Does the inherited thrombophilias worsen newborn pregnancy outcome in patients on antithrombotic medication for previous placenta-mediated diseases?

Bulgarian Medical Journal, 2023, 17(2), 45-50.

K. Neykova, V. Dimitrova

„Maichin Dom” State University Hospital and Department of Obstetrics and Gynecology et Medical faculty Medical University – Sofia

Abstract. Despite the increase in the relative risk for pregnancy complications in subsequent pregnancies in cases of a history of previous placenta mediated disorders (PMDs) and the presence of a thrombophilic state, the rise in the absolute risk for a negative pregnancy outcome remains insignificant. Aim of the study: To analyze if the presence of inherited thrombophilias (ITs) might have a negative impact on the newborn pregnancy outcome in patients on antithrombotic medication (AM) for previous PMDs. Materials and Methods. We studied 169 pregnant patients on AM for previous PMDs, who were divided into 2 groups: SG1 composed of 84 patients with previous PMDs and ITs, and SG2 containing 85 pregnant women with previous PMDs but without ITs. Each SG was further subdivided according to the type of applied AM: only on AM with low-dose aspirin (LDA) – SG1-LDA, only on AM with low-molecular weight heparin (LMWH) – SG1-LMWH, and on combined therapy both with LDA and LMWH – SG1-LDA+LMWH. SG2 was also subdivided into SG2-LDA, SG2-LMWH, and SG2-LDA+LMWH. We analyzed the following parameters: newborn average birthweight (g) – overall, as well as the case number of newborns with low, very low and extremely low birthweight. Last but not least, we studied the number of cases with neonatal death (NND) as well as the number of cases who necessitated intensive care unit (ICU) admission. Results. The average newborn birthweight in SG1-LDA was 3132.5 g, while 2618 g in SG2-LDA, 2642.85 g in SG1-LMWH, 2560.32 g in SG2-LMWH, 2288.43 g in SG1-LDA+LMWH, and 2727.33 g in SG2-LDA+LMWH. There were no newborn cases with low, very low and extremely low birthweight in SG1-LDA, as compared to SG2-LDA, SG1-LMWH, SG2-LMWH, SG1-LDA+LMWH, and SG2-LDA+LMWH. There was also a lack of cases with NND in SG1-LDA, as well as a lack of cases with ICU admission in comparison with the other studied subgroups of patients. Conclusion. The data acquired from our research did not show any negative impact of the presence of ITs on the newborn pregnancy outcome in patients on AM for previous history for PMDs. The application of a combined AM both with LDA and LMWH did not prove to lead to a better newborn pregnancy outcome than a single AM only with LDA or LMWH in patients with previous PMDs in the presence of ITs.

Key words: inherited thrombophilias (ITs), antithrombotic medication (АМ), average new-born birthweight, intensive care unit (ICU), neonatal death (NND)

Address for correspondence: Dr. Konstantsa Krassimirova Neykova, PhD, Department of Obstetrics and Gynecology et Medical faculty, Medical University, 2 “Zdrave” str., Bg – 1431 Sofia, e-mail: neykovaconstantsa@yahoo.com