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Link Between Infertility Treatments and Pre-eclampsia?
by Geoffrey Sher, M.D.

Q. Is there any link between infertility treatments and pre-eclampsia? I had a successful IUI with a vanishing twin. I had horrible morning sickness and threw up the whole pregnancy. I started getting pre-eclampsia symptoms at 24 weeks and delivered at 26 weeks 3 days with eclampsia, Hellp, kidney failure, liver failure and a Gran Mal seizure. I just wondered if there have been any links to infertility treatments with my problems.

A. Possibly so because we now are beginning to see a link between pregnancy induced complications such as pre-eclampsia and abruptio placentae and perhaps hyperemesis on the one hand and immunologic implantation problems and thrombophylia on the other.

Thrombophilia is the inherited tendency to develop blood clots too easily. Thrombophilias are due either the presence of too much of certain blood-clotting factors or too little of anti-clotting proteins in the blood. As many as one in five people in the United States has a thrombophilia.

Most women with a thrombophilia have healthy pregnancies. However, the thrombophilias can contribute to a number of pregnancy complications, including pregnancy loss in the second or third trimester (i.e., stillbirths), placental abruption (when the placenta separates from the uterine wall, partially or completely, before delivery), and poor fetal growth. The thrombophilias also may cause pre-eclampsia, a pregnancy-related disorder characterized by high blood pressure and protein in the urine that can pose serious risks for mother and baby. Several of these problems are believed to result from blood clots in placental blood vessels that lead to changes in the placenta and reduced blood flow to the fetus.

Pregnant women in general are more likely than non-pregnant women to develop a venous thrombotic episode (VTE), or development of a blood clot in a vein. This is due to normal pregnancy-related changes in blood clotting in order to limit blood loss during labor and delivery. And pregnant women with a thrombophilia are at a higher risk than other pregnant women of developing a VTE. Studies suggest that more than half of pregnant women who develop a VTE have an underlying thrombophilia.

All pregnant women who have had a blood clot should be offered testing for hereditary thrombophilias. In addition, women with a family history of blood clots, pulmonary embolism (blood clot in the lung), or strokes that occurred prior to age 60; or a history of pregnancy complications, including stillbirth, early or severe pre-eclampsia, placental abruption, or poor fetal growth due to undetermined causes may be considered for testing.

Some pregnant women with thrombophilia are treated with one or more daily injections of low dose heparin, a blood-thinning drug, which does not cross the placenta and is safe for the baby. In some cases, physicians may recommend low doses of aspirin along with heparin. Low-dose aspirin with the B vitamins folic acid, B6 and B12 can be given to women who have one of the milder thrombophilias and a history of pregnancy complications, but not a history of blood clots.

Not all pregnant women with a thrombophilia need heparin treatment during pregnancy. Regular heparin can be supplanted with a newer form of heparin, called low-molecular-weight heparin, that appears to pose a lower risk of side effects such as bone loss and can be injected once instead of twice daily (as with regular heparin) and which reduces the risk of local bruising, significantly.

Generally, treatment is not recommended for most pregnant women with one of the less severe thrombophilias (such as factor V Leiden or prothrombin mutation) and no history of blood clots or pregnancy complications. This is because the risk of blood clots or pregnancy complications due to thrombophilia appears to be less than 1 percent in these women. However, treatment may be recommended for about six weeks after birth, when the risk of blood clots may be highest, if the woman has a strong family history of blood clots or if she has had a cesarean delivery.

Heparin treatment is recommended throughout pregnancy and the postpartum period for women who have one of the more severe thrombophylias ( e.g MTHFR genetic mutations and factor II G20210A) , even if they have not experienced any blood clots or pregnancy complications. Women with a thrombophilia (regardless of severity) who have a past history of blood clots are usually treated with heparin during pregnancy and the postpartum period. Warfarin (also a blood-thinning drug) may be used safely in addition to, or instead of, heparin in the post-partum period and during breast feeding. However, it is not recommended during pregnancy because it can cause birth defects.

As yet, no proven cause and effect relationship has been shown to exist between thrombophilia on the one hand and failed embryo implantation, poor IVF outcome, and/or early recurrent miscarriages, on the other.

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