Clinical risk factors for vasculo-placental disorders: results from a prospective case-control study nested in HEMOTHEPP French cohort study

In young women, the presence of a prothrombotic disorder, termed thrombophilia, whether it is inherited or acquired, such as antiphospholipid syndrome (APS), is epidemiologically associated with vasculo-placental disorders, especially with intrauterine growth restriction (IUGR) and pre-eclampsia [1], [2], [3], [4], [5]. In the context of pre-eclampsia, thrombophilia is even associated with the earliest and the most severe clinical presentation of the disease. To support these findings, placental histopathological studies have been carried out in women with inherited thrombophilia [6], [7], [8], [9]. These studies showed that placental infarcts, fetal thrombotic vasculopathy and placental abruption were more frequently observed in women with than in women without thrombophilia [6], [7], [8], [9].

However, thrombophilia screening is costly and may have little ability to identify young women at risk of vasculo-placental disorders. One of the strongest indirect demonstrations is provided by the analysis of the risk of venous thromboembolism (VTE) in first degree relatives of patients with VTE. In patients with VTE occurring before 50 years, thrombophilia is detected in only 20% of cases; however, the risk of VTE in the first-degree relatives is high (>10%), whether inherited thrombophilia has been detected or not in probands, suggesting that most of these patients are likely to have an unknown inherited thrombophilia [10]. Consequently, it is plausible that the presence of a personal or a familial history of VTE in young pregnant women may detect more accurately women at higher risk of vasculo-placental disorders than thrombophilia screening.

However, if IUGR and pre-eclampsia have been shown to be associated with an increased risk of VTE during the postpartum period and more than ten years thereafter [11,12], the influence of a previous personal or familial history of VTE on the risk of vasculo-placental disorder has not been demonstrated yet.

Therefore, we conducted a prospective case-control study in order to determine the influence of a personal or a familial history of VTE on the risk of pre-eclampsia and IUGR, as well as the impact of other potential clinical risk factors in a large French cohort study.

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