in the studies and identify risk factors for which there is robust evidence supporting their association with PE. METHODS PubMed and ISI Web of Science were searched from inception to October 2016, to identify systematic reviews and meta-analyses of observational studies examining associations between genetic or non-genetic risk factors and PE. For each meta-analysis, the summary-effect size was estimated using random-effects and fixed-effects models, along with 95% CIs and the 95% prediction interval. Between-study heterogeneity was expressed using the I2 statistic, and evidence of small-study effects (large studies had significantly more conservative results than smaller studies) and evidence of excess significance bias (too many studies with statistically significant results) were estimated. RESULTS Fifty-eight eligible meta-analyses were identified, which included 1466 primary studies and provided data on 130 comparisons of risk factors associated with PE, covering a wide range of comorbid diseases, genetic factors, exposure to environmental agents and biomarkers. Sixty-five (50%) associations had nominally statistically significant findings at P < 0.05, while 16 (12%) were significant at P < 10-6 . Sixty-five (50%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 10 (8%) and 26 (20%) associations, respectively. The only non-genetic risk factor with convincing evidence for an association with PE was oocyte donation vs spontaneous conception, which had a summary odds ratio of 4.33 (95% CI, 3.11-6.03), was supported by 2712 cases with small heterogeneity (I2 = 26%) and 95% prediction intervals excluding the null value, and without hints of small-study effects (P for Egger's test > 0.10) or excess of significance (P > 0.05). Of the statistically significant (P < 0.05) genetic risk factors for PE, only PAI-1 4G/5G (recessive model) polymorphism was supported by strong evidence for a contribution to the pathogenesis of PE. Eleven factors (serum iron level, pregnancy-associated plasma protein-A, chronic kidney disease, polycystic ovary syndrome, mental stress, bacterial and viral infections, cigarette smoking, oocyte donation vs assisted reproductive technology, obesity vs normal weight, severe obesity vs normal weight and primiparity) presented highly suggestive evidence for an association with PE. CONCLUSIONS A large proportion of meta-analyses of genetic and non-genetic risk factors for PE have caveats that threaten their validity. Oocyte donation vs spontaneous conception and PAI-1 4G/5G polymorphism (recessive model) showed the strongest consistent evidence for an association with risk for PE. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Giannakou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - E Evangelou
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - S I Papatheodorou
- Cyprus International Institute for Environmental & Public Health, Cyprus University of Technology, Limassol, Cyprus
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17
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Vidyadhari M, Sujatha M, Krupa P, Nallari P, Venkateshwari A. A family based triad study evaluating the role of MTHFR gene polymorphisms in spontaneous abortions. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Kardi MT, Yousefian E, Allahveisi A, Alaee S. Association of Factor V Leiden and Prothrombin G20210A Polymorphisms in Women with Recurrent Pregnancy Loss in Isfahan Province, Iran. Int J Prev Med 2018. [PMID: 29541428 PMCID: PMC5843958 DOI: 10.4103/ijpvm.ijpvm_240_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Maternal thrombophilia has been identified as a risk factor for recurrent pregnancy loss (RPL). The aim of this study was to investigate the association between prothrombin G20210A and factor V Leiden (FVL) polymorphisms in women with RPL and a control group of parous women in Isfahan province of Iran. Methods: We studied 250 women with idiopathic RPL and 116 control cases. Prothrombin and FVL different genotypes were determined using polymerase chain reaction and reverse hybridization technique. Results: The frequencies of heterozygous mutation prothrombin G20210A were 6% and 0.9%, respectively (P = 0.025), in cases compared to the control group. The frequencies of homozygous mutation prothrombin G20210A were 0.4% and 0%, respectively, in cases compared to controls (P = 0.02). The prothrombin mutation was significantly higher in cases compared to the control group (odds ratio 8.81; 95% confidence interval: 1.16–66.62). There was no significant difference between the FVL mutation and pregnancy loss. Conclusions: The results indicated a significant higher frequency of prothrombin G20210A in women with RPL in comparison with controls. Our data suggest that the prothrombin G20210A mutation, but not the FVL mutation, may be an unrecognized cause of RPL in our population.
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Affiliation(s)
- Mohammad Taghi Kardi
- Department of Biology, Faculty of Sciences, University of Isfahan, Isfahan, Iran
| | - Elham Yousefian
- Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azra Allahveisi
- Department of Anatomy, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Sanaz Alaee
- Department of Reproductive Biology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
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El Masry S, Azzam H, Youssef H, Othman M, Awad M. Reduced Protein C Global Assay Levels in Infertile Women with in vitro Fertilization Failure: A Pilot Study. Acta Haematol 2018; 139:1-6. [PMID: 29301122 DOI: 10.1159/000484514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/23/2017] [Indexed: 11/19/2022]
Abstract
Protein C global is a global dotting assay that evaluates abnormalities in the protein C anticoagulant pathway. A few studies have examined this assay in relation to assisted reproductive technology (ART), but its role in infertile women with in vitro fertilization (IVF) failure remains unclear. In this study, we assessed protein C in infertile women with a history of IVF failure who were undergoing ART. We examined 45 healthy fertile women who conceived naturally, and 45 infertile women with 2 or more implantation failures undergoing ART. Both protein C and activated protein C resistance (APC-R) were evaluated. The results showed that mean protein C expressed as a normalized ratio (PCAT-NR) was significantly lower in the study group compared to the control group (0.76 ± 0.15 vs. 0.91 ± 0.14, respectively; p = 0.0001). Follow-up on ART outcomes showed that women who failed ART had significantly lower PCAT-NR compared to successful cases. PCAT-NR did not correlate with APC-R levels in the study (r = 0.125, p < 0.5) or failed ART subgroups. Using logistic regression analysis, patients with lower PCAT-NR levels showed an elevated risk of implantation failure (p = 0.04, OR 0.50, 95% CI 0.26-0.84). In conclusion, protein C global assay may play a role in the etiology of IVF failure, which might be independent of APC-R. Larger studies are encouraged to validate these findings and explore the underlying pathophysiological mechanisms.
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Affiliation(s)
- Sally El Masry
- Clinical Pathology Department, Dakahlia Psychiatric Hospital, Mansoura, Egypt
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20
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Huang Z, Tang W, Liang Z, Chen Q, Li M, Li Y, Lao S, Pan H, Huang L, Huang M, Hu X, Zhao J. Plasminogen Activator Inhibitor-1 Polymorphism Confers a Genetic Contribution to the Risk of Recurrent Spontaneous Abortion: An Updated Meta-Analysis. Reprod Sci 2017; 24:1551-1560. [DOI: 10.1177/1933719117702013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Zhan Huang
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Wenqian Tang
- Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Zhikun Liang
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Qiaopei Chen
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Mingyi Li
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Yingfeng Li
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Shaoxing Lao
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Huimin Pan
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Liying Huang
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Min Huang
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Xuehua Hu
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Jiangyang Zhao
- Department of Clinical Laboratory, Children’s Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
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21
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The value and impact of anti-Xa activity monitoring for prophylactic dose adjustment of low-molecular-weight heparin during pregnancy. Blood Coagul Fibrinolysis 2017; 28:199-204. [DOI: 10.1097/mbc.0000000000000573] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Nahas R, Saliba W, Elias A, Elias M. The Prevalence of Thrombophilia in Women With Recurrent Fetal Loss and Outcome of Anticoagulation Therapy for the Prevention of Miscarriages. Clin Appl Thromb Hemost 2016; 24:122-128. [PMID: 27799457 DOI: 10.1177/1076029616675967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of thrombophilia in women with recurrent miscarriages and to assess the effect of antithrombotic therapy. DESIGN A retrospective cohort study between the years 2004 and 2010. SETTING A hypercoagulation community clinic in northern Israel. PATIENTS Four hundred ninety pregnant women referred for thrombophilia screening. MAIN OUTCOME MEASURES Screening results for thrombophilia and antithrombotic treatment with enoxaparin, aspirin, or both and pregnancy outcomes. RESULTS The most common thrombophilia in our study group was factor V Leiden mutation with a prevalence of 20.9% followed by protein S deficiency with a prevalence of 19%. Live birth rate was higher in the group of women who received enoxaparin regardless of whether a specific thrombophilia could be found. This finding was more pronounced in women who had ≥4 miscarriages. CONCLUSION The prevalence of thrombophilia was higher in our study group than in the general population. Furthermore, treatment with enoxaparin might improve the rate of live births in women with or without evidence of thrombophilia, especially in women with ≥4 miscarriages.
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Affiliation(s)
- Rawan Nahas
- 1 Department of Pedeiatrics, Mount Sinai Hospital, New York, NY, USA
| | - Walid Saliba
- 2 Department of Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Adi Elias
- 3 Department of Medicine H, Rambam Medical Center, Haifa, Israel
| | - Mazen Elias
- 4 Department of Internal Medicine C, Haemek Medical Center, Afula, Israel
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Sekiya A, Hayashi T, Kadohira Y, Shibayama M, Tsuda T, Jin X, Nomoto H, Asakura H, Wada T, Ohtake S, Morishita E. Thrombosis Prediction Based on Reference Ranges of Coagulation-Related Markers in Different Stages of Pregnancy. Clin Appl Thromb Hemost 2016; 23:844-850. [DOI: 10.1177/1076029616673732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Careful monitoring of the hypercoagulable state is required during pregnancy. However, coagulation and fibrinolysis markers are not fully utilized because there are no reference values reflective of coagulation and fibrinolysis dynamics during pregnancy, which differ from the nonpregnant state. Methods: Changes in antithrombin (AT), fibrinogen (Fbg), prothrombin fragment 1+2 (F1+2), thrombin–antithrombin complex (TAT), soluble fibrin (SF), D-dimer (DD), and protein S (PS) were investigated in healthy pregnant women, and reference ranges in the early, mid, late, and end stages of pregnancy were established. Results: The AT was essentially constant throughout pregnancy. The Fbg, F1+2, TAT, and DD increased significantly as pregnancy progressed. In contrast, SF did not show a significant increase throughout the entire pregnancy period. Total PS antigen and total PS activity showed a corresponding decrease from early gestation. When test data in 3 cases in which deep vein thrombosis or intrauterine fetal death occurred during pregnancy were compared to the established reference ranges, all of the cases had multiple markers with values that exceeded the reference ranges. Conclusion: Establishing reference ranges for each week could potentially make it possible to evaluate abnormalities of the coagulation and fibrinolysis systems during pregnancy. Of note, SF might be a useful marker that reflects thrombus formation during pregnancy. Larger-scale studies will be required to establish reference ranges for every gestational week.
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Affiliation(s)
- Akiko Sekiya
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Tomoe Hayashi
- Department of Hematology, Kanazawa City Hospital, Heiwa-machi, Kanazawa, Ishikawa, Japan
| | - Yasuko Kadohira
- Department of Internal Medicine (III), Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Masami Shibayama
- Department of Clinical Laboratory, Kanazawa University Hospital, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Tomohide Tsuda
- Shino-Test Corporation, Oonodai, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Xiuri Jin
- Shino-Test Corporation, Oonodai, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Haruka Nomoto
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Hidesaku Asakura
- Department of Internal Medicine (III), Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Takashi Wada
- Department of Clinical Laboratory, Kanazawa University Hospital, Takara-machi, Kanazawa, Ishikawa, Japan
- Division of Nephrology, Department of Laboratory Medicine, Kanazawa University, Takara-machi, Kanazawa, Ishikawa, Japan
| | - Shigeki Ohtake
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Science, Kanazawa University Graduate School, Kodatsuno, Kanazawa, Ishikawa, Japan
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Shinozaki N, Ebina Y, Deguchi M, Tanimura K, Morizane M, Yamada H. Protein S deficiency complicated pregnancy in women with recurrent pregnancy loss. Gynecol Endocrinol 2016; 32:672-674. [PMID: 26941215 DOI: 10.3109/09513590.2016.1152239] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This prospective study aimed to evaluate pregnancy outcome and complications in women with recurrent pregnancy loss (RPL) and protein S (PS) deficiency, who received low dose aspirin (LDA) or LDA plus heparin (LDA/H) therapies. Clinical characteristics, pregnancy outcome and complications of 38 women with two or more RPL and <60% of plasma free PS antigen were compared among three groups: antiphospholipid antibody (aPL)-negative women who received LDA (group A), aPL-negative women who received LDA/H (group B) and aPL-positive women who received LDA/H (group C). Gestational weeks (GW) at delivery in group C (median 32 GW) were earlier than 40 GW in group A and 38.5 GW in group B (p < 0.05). The birth weight in group C (median 1794 g) was less than 2855 g in group B (p < 0.05). The incidences of fetal growth restriction (37.5%), pregnancy-induced hypertension (37.5%), and preterm delivery (62.5%) in group C were higher than those (4.5%, 0%, and 4.5%, respectively) in group B (p<0.05). Women with RPL, PS deficiency, and positive aPL had high risks for adverse pregnancy outcome and complications, even when they received LDA/H therapy. Among women with RPL, PS, and negative aPL, there was no difference in these risks between LDA alone and LDA/H therapies.
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Affiliation(s)
- Nanae Shinozaki
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Yasuhiko Ebina
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Masashi Deguchi
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Kenji Tanimura
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Mayumi Morizane
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
| | - Hideto Yamada
- a Department of Obstetrics and Gynecology , Kobe University Graduate School of Medicine , Kobe , Japan
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Nuriel-Ohayon M, Neuman H, Koren O. Microbial Changes during Pregnancy, Birth, and Infancy. Front Microbiol 2016; 7:1031. [PMID: 27471494 PMCID: PMC4943946 DOI: 10.3389/fmicb.2016.01031] [Citation(s) in RCA: 327] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/17/2016] [Indexed: 12/19/2022] Open
Abstract
Several healthy developmental processes such as pregnancy, fetal development, and infant development include a multitude of physiological changes: weight gain, hormonal, and metabolic changes, as well as immune changes. In this review, we present an additional important factor which both influences and is affected by these physiological processes-the microbiome. We summarize the known changes in microbiota composition at a variety of body sites including gut, vagina, oral cavity, and placenta, throughout pregnancy, fetal development, and early childhood. There is still a lot to be discovered; yet several pieces of research point to the healthy desired microbial changes. Future research is likely to unravel precise roles and mechanisms of the microbiota in gestation; perhaps linking the metabolic, hormonal, and immune changes together. Although some research has started to link microbial dysbiosis and specific microbial populations with unhealthy pregnancy complications, it is important to first understand the context of the natural healthy microbial changes occurring. Until recently the placenta and developing fetus were considered to be germ free, containing no apparent microbiome. We present multiple study results showing distinct microbiota compositions in the placenta and meconium, alluding to early microbial colonization. These results may change dogmas and our overall understanding of the importance and roles of microbiota from the beginning of life. We further review the main factors shaping the infant microbiome-modes of delivery, feeding, weaning, and exposure to antibiotics. Taken together, we are starting to build a broader understanding of healthy vs. abnormal microbial alterations throughout major developmental time-points.
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Affiliation(s)
| | - Hadar Neuman
- Faculty of Medicine, Bar-Ilan University Safed, Israel
| | - Omry Koren
- Faculty of Medicine, Bar-Ilan University Safed, Israel
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26
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Zhou L, Cheng L, He Y, Gu Y, Wang Y, Wang C. Association of gene polymorphisms of FV, FII, MTHFR, SERPINE1, CTLA4, IL10, and TNFalpha with pre-eclampsia in Chinese women. Inflamm Res 2016; 65:717-24. [DOI: 10.1007/s00011-016-0953-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/26/2016] [Accepted: 05/03/2016] [Indexed: 11/27/2022] Open
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27
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Martínez-Zamora MA, Tàssies D, Reverter JC, Creus M, Casals G, Cívico S, Carmona F, Balasch J. Increased circulating cell-derived microparticle count is associated with recurrent implantation failure after IVF and embryo transfer. Reprod Biomed Online 2016; 33:168-73. [PMID: 27236712 DOI: 10.1016/j.rbmo.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022]
Abstract
Cell-derived microparticles (cMPs) are small membrane vesicles that are released from many different cell types in response to cellular activation or apoptosis. Elevated cMP counts have been found in almost all thrombotic diseases and pregnancy wastage, such as recurrent spontaneous abortion and in a number of conditions associated with inflammation, cellular activation and angiogenesis. cMP count was investigated in patients experiencing unexplained recurrent implantation failure (RIF). The study group was composed of 30 women diagnosed with RIF (RIF group). The first control group (IVF group) (n = 30) comprised patients undergoing a first successful IVF cycle. The second control group (FER group) included 30 healthy women who had at least one child born at term and no history of infertility or obstetric complications. cMP count was significantly higher in the RIF group compared with the IVF and FER groups (P < 0.05 and P < 0.01, respectively) (RIF group: 15.8 ± 6.2 nM phosphatidylserine equivalent [PS eq]; IVF group: 10.9 ± 5.3 nM PS eq; FER group: 9.6 ± 4.0 nM PS eq). No statistical difference was found in cMP count between the IVF and FER groups. Increased cMP count is, therefore, associated with RIF after IVF and embryo transfer.
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Affiliation(s)
- M Angeles Martínez-Zamora
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain
| | - Dolors Tàssies
- Hemotherapy and Hemostasis Unit, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Juan Carlos Reverter
- Hemotherapy and Hemostasis Unit, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Montserrat Creus
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain
| | - Gemma Casals
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain
| | - Salvadora Cívico
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain
| | - Francisco Carmona
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain
| | - Juan Balasch
- Institut Clínic of Gynecology, Obstetrics and Neonatology, Faculty of Medicine - University of Barcelona, Hospital Clínic of Barcelona, Villarroel Street, 170, Barcelona 08036, Spain.
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Mohtaram S, Sheikhha MH, Honarvar N, Sazegari A, Maraghechi N, Feizollahi Z, Ghasemi N. An Association Study of the SLC19A1 Gene Polymorphisms/Haplotypes with Idiopathic Recurrent Pregnancy Loss in an Iranian Population. Genet Test Mol Biomarkers 2016; 20:235-40. [PMID: 26959650 DOI: 10.1089/gtmb.2015.0230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
AIMS The genetics of folate metabolism is one of the most significant mechanisms influencing fetal growth and may underlie some cases of unexplained recurrent miscarriage. Reduced folate carrier 1, encoded by the SLC19A1 gene, is a transporter of folate. Folate deficiency and elevated levels of homocysteine could be disadvantageous for the female reproductive system health. Thus, the balance between homocysteine and folate status can be used to measure the risk of recurrent pregnancy loss. METHODS The purpose of this study was to determine the association between -43T>C, 80G>A, and 696C>T polymorphisms of the SLC19A1 gene in 147 women who had unexplained recurrent miscarriage in comparison with 150 healthy women. Amplification refractory mutation system-polymerase chain reaction was used to genotype the molecular polymorphisms of this gene. RESULTS The results indicated that the -43T>C single nucleotide of the SLC19A1 gene was significantly associated with a risk of recurrent miscarriage in Iranian women (p < 0.05). No significant association was observed for the other two polymorphisms. The haplotype frequency distribution of -43C/80G/696C, -;43C/80G/696T, -43C/80G, and 80G/696T was significantly different in patients than controls, which may represent a novel risk factor for idiopathic recurrent pregnancy loss. CONCLUSIONS Polymorphisms and haplotypes of the SLC19A1 gene can be considered risk factors for idiopathic recurrent pregnancy loss.
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Affiliation(s)
- Shirin Mohtaram
- 1 International Campus of Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Negar Honarvar
- 1 International Campus of Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Sazegari
- 1 International Campus of Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Neda Maraghechi
- 1 International Campus of Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Feizollahi
- 1 International Campus of Yazd Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Ghasemi
- 2 Recurrent Abortion Research Centre, Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
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Peterson LK, Willis R, Harris EN, Branch WD, Tebo AE. Antibodies to Phosphatidylserine/Prothrombin Complex in Antiphospholipid Syndrome: Analytical and Clinical Perspectives. Adv Clin Chem 2016; 73:1-28. [PMID: 26975968 DOI: 10.1016/bs.acc.2015.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombosis and/or pregnancy-related morbidity accompanied by persistently positive antiphospholipid antibodies (aPL). Current laboratory criteria for APS classification recommend testing for lupus anticoagulant as well as IgG and IgM anticardiolipin, and beta-2 glycoprotein I (anti-β2GPI) antibodies. However, there appears to be a subset of patients with classical APS manifestations who test negative for the recommended criteria aPL tests. While acknowledging that such patients may have clinical features that are not of an autoimmune etiology, experts also speculate that these "seronegative" patients may test negative for relevant autoantibodies as a result of a lack of harmonization and/or standardization. Alternatively, they may have aPL that target other antigens involved in the pathogenesis of APS. In the latter, autoantibodies that recognize a phosphatidylserine/prothrombin (PS/PT) complex have been reported to be associated with APS and may have diagnostic relevance. This review highlights analytical and clinical attributes associated with PS/PT antibodies, taking into consideration the performance characteristics of criteria aPL tests in APS with specific recommendations for harmonization and standardization efforts.
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Affiliation(s)
- Lisa K Peterson
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Rohan Willis
- Rheumatology/Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | | | - Ware D Branch
- Maternal Fetal Medicine, University of Utah and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anne E Tebo
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA; ARUP Laboratories, Institute of Clinical and Experimental Pathology, Salt Lake City, Utah, USA.
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Mekaj Y, Lulaj S, Daci F, Rafuna N, Miftari E, Hoxha H, Sllamniku X, Mekaj A. Prevalence and role of antithrombin III, protein C and protein S deficiencies and activated protein C resistance in Kosovo women with recurrent pregnancy loss during the first trimester of pregnancy. J Hum Reprod Sci 2016; 8:224-9. [PMID: 26752858 PMCID: PMC4691975 DOI: 10.4103/0974-1208.170407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Several studies have reported that thrombophilia is responsible for recurrent pregnancy loss (RPL). AIMS The aim of this study was to evaluate the prevalence and role of inherited thrombophilia in early pregnancy loss, specifically in the first trimester. MATERIALS AND METHODS A total of 104 women (patients) with a history of two or more miscarriages during the first trimester of pregnancy and 110 women (controls) who had experienced two or more births without a miscarriage were included in this study. In both groups, we determined the biological activities of antithrombin III (ATIII) and protein C (PC) using the chromogenic method and the biological activity of protein S (PS) and the activated protein C resistance (APCR) were examined using a clotting method. RESULTS In the patient group, deficiencies of ATIII, PC, and PS were detected in 3 (2.88%), 4 (3.85%), and 6 (5.77%) cases, respectively. In the control group, ATIII (0%) deficiencies were not detected, and deficiencies for PC (0.9%) and PS (0.9%) were each detected in 1 patient. APCR was detected in 9 patients (8.65%) and 4 control subjects (3.63%). CONCLUSION Based on our results, we can conclude that thrombophilia is a causal factor for miscarriages in the first trimester of pregnancy, although there are the conflicting data in the literature.
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Affiliation(s)
- Ymer Mekaj
- Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina 10000, Kosovo; Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina 10000, Kosovo
| | - Shefqet Lulaj
- Clinic of Gynecology and Obstetrics, University Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Fetie Daci
- Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina 10000, Kosovo
| | - Naser Rafuna
- Clinic of Gynecology and Obstetrics, University Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Ermira Miftari
- Clinic of Gynecology and Obstetrics, University Clinical Center of Kosovo, Prishtina 10000, Kosovo
| | - Hakif Hoxha
- Institute of Pathophysiology, Faculty of Medicine, University of Prishtina, Prishtina 10000, Kosovo; Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina 10000, Kosovo
| | - Xhemile Sllamniku
- Department of Hemostasis and Thrombosis, National Blood Transfusion Center of Kosovo, Prishtina 10000, Kosovo
| | - Agon Mekaj
- Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina 10000, Kosovo
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Yilmaz M, Delibas IB, Isaoglu U, Ingec M, Borekci B, Ulug P. Relationship between mean platelet volume and recurrent miscarriage: a preliminary study. Arch Med Sci 2015; 11:989-93. [PMID: 26528341 PMCID: PMC4624730 DOI: 10.5114/aoms.2013.40095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/17/2013] [Accepted: 11/11/2013] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The aim of the study was to examine the relationship between mean platelet volume (MPV) and recurrent miscarriage in order to illuminate the etiopathogenesis of recurrent miscarriage. MATERIAL AND METHODS We retrospectively investigated the data of 120 patients with unexplained recurrent miscarriage (group 1), and compared them with the data of 120 match-paired patients in the control group (group 2). The definition of recurrent miscarriage was accepted as two or more failed clinical pregnancies which were documented by ultrasonography or histopathologic examination. All patients in the recurrent miscarriage group were evaluated with diagnostic tests for the etiology of recurrent miscarriage. Total blood count parameters, including hemoglobin, mean corpuscular volume, red cell distribution width, white blood cells, platelets, and mean platelet volume, were compared. RESULTS The average patient age at the time of examination was 29.07 ±2.81 years in group I and 28.53 ±3.5 years in group II (p > 0.05). Mean body mass index (BMI) was similar between group 1 and group 2, 22.54 ±3.17 and 22.99 ±2.38, respectively (p > 0.05). Mean hemoglobin, mean corpuscular volume, red cell distribution width, and white blood cell and platelet levels were similar in both groups (p > 0.05). Mean platelet volume levels were significantly higher in group I (9.45 ±1.09 fl) than in group II (7.63 ±0.52 fl) (p = 0.001). CONCLUSIONS Higher MPV values in the study group suggest and support the importance of thromboembolic events in the etiology of recurrent miscarriage.
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Affiliation(s)
- Mehmet Yilmaz
- Obstetrics and Gynecology Department, Ataturk University, Erzurum, Turkey
| | | | - Unal Isaoglu
- Nene Hatun Obstetrics and Gynecology Hospital, Erzurum, Turkey
| | - Metin Ingec
- Obstetrics and Gynecology Department, Ataturk University, Erzurum, Turkey
| | - Bunyamin Borekci
- Obstetrics and Gynecology Department, Ataturk University, Erzurum, Turkey
| | - Pasa Ulug
- Nene Hatun Obstetrics and Gynecology Hospital, Erzurum, Turkey
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Abstract
CONTEXT Anti-DFS70 antibodies are the most frequent antinuclear antibodies (ANA) found in healthy individuals. We assessed the clinical significance of the presence of anti-DFS70 antibodies. METHODS We defined a group of patients (n = 421) with anti-DFS70 antibodies and a group of patients (n = 63) with a history of idiopathic arterial and/or venous thrombotic disease and/or obstetric complication (i.e. ≥ 3 miscarriages, fetal death or premature birth with eclampsia). Anti-DFS70 antibodies prevalence was also assessed in a cohort of 300 healthy blood donors. RESULTS The prevalence of thrombotic disease and/or obstetric complication in the 421 patients with anti-DFS70 antibodies was 13.1% (n = 55) and the prevalence of connective tissue disease was 19% (n = 80). Among the 63 patients with a history of thrombosis and/or obstetric complications, 7 (11.1%) had anti-DFS70 antibodies and among the latter, 5 had no common thrombophilic factor. In contrast, the prevalence of anti-DFS70 antibodies was of 3.0% (9 out of 300) in healthy donors. Finally, the Activated Partial Thromboplastin Time (aPTT) ratio of patients with a history of thrombosis and anti-DFS70 antibodies was lower than the aPTT ratio of other patients, suggesting that thrombotic patients with anti-DFS70 antibodies may have a hypercoagulable state. CONCLUSION We described here for the first time an immune procoagulant state involving anti-DFS70 antibodies.
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Sokol J, Skerenova M, Biringer K, Lasabova Z, Stasko J, Kubisz P. Genetic variations of the GP6 regulatory region in patients with sticky platelet syndrome and miscarriage. Expert Rev Hematol 2015; 8:863-8. [PMID: 26308704 DOI: 10.1586/17474086.2015.1083417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Thrombophilia increases the risk of venous thrombosis during pregnancy and may predispose to gestational vascular complications. OBJECTIVE The aim of this study is to evaluate the variability of GP6 regulatory regions in a group of patients with platelet hyperaggregability manifested as miscarriage compared with control subjects. METHODS We examined 27 female patients with platelet hyperaggregability and history of spontaneous abortion and 42 healthy women. Platelet hyperaggregability was established by light transmission aggregometry. We also assessed eight SNPs within the GP6 gene. RESULTS We found a higher occurrence of three SNPs in patients with platelet hyperaggregability and history of miscarriage (rs1671152, rs1654433, rs1671215). The haplotype analysis showed a significant higher occurrence of two haplotypes (ACGG, CCGT). CONCLUSIONS Our results support the idea that genetic variability of GP6 regulatory regions can be associated with platelet hyperaggregability - a possible cause of miscarriage.
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Affiliation(s)
- Juraj Sokol
- a 1 Department of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
| | - Maria Skerenova
- b 2 Department of Clinical Biochemistry, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
| | - Kamil Biringer
- c 3 Department of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
| | - Zora Lasabova
- d 4 Department of Molecular Biology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
| | - Jan Stasko
- a 1 Department of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
| | - Peter Kubisz
- a 1 Department of Hematology and Transfusiology, National Centre of Hemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Kollarova 2, 036 59 Martin, Slovakia
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Anti-Phosphatidylserine/Prothrombin Antibodies Are Associated with Adverse Pregnancy Outcomes. J Immunol Res 2015; 2015:975704. [PMID: 26078985 PMCID: PMC4452858 DOI: 10.1155/2015/975704] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/15/2015] [Indexed: 11/18/2022] Open
Abstract
Objective. To determine the prevalence and clinical association of anti-phosphatidylserine/prothrombin antibodies (aPS/PT) in patients with a history of pregnancy complications relevant to antiphospholipid syndrome (APS). Materials and Methods. Two hundred and eleven patients with a history of (a) three or more consecutive miscarriages before 10th week of gestation (WG) (n = 64), (b) death of a morphologically normal fetus beyond 10th WG (n = 72), (c) premature birth of a morphologically normal neonate before 34th WG due to eclampsia, preeclamsia and placental insufficiency (n = 33), and (d) less than three unexplained consecutive miscarriages before 10th WG (n = 42). Subjects sera were analyzed for lupus anticoagulant (LA), anti-cardiolipin (aCL), anti-β2-glycoprotein I (anti-β2GPI), and aPS/PT antibodies. Results. 41/169 (24.3%) of patients were positive for at least one measured aPL. The highest prevalence was found for aPS/PT and aCL (13.0% and 12.4%, resp.) followed by LA (7.7%) and anti-β2GPI (7.1%). 11/169 with APS-related obstetric manifestations had only aPS/PT. 17.8% of patients were positive for LA or aCL and/or anti-β2GPI; however when adding the aPS/PT results, an additional 7% of patients could be evaluated for APS. Conclusion. aPS/PT are associated with recurrent early or late abortions and with premature delivery irrespective of other aPL.
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Ebina Y, Ieko M, Naito S, Kobashi G, Deguchi M, Minakami H, Atsumi T, Yamada H. Low levels of plasma protein S, protein C and coagulation factor XII during early pregnancy and adverse pregnancy outcome. Thromb Haemost 2015; 114:65-9. [PMID: 25879167 DOI: 10.1160/th14-11-0928] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
It was the study objective to evaluate whether low levels of plasma protein S (PS) activity, free PS, protein C (PC) activity and coagulation factor XII (FXII) during early pregnancy are related to adverse pregnancy outcomes. Peripheral blood samples were obtained at 8-14 gestational weeks (GW) from a consecutive series of 1,220 women. The levels of plasma PS activity, free PS, PC activity, and FXII were measured. Cut-off values were defined as < 1st, < 5th, and < 10th percentiles of values obtained from 933 women whose pregnancies ended in normal deliveries without complications. PS activity of < 10th percentile yielded risks of pregnancy-induced hypertension (PIH) and severe PIH, while free PS level of < 5th percentile yielded a risk of pre-eclampsia. FXII level of < 1st percentile yielded a risk of premature delivery (PD) at < 34 GW. None was associated with PD at < 37 GW, fetal growth restriction or fetal loss. A multivariate analysis demonstrated that PS activity of < 10th percentile (odds ratio 5.9, 95 % confidence interval 1.7-18.1) and body mass index (BMI) ≥ 25 kg/m² (4.3, 1.1-13.3) were independent risk factors for severe PIH. Similarly, free PS level of < 5th percentile (4.4, 1.0-14.3) and BMI ≥ 25 kg/m² (4.0, 1.3-10.9) were independent risk factors for pre-eclampsia. In conclusion, women with low levels of plasma PS activity and free PS during early pregnancy might have increased risks of PIH, severe PIH or pre-eclampsia. Women with low FXII level might have an increased risk of PD at < 34 GW.
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Affiliation(s)
| | | | | | | | | | | | | | - Hideto Yamada
- Prof. Hideto Yamada, MD, PhD, Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan, Tel.: +81 78 382 6005, Fax: +81 78 382 6019, E-mail:
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Li X, Liu Y, Zhang R, Tan J, Chen L, Liu Y. Meta-analysis of the association between plasminogen activator inhibitor-1 4G/5G polymorphism and recurrent pregnancy loss. Med Sci Monit 2015; 21:1051-6. [PMID: 25862335 PMCID: PMC4403499 DOI: 10.12659/msm.892898] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The association between plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism and recurrent pregnancy loss (RPL) risk is still contradictory. We thus performed a meta-analysis. Material/Methods Relevant studies were searched for in PubMed, Web of Science, Embase, and Cochrane Library. An odds ratio (OR) with a 95% confidence interval (CI) was used to assess the association between PAI-1 4G/5G polymorphism and RPL risk. Results A total of 22 studies with 4306 cases and 3076 controls were included in this meta-analysis. We found that PAI-1 4G/5G polymorphism was significantly associated with an increased RPL risk (OR=1.89; 95% CI 1.34–2.67; P=0.0003). In the subgroup analysis by race, PAI-1 4G/5G polymorphism was significantly associated with an increased RPL risk in Caucasians (OR=2.23; 95% CI 1.44–3.46; P=0.0003). However, no significant association was observed in Asians (OR=1.47; 95% CI 0.84–2.59; P=0.18). Conclusions In conclusion, this meta-analysis suggests that PAI-1 4G/5G polymorphism might be associated with RPL development in Caucasians.
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Affiliation(s)
- Xuejiao Li
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yukun Liu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Rui Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Jianping Tan
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Libin Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
| | - Yinglin Liu
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China (mainland)
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Duffett L, Rodger M. LMWH to prevent placenta-mediated pregnancy complications: an update. Br J Haematol 2014; 168:619-38. [DOI: 10.1111/bjh.13209] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Lisa Duffett
- Thrombosis Program; Division of Hematology; Department of Medicine; University of Ottawa; Ottawa ON Canada
| | - Marc Rodger
- Thrombosis Program; Division of Hematology; Department of Medicine; University of Ottawa; Ottawa ON Canada
- Clinical Epidemiology Program; The Ottawa Hospital Research Institute; Ottawa ON Canada
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Mazzucconi MG, De Sanctis V, Alfò M, Amendolea MA, Conti L, Santoro C, Baldacci E, Peraino M, Masala C. Maternal thrombophilia and adverse pregnancy outcome: a case-control study. Acta Haematol 2014; 133:242-8. [PMID: 25401392 DOI: 10.1159/000363048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the risk of adverse pregnancy outcomes in patients with acquired and/or congenital thrombophilia factors. PATIENTS AND METHODS A cohort of 130 women with a history of pregnancy loss and no successful gestation were investigated for the presence of congenital and acquired thrombophilia factors, and then compared with a control group of 130 healthy women who had had at least one successful gestation and no pregnancy loss, and were screened for congenital and acquired thrombophilia factors. RESULTS Acquired and congenital thrombophilia factors were found in 30 (23%) patients and in 14 (10.8%) controls (p < 0.015). The presence of ≥1 congenital thrombophilia factor was associated with pregnancy loss with an odds ratio of 2.46 (p = 0.040). Moreover, women who had had >1 early fetal loss had a 2.85-fold risk of being carriers of congenital thrombophilia factors, compared to the controls. CONCLUSION Our study showed the increased risk of miscarriage in patients with congenital thrombophilia factors and >1 early fetal loss.
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Enhanced prevalence of plasmatic soluble MHC class I chain-related molecule in vascular pregnancy diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:653161. [PMID: 25243172 PMCID: PMC4160641 DOI: 10.1155/2014/653161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 01/04/2023]
Abstract
The major histocompatibility complex class I related chain (MIC) is a stress-inducible protein modulating the function of immune natural killer (NK) cells, a major leukocyte subset involved in proper trophoblast invasion and spiral artery remodeling. Aim of the study was to evaluate whether upregulation of soluble MIC (sMIC) may reflect immune disorders associated to vascular pregnancy diseases (VPD). sMIC was more frequently detected in the plasma of women with a diagnostic of VPD (32%) than in normal term-matched pregnancies (1.6%, P < 0.0001), with highest prevalence in intrauterine fetal death (IUDF, 44%) and vascular intrauterine growth restriction (IUGR, 39%). sMIC levels were higher in preeclampsia (PE) than in IUFD (P < 0.01) and vascular IUGR (P < 0.05). sMIC detection was associated with bilateral early diastolic uterine notches (P = 0.037), thrombocytopenia (P = 0.03), and high proteinuria (P = 0.03) in PE and with the vascular etiology of IUGR (P = 0.0038). Incubation of sMIC-positive PE plasma resulted in downregulation of NKG2D expression and NK cell-mediated IFN-γ production in vitro. Our work thus suggests that detection of sMIC molecule in maternal plasma may constitute a hallmark of altered maternal immune functions that contributes to vascular disorders that complicate pregnancy, notably by impairing NK-cell mediated production of IFN-γ, an essential cytokine favoring vascular modeling.
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Weintraub AY, Press F, Wiznitzer A, Sheiner E. Maternal thrombophilia and adverse pregnancy outcomes. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.2.2.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Philipp CS, Faiz AS, Beckman MG, Grant A, Bockenstedt PL, Heit JA, James AH, Kulkarni R, Manco-Johnson MJ, Moll S, Ortel TL. Differences in thrombotic risk factors in black and white women with adverse pregnancy outcome. Thromb Res 2014; 133:108-11. [PMID: 24246297 PMCID: PMC4405792 DOI: 10.1016/j.thromres.2013.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/23/2013] [Accepted: 10/25/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Black women have an increased risk of adverse pregnancy outcomes and the characteristics of thrombotic risk factors in this population are unknown. The objective of this study was to examine the racial differences in thrombotic risk factors among women with adverse pregnancy outcomes. METHODS Uniform data were collected in women with adverse pregnancy outcomes (pregnancy losses, intrauterine growth restriction (IUGR), prematurity, placental abruption and preeclampsia) referred to Thrombosis Network Centers funded by the Centers for Disease Control and Prevention (CDC). RESULTS Among 343 white and 66 black women seen for adverse pregnancy outcomes, protein S and antithrombin deficiencies were more common in black women. The prevalence of diagnosed thrombophilia was higher among whites compared to blacks largely due to Factor V Leiden mutation. The prevalence of a personal history of venous thromboembolism (VTE) did not differ significantly by race. A family history of VTE, thrombophilia, and stroke or myocardial infarction (MI) was higher among whites. Black women had a higher body mass index, and a higher prevalence of hypertension, while the prevalence of sickle cell disease was approximately 27 fold higher compared to the general US black population. CONCLUSIONS Thrombotic risk factors differ significantly in white and black women with adverse pregnancy outcomes. Such differences highlight the importance of considering race separately when assessing thrombotic risk factors for adverse pregnancy outcomes.
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Affiliation(s)
- Claire S Philipp
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Ambarina S Faiz
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michele G Beckman
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Althea Grant
- Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - John A Heit
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Andra H James
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Roshni Kulkarni
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - Marilyn J Manco-Johnson
- Department of Pediatrics, University of Colorado, Denver and the Children's Hospital, Aurora, CO, USA
| | - Stephan Moll
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas L Ortel
- Departments of Medicine and Pathology, Duke University, Durham, NC, USA
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Settin A, Alkasem RA, Ali E, ElBaz R, Mashaley AM. Factor V Leiden and prothrombin gene mutations in Egyptian cases with unexplained recurrent pregnancy loss. Hematology 2013; 16:59-63. [DOI: 10.1179/102453311x12902908411959] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmad Settin
- Genetics Unit Mansoura University Children Hospital, Egypt
| | | | - Ehab Ali
- Department of BiochemistryFaculty of Science, Tanta University, Egypt
| | - Rizk ElBaz
- Genetics Unit Mansoura University Children Hospital, Egypt
| | - Abdel Megid Mashaley
- Department of Obstetrics and GynecologyFaculty of Medicine, Mansoura University, Egypt
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Abstract
Thrombophilias represent an evolving story that continues to stir controversy for care providers and obstetrical patients. The predominant thrombophilic mutations include the factor V Leiden mutation, prothrombin gene mutation G20210A, methylene tetrahydrafolate reductase C667T, and deficiencies of the natural anticoagulants proteins C and S, and antithrombin. Prospective cohort studies have provided an accurate assessment of the risk of placenta-mediated complications posed by common inherited thrombophilic conditions. Acquired thrombophilic conditions consist of the antiphospholipid antibody syndrome (APAS) and hyperhomocysteinemia. Well-conducted, placebo-controlled, randomized trials have demonstrated no benefit of anticoagulation in women with recurrent pregnancy loss and inherited thrombophilia. The routine use of anticoagulation to prevent other placenta-mediated complications in the setting of inherited thrombophilia should be considered experimental until the results of adequate clinical trials are available. Heparin anticoagulation and antiplatelet therapies are the cornerstone of treatment of APAS in pregnancy.
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Deveer R, Engin-Ustun Y, Akbaba E, Halisdemir B, Cakar E, Danisman N, Mollamahmutoglu L, Yesilyurt A, Candemir Z. Association between pre-eclampsia and inherited thrombophilias. Fetal Pediatr Pathol 2013; 32:213-7. [PMID: 23002795 DOI: 10.3109/15513815.2012.721475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim was to determine whether inherited thrombophilia increases the risk of pre-eclampsia (PE) or interferes with its clinical course. MATERIAL AND METHODS We included 50 patients with severe PE and 50 healthy pregnant women. Patients were evaluated for inherited thrombophilia. RESULTS Fourteen patients in the study group was factor V Leiden (FVL) carrier while it was 12% in the control group. In women with PE, FVL and other inherited thrombophilic factors were not more prevalent than in the controls. CONCLUSION The present study failed to demonstrate an association between the inherited thrombophilias and PE.
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Affiliation(s)
- Rüya Deveer
- Zekai Tahir Burak Women Health Research and Education Hospital, Ankara, Turkey.
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Rath W, Thaler CJ. [Hereditary thrombophilias and placental-mediated pregnancy complications in the II./III. trimester]. Hamostaseologie 2013; 33:21-36. [PMID: 23392307 DOI: 10.5482/hamo-12-11-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/18/2013] [Indexed: 11/05/2022] Open
Abstract
UNLABELLED Placental-mediated pregnancy complications (PmC) like preeclampsia, intrauterine growth restriction and placental abruption are common causes of fetal and maternal morbidity and mortality. The high prevalence of hereditary thrombophilias in case-control studies associated with pathological morphological findings of the placenta in these cases gave evidence for the association between hereditary thrombophilias and PmC. However, data from the literature are inconsistent, since subsequent prospective cohort studies could not demonstrate significant associations between inherited thrombophilia and PmC. Because of the multifactorial aetiology of PmC it may be difficult to prove, that hereditary thrombophilias are independent risk factors for PmC. Current guidelines do not recommend screening for inherited thrombophilias in patients with previous PmC. Evidence from current in vitro studies have shown, that heparin has beneficial non-anticoagulatory effects on trophoblast invasion. Retrospective case-control studies and recently published randomised controlled cohort studies have shown, that prophylactic administration of low-molecular-weight heparin (LWH), started in early pregnancy, may lead to a significant reduction in the incidence of PmC in subsequent pregnancies in patients with and without hereditary thrombophilias and previous PmC. CONCLUSION Large, well-designed multicenter studies are needed to elucidate the role of hereditary thrombophilias in cases of PmC and to confirm the benefit of LWH for subsequent pregnancy outcomes.
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Affiliation(s)
- W Rath
- Gynäkologie und Geburtshilfe, Medizinische Fakultät, Universitätsklinikum, Wendlingweg 2, 52074 Aachen.
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Abstract
PURPOSE OF REVIEW Acquired and inherited thrombophilia is an important research avenue in the recurrent miscarriage field. The optimum treatment for patients with recurrent miscarriage and a confirmed thrombophilia remains a contentious issue. We aim to appraise and explore the latest research in the field of thrombophilia and recurrent miscarriage in this review. RECENT FINDINGS Antiphospholipid syndrome (APS) is the only proven thrombophilia that is associated with adverse pregnancy outcomes. Research involving inherited thrombophilia and recurrent miscarriage is limited to small observational studies with small and heterogeneous populations. Aspirin and heparin therapy are frequently prescribed for APS, yet there is no robust evidence for the most efficacious regime. The combination of inherited hypercoagulability and environmental factors in association with recurrent miscarriage has recently been explored as an aid to identify high-risk individuals. SUMMARY The cause of recurrent miscarriage is multifactorial and appropriate treatment continues to be a challenge. Laboratory tests need to be standardized and well designed multicentre research trials are essential to expand on the current knowledge base with the aim to produce strong evidence-based medicine.
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Pristov JB, Maglić D, Opačić M, Mandić V, Miković Ž, Spasić M, Spasojević I. Ante- and postpartum redox status of blood in women with inherited thrombophilia treated with heparin. Thromb Res 2012; 130:826-9. [DOI: 10.1016/j.thromres.2012.08.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 08/13/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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Effects of low molecular weight heparins and unfractionated heparin on viability of human umbilical vein endothelial cells. Arch Gynecol Obstet 2012; 287:217-22. [DOI: 10.1007/s00404-012-2558-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 09/06/2012] [Indexed: 11/26/2022]
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50
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The association of antiphospholipid antibodies with intrauterine fetal death: A case–control study. Thromb Res 2012; 130:32-7. [DOI: 10.1016/j.thromres.2011.11.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/04/2011] [Accepted: 11/16/2011] [Indexed: 11/20/2022]
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