Thrombophilias and stillbirth.

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Reproductive Medicine

Background:

• Thrombophilias, encompassing inherited and acquired conditions, are frequently implicated as risk factors for stillbirth.
• Anticoagulant therapy is often prescribed to pregnant individuals with a history of fetal loss and thrombophilia to mitigate this perceived risk.

Purpose of the Study:

• To critically evaluate the evidence supporting a causal link between thrombophilias and stillbirth.
• To assess the efficacy of anticoagulation in reducing the recurrence risk of stillbirth in affected pregnancies.

Main Methods:

• Review of prospective studies investigating the association between inherited thrombophilias and stillbirth.
• Analysis of literature examining the impact of antiphospholipid antibodies on stillbirth risk.
• Evaluation of studies on the effectiveness of anticoagulation in pregnant women with prior fetal losses and thrombophilia.

Main Results:

• Prospective studies have not established a definitive causal relationship between inherited thrombophilias and stillbirth.
• High concentrations of antiphospholipid antibodies appear to be the primary thrombophilic factor associated with an increased risk of stillbirth.
• The benefit of anticoagulation in reducing stillbirth recurrence in women with prior fetal losses, even with high antiphospholipid antibody levels, is not clearly demonstrated.

Conclusions:

• The postulated link between inherited thrombophilias and stillbirth lacks robust scientific validation.
• Antiphospholipid antibody syndrome is the most consistently identified thrombophilia associated with stillbirth.
• The routine use of anticoagulation for thrombophilia in pregnancy to prevent stillbirth requires further investigation due to uncertain efficacy.