[Pregnancy and thrombophilia in women with congenital deficit of antithrombin III, protein C, protein S or plasminogen: analysis of 39 cases].
BACKGROUND
Pregnancy, delivery and puerperium are situations which increment the risk of thromboembolic complications in women who are carriers of congenital heterozygotic deficits of type I antithrombin III (ATIII), protein C (PC) or protein S (PS). The aim of this study was to analyze the experience of the authors and propose therapeutic conduct in each case. Furthermore, the spontaneous losses of pregnancy related with these deficits were studied.


METHODS
Thirty-nine women, seventeen with ATIII deficit, fifteen with PC deficit and four with a deficit of PS and three with a plasminogen (Pg) deficit totalling 79 pregnancies and 51 thrombotic episodes sixteen of which were related with the pregnancy, delivery or puerperium were studied. The antigenic and functional activity of ATIII, PC, PS and Pg were determined.


RESULTS
The incidence of thrombosis for the ATIII deficit during pregnancy was 39%, which was greater, of statistical significance (p = 0.046), than the 15% observed during puerperium. In women with a deficit of PC, the incidence of thrombosis was 4.5% during pregnancy and 14% during puerperium with no significant difference between the two situations. The incidence of thrombosis during pregnancy and postpartum in the deficit of ATIII was significantly higher (p < 0.025) than that observed for the deficit of PC. For women with a deficit of PS and Pg the incidence of thrombosis was nul in pregnancy and puerperium.


CONCLUSIONS
Pregnancy and puerperium are situations which trigger thrombotic phenomena and increase the risk of the same in women with a deficit of antithrombin III and protein C and, to a lesser degree, the deficit of protein S or plasminogen. A strict control of these situations and individualized treatment is required according to the type of deficit, presence of previous thromboembolic history and anticoagulant history at the time of pregnancy. No increase in the risk of loss of pregnancy in any of the deficits studied was observed.
Montagud
M
M
Unidad de Hemostasia y Trombosis (Departamento de Hematología), Hospital de la Santa Creu i Sant Pau, Barcelona.
Montserrat
I
I
Oliver
A
A
Adelantado
J M
JM
Mateo
J
J
Borrell
M
M
Fontcuberta
J
J
D000328:Adult; D020152:Antithrombin III Deficiency; D005260:Female; D006801:Humans; D008661:Metabolism, Inborn Errors / Q000097:blood; D008875:Middle Aged; D010958:Plasminogen / Q000172:deficiency; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000378:metabolism; D020151:Protein C Deficiency; D018455:Protein S Deficiency; D013927:Thrombosis / Q000209:etiology*
D010958:Plasminogen