A Systematic Search for Thrombophilia in 396 women with a History of Preeclampsia and the Impact on Subsequent Pregnancies

Objective: To assess the prevalence and impact of thrombophilia in preeclampsia. Study Design: Our postnatal screening implied protein S and C-deficiency, APC-resistance, factor V Leiden- and prothombin G20210A-mutation, anticardiolipin AB, lupus AC and ATIII deficiency and hyperhomocysteinemia in 252 women with early-onset <32 weeks and 144 women with late-onset preeclampsia. In subsequent pregnancies (72 with ≥1 thrombophilia) we compared the perinatal outcome. Results: Thrombophilias were present in 37% of patients with early- and 31% with late-onset preeclampsia. Only protein S deficiency (9,5%; PR 118,75; BI 102,1–138,1) and prothrombin G20210A mutation (5,0%; PR 1,25; BI 1,08–1,45) were significantly more involved in early preeclampsia considering the general prevalence. The recurrence risk in patients without thrombophilia was 46,6% in non-treated and 16,5% in women who received aspirin and for women with ≥ 1 thrombophilia it was 33% in non-treated or only aspirin treated women and 13,5% in women treated with heparin, vitamin B6 + folic acid. The outcome of subsequent pregnancies was better than of the index-pregnancy. Conclusions: Our study provides the largest population with known thrombophilic status and subsequent pregnancies. In the most recent metaanalysis (Lin and August, AJOG 2005) protein S deficiency and subsequent pregnancies were not investigated. Our data suggest that subsequent pregnancy outcomes do not differ between former preeclamptic women with or without thrombophilia. We now participate in a randomised trial to evaluate the impact of heparin.