title: The search for thrombophilic gene mutations in women with gestational hypertension does not help in predicting poor pregnancy outcome.
abstract: OBJECTIVE
  To evaluate whether genetic thrombophilic mutations, biochemical and biophysical indices help to predict pregnancy outcome in women with gestational hypertension.
  
  
  METHODS
  A group of 59 women with gestational hypertension were prospectively tested between 24 and 26 weeks of gestation for: (i) DNA analysis to search for gene mutations of Factor V Leiden, prothrombin, methylenetetrahydrofolate reductase and plasminogen activator inhibitor type 1 (PAI-I) polymorphism; (ii) maternal serum concentrations of homocysteine and PAI-1, activated protein resistance and Factor II:C activity levels; (iii) mean uterine arterial resistance index (RI) by Doppler velocimetry; and (iv) history of hypertensive disorders in relatives (the mother and/or the father). Pregnancy outcome was evaluated, and considered 'poor' when patients developed severe pre-eclampsia, haemolysis-elevated liver enzymes-low platelets (HELLP) syndrome, fetal growth restriction (FGR), thromboembolic complications and disseminated intravascular coagulopathy (DIC).
  
  
  RESULTS
  Eighteen women had a poor pregnancy outcome (11 with severe pre-eclampsia, of whom two had superimposed FGR; three with full HELLP syndrome, of whom one had DIC; four with FGR) and delivered, by emergency Caesarean section, neonates with a significantly lower mean gestational age (P < 0.0001) and birthweight (P < 0.0001). History of hypertensive disorders was significantly (P < 0.001) more common in the women group with poor (11 of 18) than normal (10 of 41) outcome. In addition, patients with a poor pregnancy outcome did not have a higher incidence of gene polymorphisms incidence, but significantly (P < 0.01) higher Factor II:C activity levels and significantly (P < 0.0001) higher mean uterine arterial RI than women with normal pregnancy outcome.
  
  
  CONCLUSIONS
  Only Factor II:C activity levels, uterine arterial Doppler and a history of familial hypertension are useful in predicting poor pregnancy outcome in gestational hypertension.
mesh_terms: D000328:Adult; D005165:Factor V / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D017359:HELLP Syndrome / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D006710:Homocysteine / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000453:epidemiology / Q000235:genetics*; D017078:Laser-Doppler Flowmetry; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood / Q000235:genetics; D011225:Pre-Eclampsia / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000235:genetics*; D011516:Prothrombin / Q000235:genetics / Q000378:metabolism; D012307:Risk Factors; D013927:Thrombosis / Q000097:blood* / Q000453:epidemiology / Q000235:genetics*; D014463:Ultrasonography; D014599:Uterus / Q000098:blood supply
chemical_list: D017395:Plasminogen Activator Inhibitor 1; C095381:factor V Leiden; D006710:Homocysteine; D005165:Factor V; D011516:Prothrombin; D042965:Methylenetetrahydrofolate Reductase (NADPH2)