Document Detail

Thrombophilias and adverse pregnancy outcome - A confounded problem!
MedLine Citation:
PMID:  18217138     Owner:  NLM     Status:  MEDLINE    
It was the objective of this study to analyse the influence of confounders, such as ethnicity, severity of illness and method of testing, in articles concerning the still moot relationship of thrombophilias to adverse pregnancy outcome (APO). Relevant case-control studies were identified using Medline and EMBASE databases between 1966 and 2006. Search terms were recurrent fetal loss, intrauterine fetal death, preeclampsia, HELLP-syndrome, eclampsia, fetal growth restriction, abruptio placentae, combined with maternal thrombophilias. Data was extracted from the articles per subgroup of APO regardless of confounder. These subgroups were tested if they fulfilled the heterogeneity testing criterion (I(2) > 35%) to weigh the influence of the confounder. Confounders were selected and examined with Mantel-Haenszel method. Increased thrombophilia prevalence was confirmed in most adverse pregnancy outcomes. Ethnicity, genetic testing only and severity of illness were confounders in the various forms of APO. Stronger relationships between factor V Leiden and severity of disease were found in 2(nd) and 3(rd) trimester than 1(st) trimester recurrent fetal loss, in preeclampsia with: blood pressure > or =160/110 mmHg than > or =140/90 mmHg; proteinuria > or =5 grams per day than <5 grams; onset before than after 28 weeks, in fetal growth restriction <3(rd) percentile than <5(th), than <10(th), and in earlier occurrence of abruptio placentae than 3(rd) trimester. In conclusion, reports on the prevalence of maternal thrombophilias and APO are influenced by various confounders, which are not always appropriately analysed. The differences we have identified reflect the differential impact of these confounders. These data emphasise the importance of more uniform research.
Willem J Kist; Nard G Janssen; Jakoba J Kalk; William M Hague; Gustaaf A Dekker; Johanna I P de Vries
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review    
Journal Detail:
Title:  Thrombosis and haemostasis     Volume:  99     ISSN:  0340-6245     ISO Abbreviation:  Thromb. Haemost.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-02-21     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7608063     Medline TA:  Thromb Haemost     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  77-85     Citation Subset:  IM    
Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands.
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MeSH Terms
Abortion, Habitual / epidemiology*,  ethnology,  genetics
Abruptio Placentae / epidemiology*,  ethnology,  genetics
Case-Control Studies
Confounding Factors (Epidemiology)
Epidemiologic Research Design
Fetal Growth Retardation / epidemiology*,  ethnology,  genetics
Genetic Predisposition to Disease
Genetic Testing
Pregnancy Complications, Hematologic / epidemiology*,  ethnology,  genetics
Pregnancy Outcome* / ethnology,  genetics
Reproducibility of Results
Risk Factors
Severity of Illness Index
Thrombophilia / epidemiology*,  ethnology,  genetics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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