ABSTRACT
Pre-eclampsia (P-EC) is a major cause of maternal and fetal morbidity and mortality.
Inherited thrombophilia has been suggested to increase the risk of P-EC or may accelerate
the pathophysiological process. In the past 20 years, numerous studies and meta-analyses
have yielded contradictory results regarding the association between inherited thrombophilia
and P-EC/hemolysis, elevated liver enzymes, low platelets syndrome. Although studies
published until 2002 reported on an increased prevalence of inherited thrombophilia
in pre-eclamptic women, most subsequent studies did not. Inconsistency of data may
be due to numerous confounders such as ethnicity, different definitions of P-EC, severity
of illness, and methods of testing. Mild P-EC is unlikely to be associated with thrombophilic
gene defects, whereas severe and early-onset P-EC is significantly related to inherited
and acquired thrombophilia. Thrombophilic patients with severe P-EC appear to have
an increased risk of overall maternal morbidity and recurrences of P-EC compared with
pre-eclamptic women without thrombophilia. It remains a matter of debate if women
with a previous history of (severe) P-EC should be screened for inherited thrombophilias
and if the administration of low molecular weight heparin should be recommended in
women with positive results to prevent adverse outcomes in subsequent pregnancies.
Large prospective studies are urgently needed to determine the benefits and risks
of prophylactic strategies.
KEYWORDS
Pre-eclampsia - inherited thrombophilia - conflicting data - confounders - management
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Werner RathM.D.
Professor of Obstetrics and Gynaecology, Faculty of Medicine, University Hospital
Aachen
Wendlingweg 2, 52074 Aachen, Germany
eMail: wrath@ukaachen.de
