Estudio revela exigua asociación entre trombofilias heredadas y complicaciones del embarazo
Las trombofilias son modelos biológicos complejos y elegantes, que han poblado la literatura obstétrica de historias de terror y decepción.
En su edición de enero de 2010, el Obstet Gynecol, publicó un estudio con más de 2 mil casos reclutados antes de las 22 semanas que indica que, a excepción de la mutación del gen de la protrombina, ninguna de otras 4 trombofilias examinadas se asoció a un curso adverso del embarazo.
Inherited Thrombophilia Polymorphisms and Pregnancy Outcomes in Nulliparous Women
Said, Joanne M. MBBS, et al. Obstet Gynecol Jan 2010
OBJECTIVE:
To estimate the association between five commonly inheritedthrombophilia polymorphisms and adverse pregnancy outcomes in women whohad no prior history of adverse pregnancy outcomes or personal orfamily history of venous thromboembolism.
METHODS:
Healthy nulliparous women (n=2,034) were recruited to this prospectivecohort study before 22 weeks of gestation. Genotyping for factor VLeiden, prothrombin gene mutation, methylenetetrahydrofolate reductaseenzyme (MTHFR) C677T, MTHFR A1298C, and thrombomodulin polymorphism wasperformed. Clinicians caring for women were blinded to the results ofthrombophilia tests. The primary composite outcome was the developmentof severe preeclampsia, fetal growth restriction, placental abruption,stillbirth, or neonatal death.
RESULTS:
Completemolecular results and pregnancy outcome data were available in 1,707women. These complications were experienced by 136 women (8.0%).Multivariable logistic regression demonstrated two statisticallysignificant findings. Women who carried the prothrombin gene mutationhad an odds ratio of 3.58 (95% confidence interval [CI] 1.20–10.61, P=.02)for the development of the composite primary outcome. Homozygouscarriers of the MTHFR 1298 polymorphism had an odds ratio of 0.26 (95%CI 0.08–0.86, P=.03). None of the other polymorphisms studiedshowed a significant association with the development of the primaryoutcome in this cohort of women.
CONCLUSION:
Prothrombin gene mutation confers an increased risk for the developmentof adverse pregnancy outcomes in otherwise asymptomatic, nulliparouswomen, whereas homozygosity for MTHFR 1298 may protect against thesecomplications. The majority of asymptomatic women who carry aninherited thrombophilia polymorphism have a successful pregnancyoutcome.
LEVEL OF EVIDENCE: II
Obstetrics & Gynecology:
January 2010 - Volume 115 - Issue 1 - pp 5-13
doi: 10.1097/AOG.0b013e3181c68907
Original Research
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