Genetic thrombophilia and hypertensive complications of pregnancy

Abstract

Objective: To assess the frequency of genetic thrombophilia in patients with a history of hypertensive complications. Study design: We did a retrospective study of women referred for consultation with a history of severe preeclampsia, eclampsia, or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) from January 1998 to May 2000. Patients were tested for factor V Leiden (FVL), methylenetetrahydrofolate reductase (MTHFR), and prothrombin G (ProG) mutations. Maternal demographics were collected. Prevalence data adjusted to match the ethnic origin of the study population were used for comparison. Results: Fifty-four patients were evaluated. The median age, gravidity, and parity were 31.5 years (range, 18–52), 3 (range, 1–8), and 1 (range, 1–3). Of the patients, 46% were Caucasian, 36% African-American, 16% Hispanic, and 2% Asian. There were complications from HELLP syndrome and eclampsia in 17% and 5% of cases, respectively. Prevalence OR (CI) P FVL 10.2% 7.7 (1.3–44.3) <0.05 ProG 0% — NS MTHFR 32.1% — NS Conclusions: The prevalence of ProG and MTHFR were not higher than in controls. The increased frequency of the Leiden mutation suggests that a thromboembolic pathophysiology is important in preeclampsia. In a referral population, evaluation of the FVL mutation may be helpful for selection of women who potentially may benefit from anticoagulation treatment.