Inherited Thrombophilia and Pregnancy Loss

Abstract

IntroductionA successful pregnancy is dependent on the development of adequate placental circulation. Abnormalities of placental vasculature may result in a number of gestational pathologies, including first and second trimester miscarriages, intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD), placental abruption, and preeclampsia.1 Approximately 5% of women experience two or more consecutive abortions. Habitual abortions, defined as three or more spontaneous recurrent pregnancy losses, may affect as many as 1% to 2% of women of reproductive age. The discovery of an association between recurrent pregnancy loss, and antiphospholipid antibodies, specifically lupus anticoagulant, and anticardiolipin antibodies increased interest in a possible acquired thrombotic autoimmune cause.The inherited thrombophilias are a group of genetic disorders of blood coagulation resulting in an increased risk of thrombosis. Today, a full understanding of the inherited thrombophilias is becoming increasingly important in the management of high-risk gestations. Several reports over the last three years have suggested that not only are these disorders associated with an increased risk of thromboembolic disease during pregnancy and puerperium, but they are also associated with an increased incidence of vascular pathologies, resulting in poor gestational outcome.2 This review will cover recent data concerning thrombophilia and vascular placental pathology, potential pathophysiologic mechanisms for this association, and available therapeutic modalities for prevention of placental vascular thrombosis in order to maximize successful gestational outcome.