Preeclampsia and pregnancy loss in women with a history of venous thromboembolism and prophylactic low-molecular-weight heparin (LMWH) during pregnancy

Summary

Limited data are available regarding complications of pregnancy and pregnancy outcome under prophylaxis with low-molecular-weight heparin (LMWH) in women with a history of thromboembolism (TE).We retrospectively evaluated pregnancy complications ina cohort of 80 women. All hada history of TE (76 venous, two arterial and two venous and arterial) and received prophylactic LMWH during 86 pregnancies. The rate of preeclampsia and stillbirth in these women was compared to that of a control group of 313 women without a history of TE and LMWH. Prophylaxis was started at a median of 10 weeks of gestation and usually continued until six weeks post partum. In 94% of the cases the outcome of pregnancy was favourable with a live birth. Four pregnancies (4.7%) ended in miscarriage. Two (2.3%) pregnancies were complicated bya thromboembolic event (one deep leg vein thrombosis and PRIND, respectively). One patient developed HELLP-syndrome. Severe preeclampsia occurred in three (3.8%) and stillbirth in one (1.3%) of the patients (n=80), whereas this was the case in four (1.3%, odds ratio 3.01; 95% confidence interval (CI) 0.66–13.73, p=0.15) and 10 (3.2%, OR=0.38; 95% CI 0.05–3.04, p=0.72) control women. Mean birth weight and standard deviation of infants was 3,160± 930 g in patients and 3,300 ± 540 g in controls (p=0.11).We conclude that a favourable pregnancy outcome in women with a history of thromboembolism who use prophylactic LMWH during pregnancy can be expected. There was a trend towardsa higher risk of preeclampsia, and these women should be carefully monitored for this complication.

Keywords

Low-molecular-weight heparin - history of VTE - pregnancy loss - preeclampsia

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