title: Prevention, management and extent of adverse pregnancy outcomes in women with hereditary antithrombin deficiency.
abstract: Antithrombin (AT) deficiency is a rare hereditary thrombophilia with a mean prevalence of 0.02 % in the general population, associated with a more than ten-fold increased risk of venous thromboembolism (VTE). Within this multicenter retrospective clinical analysis, female patients with inherited AT deficiency were evaluated concerning the type of inheritance and extent of AT deficiency, medical treatment during pregnancy and postpartally, VTE risk as well as maternal and neonatal outcome. Statistical analysis was performed with SPPS for Windows (19.0). A total of 18 pregnancies in 7 patients were evaluated, including 11 healthy newborns ≥37th gestational weeks (gw), one small for gestational age premature infant (25th gw), two late-pregnancy losses (21st and 28th gw) and four early miscarriages. Despite low molecular weight heparin (LMWH) administration, three VTE occurred during pregnancy and one postpartally. Several adverse pregnancy outcomes occurred including fetal and neonatal death, as well as severe maternal neurologic disorders occurred. Patients with substitution of AT during pregnancy in addition to LMWH showed the best maternal and neonatal outcome. Close monitoring with appropriate anticoagulant treatment including surveillance of AT levels might help to optimize maternal and fetal outcome in patients with hereditary AT deficiency.
authors.affiliation: Division of Gynecological Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Ludwig-Maximilians University-Großhadern, Marchioninistrasse 15, 81377, Munich, Germany, nina.rogenhofer@med.uni-muenchen.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Rogenhofer
authors.forename: Michael K
authors.initials: MK
authors.lastname: Bohlmann
authors.forename: Petra
authors.initials: P
authors.lastname: Beuter-Winkler
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Würfel
authors.forename: Andreas
authors.initials: A
authors.lastname: Rank
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Thaler
authors.forename: Bettina
authors.initials: B
authors.lastname: Toth
mesh_terms: D000026:Abortion, Habitual / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D000990:Antithrombin III / Q000009:adverse effects / Q000032:analysis / Q000627:therapeutic use*; D020152:Antithrombin III Deficiency / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005313:Fetal Death / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005317:Fetal Growth Retardation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D005858:Germany / Q000453:epidemiology; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006785:Hospitals, University; D006801:Humans; D009154:Mutation; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000188:drug therapy* / Q000235:genetics / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C542513:SERPINC1 protein, human; D000990:Antithrombin III; D006493:Heparin