HYPERHOMOCYSTEINAEMIA AND PROTEIN-S DEFICIENCY IN COMPLICATED PREGNANCIES

Objective The aim of our study was to investigate whether women with p lacental abruption, intrauterine fetal death or small for gestational age infants have metabolic and/or haemostatic abnormalities which are known to be risk factors for intravascular thrombosis. Design For two years blood tests were performed at > 10 weeks after delivery on all w omen without hypertensive disorders either before or during pregnancy, who had been consecutively admitted to our hospital with placental ab ruption, intrauterine fetal death and small for gestational age. Sampl e A total of 62 women who had placental abruption (n = 31), intrauteri ne fetal death (n = 18) and a small for gestational age infant (n = 13 ). Setting Obstetric outpatient clinic in a university hospital (Free University Hospital, Amsterdam). Methods Presence of hyperhomocysteina emia, various coagulation abnormalities and anticardiolipins was inves tigated. Results Abnormalities were found in 20 women in the placental abruption group (20/31, 65%), in 10 women in the intrauterine fetal d eath group (10/18, 56%) and in 11 women in the small for gestational a ge group (11/13, 85%). Eight out of these 31 women had more than one a bnormality In the group of 62 women protein S deficiency was demonstra ted in 26%, hyperhomocysteinaemia in 24%, Protein C deficiency in 6%, anticardiolipin IgG in 11%, anticardiolipin IgM in 5%, Lupus anticoagu lant in 2%. An antithrombin III deficiency was not found. Thirty-three women were tested for activated protein C resistance (9% positive) an d factor V Leiden mutation (6% positive). Hyperhomocysteinaemia was tr eated with a daily oral dose of 250 mg pyridoxine and 5 mg folic acid. After six weeks of vitamin supplementation homocysteine levels were t ested again. At that time a mean reduction of fasting homocysteine val ue of 68% (95% CI 57-79) was found and of post-load value of 65% (95% CI55-76). Conclusions Based on the results of our study, it can be con cluded that women whose pregnancies are complicated by either placenta l abruption, intrauterine fetal death or small for gestational age, ev en if there is no history of thrombo-embolic disorders or hypertension during pregnancy, should be advised to undergo an examination for met abolic and/or haemostatic abnormalities.