Inherited and acquired prothrombotic risk factors in women with early or late pregnancy losses

Abstract number: P0926

Iglesias Varela^* M. L., Adamczuk^* Y., Cerrato^* G., Martinuzzo^* M., Forastiero† R.

^*Argentina; †Favaloro University, Favaloro Foundation, Argentina

Thrombophilia is defined as a tendency to thrombosis. The association between inherited and acquired thrombophilic defects and pregnancy loss is a rapidly developing field. However, apart from antiphospholipid antibodies (aPL), the role of other defects in the hemostatic pathways remains to be established. The purpose of this study was to investigate the possible role of inherited and acquired thrombophilia in women with 2 or more consecutive unexplained abortions (before the 10th week of gestation) or at least one fetal death (at or beyond the 10th week of gestation). We included 215 women (median age 36 years) with recurrent abortions (n = 77) or fetal losses (n = 138), and 88 control women (median age 40 years) with at least one healthy term infant and without gestational complications. Previous to the evaluation of thrombophilia, women with pregnancy losses had a number of gestations ranging from 1 to 13 (median 3). Mutation of factor V Leiden (FVL), G20210A polymorphism of prothrombin gene (PT-20210), 4G/5G promoter polymorphism of plasminogen activator inhibitor (PAI-1), and aPL (lupus anticoagulant and anticardiolipin antibodies) and fasting homocysteine (Hcy) concentration were analyzed. The presence of persistent aPL tended to be higher in women with abortions compared to that found in the control group (9.7% vs. 2.3%, P = 0.08). It was significantly more common in cases with fetal death (15.0%, OR 7.6, 95% CI 1.7–33.9, P < 0.003). There were no significant differences in the frequency of hyperhomocysteinemia (Hcy > 15 mM) between women with abortions (5.7%) or fetal deaths (16.4%) and the normal group (9.1%). A nonsignificant increase in FVL was detected in women with abortions (9.7%) compared with 1.3% in patients with fetal deaths and 2.3% in the control group. PT-20210AG showed similar prevalence in patients with previous abortions (0%), fetal deaths (3.6%) and control women (2.3%). In contrast to other polymorphisms or mutations, homozygous 4G/4G PAI-1 genotype was significantly more common in women with spontaneous abortions (53.8%) than in the control group (21.6%, OR 4.2, 95% CI 1.7–10.7, P < 0.003) or patients with fetal losses (29.0%). The significant high prevalence of some thrombophilic risk factors in patients with pregnancy losses suggests that their evaluation should be carried out.