title: Recurrence and severity of abnormal pregnancy outcome in patients treated by low-molecular-weight heparin: a prospective pilot study.
abstract: OBJECTIVE
  This prospective pilot study assesses the recurrence rate and severity of abnormal pregnancy outcome (APO), excluding early pregnancy complications, in pregnant patients, without acquired thrombophilia, treated by prophylactic doses of low-molecular-weight heparin (LMWH), independently from their congenital thrombophilic condition.
  
  
  METHODS
  We recruited a cohort of 128 pregnant patients with previous APO; 100 of whom with APO and intrauterine growth restriction (IUGR) and 28 with maternal APO only. LMWH treatment was started at recruitment. Composite cross-over recurrence rate IUGR, gestational hypertension, preeclampsia, help syndrome, abruptio placenta were analyzed. The main outcome measure was severe APOs with iatrogenic delivery ≤ 32 weeks of gestation.
  
  
  RESULTS
  Median gestational age at LMWH treatment was 20 weeks. Severe APO decreased in treated pregnancies from 45% to 4% (relative risk = 0.3, confidence interval 95% = 0.2-0.8). This value was not significantly different in thrombophilic and nonthrombophilic patients. When severe and minor complications were analyzed altogether, the recurrence rate was 28%. In patients with APO and fetal growth restriction (FGR) in the index pregnancy, newborn weights were significantly better in the treated pregnancy: 1090 g (1035-1145) vs. 850 g (535-1200), p < 0.01.
  
  
  CONCLUSIONS
  Prophylactic regimen of LMWH significantly reduced the recurrence rate of severe composite APO in pregnancies affected in the index pregnancy by APO and FGR or small for gestational age newborns. This result was independent from the patients' inherited thrombophilic conditions.
authors: University Department of Clinical Sciences, Sacco and Buzzi Children's Hospital, Milan, Italy.
authors: Valentina
authors: V
authors: Conserva
authors: Marialuisa
authors: M
authors: Muggiasca
authors: Luisa
authors: L
authors: Arrigoni
authors: Valeria
authors: V
authors: Mantegazza
authors: Edoardo
authors: E
authors: Rossi
authors: Enrico
authors: E
authors: Ferrazzi
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight