Tags

Type your tag names separated by a space and hit enter

Case-control study of the frequency of thrombophilic disorders in couples with late foetal loss and no thrombotic antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5).
Thromb Haemost. 1999 Jun; 81(6):891-9.TH

Abstract

BACKGROUND

Women with familial thrombophilia have an increased risk of still birth. We postulated that the presence of asymptomatic risk factors for venous thrombosis might be a risk factor for late foetal loss.

METHODS

We performed a case-control study on the prevalence of heritable thrombophilic defects, of antiphospholipid-related markers and of the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with at least one episode of late unexplained foetal loss and in control women with successful pregnancies. Partners of cases and controls were also studied. Written conclusions of the pathological examination of the placentas, when available, were also reviewed.

RESULTS

We found at least one positive biological risk factor for venous thrombosis in 21.1% of the patients and in 3.9% of the controls (p < 10(-4)). In women, the crude odds ratio for still birth associated with any positive biological risk factor for venous thrombosis was 5.5, 95% confidence interval (95%CI) [3.4-9.0]. No difference was found between partners of cases and controls (5.2% and 4.7%). Using conditional logistic regression analysis, 4 adjusted risk factors for still birth remained: protein S deficiency, positive anti beta2 glycoprotein I IgG antibodies, positive anticardiolipin IgG antibodies and the factor V Leiden mutation. The C677T mutation in the MTHFR gene was not an individual risk factor but an homozygous genotype was strongly associated with the former 4 risk factors (16.8% of patients vs. 0.9% of controls). In women with such associations, still births always occurred in absence of folic acid supplementation during pregnancy. Available conclusions of pathological analysis of placentas were found to have a very high proportion of "maternal vascular disease of the placenta" in patients with at least one positive risk marker for thromboembolism, specially in case of association with the C677T MTHFR homozygous genotype, compared to patients with negative markers (p <10(-4)).

CONCLUSIONS

Late foetal loss, through placenta thrombosis, may sometimes be the consequence of a maternal multifactorial prothrombotic state associating traditional heritable or acquired thrombosis risk factors to conditions predisposing to an acute mild hyperhomocysteinaemia (coexistence of a genetic predisposition with late pregnancy-related increased folate needs).

Authors+Show Affiliations

Consultation et Laboratoire d'Hématologie, University Hospital, Nîmes, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10404763

Citation

Gris, J C., et al. "Case-control Study of the Frequency of Thrombophilic Disorders in Couples With Late Foetal Loss and No Thrombotic Antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5)." Thrombosis and Haemostasis, vol. 81, no. 6, 1999, pp. 891-9.
Gris JC, Quéré I, Monpeyroux F, et al. Case-control study of the frequency of thrombophilic disorders in couples with late foetal loss and no thrombotic antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5). Thromb Haemost. 1999;81(6):891-9.
Gris, J. C., Quéré, I., Monpeyroux, F., Mercier, E., Ripart-Neveu, S., Tailland, M. L., Hoffet, M., Berlan, J., Daurès, J. P., & Marès, P. (1999). Case-control study of the frequency of thrombophilic disorders in couples with late foetal loss and no thrombotic antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5). Thrombosis and Haemostasis, 81(6), 891-9.
Gris JC, et al. Case-control Study of the Frequency of Thrombophilic Disorders in Couples With Late Foetal Loss and No Thrombotic Antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5). Thromb Haemost. 1999;81(6):891-9. PubMed PMID: 10404763.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Case-control study of the frequency of thrombophilic disorders in couples with late foetal loss and no thrombotic antecedent--the Nîmes Obstetricians and Haematologists Study5 (NOHA5). AU - Gris,J C, AU - Quéré,I, AU - Monpeyroux,F, AU - Mercier,E, AU - Ripart-Neveu,S, AU - Tailland,M L, AU - Hoffet,M, AU - Berlan,J, AU - Daurès,J P, AU - Marès,P, PY - 1999/7/15/pubmed PY - 1999/7/15/medline PY - 1999/7/15/entrez SP - 891 EP - 9 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 81 IS - 6 N2 - BACKGROUND: Women with familial thrombophilia have an increased risk of still birth. We postulated that the presence of asymptomatic risk factors for venous thrombosis might be a risk factor for late foetal loss. METHODS: We performed a case-control study on the prevalence of heritable thrombophilic defects, of antiphospholipid-related markers and of the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with at least one episode of late unexplained foetal loss and in control women with successful pregnancies. Partners of cases and controls were also studied. Written conclusions of the pathological examination of the placentas, when available, were also reviewed. RESULTS: We found at least one positive biological risk factor for venous thrombosis in 21.1% of the patients and in 3.9% of the controls (p < 10(-4)). In women, the crude odds ratio for still birth associated with any positive biological risk factor for venous thrombosis was 5.5, 95% confidence interval (95%CI) [3.4-9.0]. No difference was found between partners of cases and controls (5.2% and 4.7%). Using conditional logistic regression analysis, 4 adjusted risk factors for still birth remained: protein S deficiency, positive anti beta2 glycoprotein I IgG antibodies, positive anticardiolipin IgG antibodies and the factor V Leiden mutation. The C677T mutation in the MTHFR gene was not an individual risk factor but an homozygous genotype was strongly associated with the former 4 risk factors (16.8% of patients vs. 0.9% of controls). In women with such associations, still births always occurred in absence of folic acid supplementation during pregnancy. Available conclusions of pathological analysis of placentas were found to have a very high proportion of "maternal vascular disease of the placenta" in patients with at least one positive risk marker for thromboembolism, specially in case of association with the C677T MTHFR homozygous genotype, compared to patients with negative markers (p <10(-4)). CONCLUSIONS: Late foetal loss, through placenta thrombosis, may sometimes be the consequence of a maternal multifactorial prothrombotic state associating traditional heritable or acquired thrombosis risk factors to conditions predisposing to an acute mild hyperhomocysteinaemia (coexistence of a genetic predisposition with late pregnancy-related increased folate needs). SN - 0340-6245 UR - https://www.unboundmedicine.com/medline/citation/10404763/Case_control_study_of_the_frequency_of_thrombophilic_disorders_in_couples_with_late_foetal_loss_and_no_thrombotic_antecedent__the_Nîmes_Obstetricians_and_Haematologists_Study5__NOHA5__ DB - PRIME DP - Unbound Medicine ER -