Favorable Outcome in the Pregnancy behind Treatment with Heparin in Women with Mutation of Methylenetetrahydrofolate Reductase (MTHFR) Gene and Fetal Loss Previous

Abstract number: P0485

Fisac Herrero¹ R, Santamaria² R, Olivier¹ C, Hernandez¹ J, Queizan¹ J, Fisac Martin¹ M, Martinez¹ M, Calmuntia¹ M

¹¹Dpt. Hematology-Hospital General Of Segovia ¹¹Dpt. Hematology-Hospital General Of Segovia ²²Dpt. Obstetric-Hospital General of Segovia

Introduction:  In the last few years, hyperhomocysteinemia and the mutation of the MTHFR gene have been associated with recurring fetal loss and placentary pathology (eclampsia, abruptio, . . .), probably thromboembolic. For this reason, our aim was to investigate the benefits of heparin, together with daily vitamin supplements, from the beginning of pregnancy, in women with a history of fetal loss and homozygotic or heterozigotic mutation of the MTHFR gene.

Materials and method:  Eleven pregnant women (median age 32; 24/42) with a history of at last one stillbirth, and in some cases miscarriage (9 cases) with polymorphism C-677-T (5 homozygotic and 6 heterozygotic). Obstetric causes were excluded. In all cases basic coagulation, Lupic Anticoagulant, Cardiolipins, beta-2 glycoprotein-1, AT-III, C-prot., S-prot., factor V Leiden, 20210-a gene, Plasminogen and serum levels of total homocysteine (tHcy), folic intraeritrocytic, were analyzed. Treatment: folic acid and vitamin B12 supplements plus heparins in adjusted doses according to the week of pregnancy: HBPM prior to conception until week 20 in prophylactic doses; HBPM between weeks 21 and 32 in therapeutic doses; HNF s.c. until week 38 in therapeutic doses, and HNF i.v. until a few hours before labour, in therapeutic doses.

Results:  The median serum levels of tHcy were 7.26 micromol/l (min/max: 4.64/9.97) and folic intraeritrocyte were 738 ng/ml (min/max: 322/1500). All women showed tHcy levels lower than 10 micromol/l. Six cases reached full term, without neonatal or placentary complications, one miscarried at 23 weeks. The other 4 reached 20 weeks. Neither mother or child had toxicity (haemorrhages, hyperlipidemia, thrombocytopenia, teratogenic) in any case.

Conclusion:  In our experience. The combination of folic acid, B12 and Heparins (in different forms and doses depending on the week of gestation) have been effective in reaching the full term of pregnancy in women with a mutation of the MTHFR gene.