title: Thrombophilia and Pregnancy Complications.
abstract: There is a paucity of strong evidence associated with adverse pregnancy outcomes and thrombophilia in pregnancy. These problems include both early (recurrent miscarriage) and late placental vascular-mediated problems (fetal loss, pre-eclampsia, placental abruption and intra-uterine growth restriction). Due to poor quality case-control and cohort study designs, there is often an increase in the relative risk of these complications associated with thrombophilia, particularly recurrent early pregnancy loss, late fetal loss and pre-eclampsia, but the absolute risk remains very small. It appears that low-molecular weight heparin has other benefits on the placental vascular system besides its anticoagulant properties. Its use is in the context of antiphospholipid syndrome and recurrent pregnancy loss and also in women with implantation failure to improve live birth rates. There is currently no role for low-molecular weight heparin to prevent late placental-mediated complications in patients with inherited thrombophilia and this may be due to small patient numbers in the studies involved in summarising the evidence. There is potential for low-molecular weight heparin to improve pregnancy outcomes in women with prior severe vascular complications of pregnancy such as early-onset intra-uterine growth restriction and pre-eclampsia but further high quality randomised controlled trials are required to answer this question.
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Hathersage Road, Manchester M13 9WL, UK. Louise.simcox@postgrad.manchester.ac.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK. Louise.simcox@postgrad.manchester.ac.uk.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Simcox
authors.affiliation: St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK. Laura.Moncreiffe@cmft.nhs.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: Ormesher
authors.affiliation: Maternal and Fetal Health Research Centre, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Hathersage Road, Manchester M13 9WL, UK. Clare.Tower@cmft.nhs.uk.|St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK. Clare.Tower@cmft.nhs.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Tower
authors.affiliation: The University of Manchester, Oxford Road, Manchester M13 9PL, UK. ian.greer@manchester.ac.uk.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Greer
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D019468:Disease Management; D010064:Embryo Implantation; D005260:Female; D005307:Fertilization in Vitro; D005865:Gestational Age; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000209:etiology*; D011256:Pregnancy Outcome; D019851:Thrombophilia / Q000150:complications* / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: fetal growth restriction; heparin; pregnancy complications; recurrent pregnancy loss; thrombophilia