title: Outcomes in an obstetrical population with hereditary thrombophilia and high tobacco use.
abstract: OBJECTIVE
  The purpose of this study was to examine birth outcomes in women treated or untreated for thrombophilia during pregnancies affected or not by tobacco exposure.
  
  
  METHODS
  This was a retrospective cohort study of consecutive women from a single maternal fetal medicine clinic who delivered between January 2009 and December 2013. We compared birth outcomes by four groups of thrombophilia and smoking combinations and then by treated or untreated groups.
  
  
  RESULTS
  Of the 8889 pregnant women in this study, 113 had thrombophilia and 97 received treatment. Thromboprophylaxis included: low molecular weight heparin, aspirin, unfractionated heparin, folic acid, and combinations of these. Smokers with thrombophilia had significantly higher rates of preeclampsia, intrauterine growth restriction, preterm birth (<37 weeks gestation) and low birth weight (all p ≤ .001). Conversely, this group had significantly lower rates of hemolysis, elevated liver enzymes, low platelet count (HELLP syndrome) and placental abruption. Women with thrombophilia who received thromboprophylaxis had lower rates of adverse birth outcomes, reaching significance for preterm birth <32 weeks gestation (4.3% versus 21.1%, p = .026).
  
  
  CONCLUSIONS
  Pregnant women who smoke and have thrombophilia may be more likely to experience adverse birth outcomes and receive more benefit from thromboprophylaxis than their nonsmoking counterparts.
authors.affiliation: a Department of Obstetrics and Gynecology , West Virginia University Charleston Campus , Charleston , WV , USA.
authors.forename: Byron
authors.initials: B
authors.lastname: Calhoun
authors.affiliation: b Center for Health Services and Outcomes Research , Charleston Area Medical Center Health Education and Research Institute , Charleston , WV , USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hoover
authors.affiliation: b Center for Health Services and Outcomes Research , Charleston Area Medical Center Health Education and Research Institute , Charleston , WV , USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Seybold
authors.affiliation: b Center for Health Services and Outcomes Research , Charleston Area Medical Center Health Education and Research Institute , Charleston , WV , USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Broce
authors.affiliation: a Department of Obstetrics and Gynecology , West Virginia University Charleston Campus , Charleston , WV , USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Hill
authors.affiliation: a Department of Obstetrics and Gynecology , West Virginia University Charleston Campus , Charleston , WV , USA.
authors.forename: Burk
authors.initials: B
authors.lastname: Schaible
authors.affiliation: c Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Hofstra Northwell School of Medicine , Southside Hospital , Bay Shore , NY , USA.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Bracero
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005865:Gestational Age; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018811:Maternal Exposure; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D019851:Thrombophilia / Q000188:drug therapy* / Q000453:epidemiology; D064424:Tobacco Use / Q000009:adverse effects* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Thrombophilia; birth outcome; pregnancy; treatment