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Thrombophilias and adverse pregnancy outcome - A confounded problem!
Willem J Kist1, Nard G Janssen, Jakoba J Kalk
1Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands.
Thrombosis and Haemostasis
|January 25, 2008
Summary
Maternal thrombophilias are linked to adverse pregnancy outcomes (APO). Factors like ethnicity and illness severity influence study results, highlighting the need for standardized research methods in thrombophilia and pregnancy outcome studies.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Medical Research Methodology
Background:
- The relationship between maternal thrombophilias and adverse pregnancy outcomes (APO) remains debated.
- Confounding factors may influence the reported associations between thrombophilias and APO.
Purpose of the Study:
- To analyze the influence of confounders (ethnicity, illness severity, testing methods) on studies of thrombophilias and APO.
- To identify how these confounders affect the observed relationships.
Main Methods:
- Systematic review of case-control studies (Medline, EMBASE, 1966-2006).
- Searched for terms related to APO and maternal thrombophilias.
- Data extraction and subgroup analysis, assessing heterogeneity (I² > 35%) and using Mantel-Haenszel methods for confounder analysis.
Main Results:
- Increased thrombophilia prevalence was confirmed in most APO cases.
- Ethnicity, genetic testing methods, and illness severity were identified as significant confounders.
- Stronger associations were observed with specific APO subtypes and varying confounder levels (e.g., Factor V Leiden and disease severity, preeclampsia criteria, fetal growth restriction percentiles, timing of abruptio placentae).
Conclusions:
- Research on maternal thrombophilias and APO is significantly influenced by various confounders.
- These confounders are not consistently analyzed, leading to differential impacts on reported associations.
- Emphasizes the critical need for more uniform and rigorous research methodologies in this field.
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