Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study

Abstract

Objective: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH).

Methods: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion.

Results: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p > 0.05). There was no increased risk of SGA (unadjusted OR = 1.28, 95% confidence interval [CI] 0.9–1.83; adjusted OR = 1.35, 95% CI 0.91–2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p > 0.05). Also, we did not find a significant risk of IUGR (OR = 0.66; 95% CI 0.34–1.28; adjusted OR = 0.843; 95% CI 0.42–1.70).

Conclusions: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.

Keywords:

• Protein S deficiency
• fetal growth
• intrauterine growth retardation
• low-molecular-weight heparin
• birth weight

Declaration of interest

J. J. Fernández-Alba has received speaker’s honoraria from Sanofi. The other authors state that they do not have conflict of interest. The present study was approved by our local Ethics Committee (Comité de Ética de la Investigación del Hospital Universitario Puerto Real, Bahía de Cádiz-La Janda y Campo de Gibraltar) on April 30, 2015 (Reference number El 15_22). The authors received no specific funding for this article.