Predicting Thrombophilia in Preeclampsia: Is Universal Testing Necessary?

Abstract

IntroductionThrombophilia (TP) has been proposed as a potential contributor to preeclampsia (PE). However, there is not a clear consensus on testing PE patients for TP due to contradictory evidences on this association. This study aims to identify what conditions of women with PE are associated with acquired and hereditary TP, and, additionally, to build a model of TP probability using these characteristics.Material and MethodsRetrospective unicentric analysis of women diagnosed with PE referred for TP testing between May 2019 and May 2024.ResultsIn 95 women, 19 (20%) tested positive for TP, of which nine (47%) had antiphospholipid syndrome (APS), six (32%) were heterozygous for PT G20210A, two (11%) had ADAMTS13 deficiency, one (5%) had PS deficiency and one (5%) had heterozygous FV Leiden. In multivariate analysis, intrauterine growth retardation (IUGR; odds ratio (OR) 0.08, 95% confidence interval (CI) 0.01-0.55) and history of previous abortions (OR 0.22, 95%CI 0.06-0.96) were negatively associated with TP. The group of women with both, one or none of those traits showed respectively a TP prevalence of 0%, 15% and 32%. The higher the prevalence of TP, the lower the incidence of placental insufficiency and prematurity (P < .05).ConclusionsIn pregnant women with PE, a history of previous abortions and IUGR were independently associated with the absence of TP. Women without these characteristics would probably benefit most from a Hematology consultation that includes a TP screening. A multinational standard TP screening framework for future studies is warranted to further our understanding of the role of TP in PE and to identify risk-groups for testing.

Keywords: preeclampsia; thrombophilia.