Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications

A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs)...

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Published inBlood Vol. 123; no. 6; pp. 822 - 828
Main Authors Rodger, Marc A., Carrier, Marc, Le Gal, Grégoire, Martinelli, Ida, Perna, Annalisa, Rey, Évelyne, de Vries, J.I.P., Gris, Jean-Christophe
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 06.02.2014
American Society of Hematology
Subjects
Female
Heparin, Low-Molecular-Weight - administration & dosage
Humans
Infant, Newborn
Life Sciences
Placenta Diseases - prevention & control
Pre-Eclampsia - prevention & control
Pregnancy
Pregnancy Complications - prevention & control
Secondary Prevention
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Abstract A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs) comparing low-molecular-weight heparin (LMWH) vs no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs that included a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of pre-eclampsia (PE), birth of a small-for-gestational-age (SGA) newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67 (18.7%) of 358 of women being given prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications compared with 127 (42.9%) of 296 women with no LMWH (relative risk reduction, 0.52; 95% CI, 0.32 to 0.86; P = .01; I2, 69%, indicating moderate heterogeneity). We identified similar relative risk reductions with LMWH for individual outcomes, including any PE, severe PE, SGA <10th percentile, SGA <5th percentile, preterm delivery <37 weeks, and preterm delivery <34 weeks with minimal heterogeneity. LMWH may be a promising therapy for recurrent, especially severe, placenta-mediated pregnancy complications, but further research is required.
AbstractList A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs) comparing low-molecular-weight heparin (LMWH) vs no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs that included a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of pre-eclampsia (PE), birth of a small-for-gestational-age (SGA) newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67 (18.7%) of 358 of women being given prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications compared with 127 (42.9%) of 296 women with no LMWH (relative risk reduction, 0.52; 95% CI, 0.32 to 0.86; P = .01; I(2), 69%, indicating moderate heterogeneity). We identified similar relative risk reductions with LMWH for individual outcomes, including any PE, severe PE, SGA <10th percentile, SGA <5th percentile, preterm delivery <37 weeks, and preterm delivery <34 weeks with minimal heterogeneity. LMWH may be a promising therapy for recurrent, especially severe, placenta-mediated pregnancy complications, but further research is required.A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs) comparing low-molecular-weight heparin (LMWH) vs no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs that included a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of pre-eclampsia (PE), birth of a small-for-gestational-age (SGA) newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67 (18.7%) of 358 of women being given prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications compared with 127 (42.9%) of 296 women with no LMWH (relative risk reduction, 0.52; 95% CI, 0.32 to 0.86; P = .01; I(2), 69%, indicating moderate heterogeneity). We identified similar relative risk reductions with LMWH for individual outcomes, including any PE, severe PE, SGA <10th percentile, SGA <5th percentile, preterm delivery <37 weeks, and preterm delivery <34 weeks with minimal heterogeneity. LMWH may be a promising therapy for recurrent, especially severe, placenta-mediated pregnancy complications, but further research is required.
A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs) comparing low-molecular-weight heparin (LMWH) vs no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs that included a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of pre-eclampsia (PE), birth of a small-for-gestational-age (SGA) newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67 (18.7%) of 358 of women being given prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications compared with 127 (42.9%) of 296 women with no LMWH (relative risk reduction, 0.52; 95% CI, 0.32 to 0.86; P = .01; I(2), 69%, indicating moderate heterogeneity). We identified similar relative risk reductions with LMWH for individual outcomes, including any PE, severe PE, SGA <10th percentile, SGA <5th percentile, preterm delivery <37 weeks, and preterm delivery <34 weeks with minimal heterogeneity. LMWH may be a promising therapy for recurrent, especially severe, placenta-mediated pregnancy complications, but further research is required.
A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent recurrent placenta-mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomized controlled trials (RCTs) comparing low-molecular-weight heparin (LMWH) vs no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs that included a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of pre-eclampsia (PE), birth of a small-for-gestational-age (SGA) newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67 (18.7%) of 358 of women being given prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications compared with 127 (42.9%) of 296 women with no LMWH (relative risk reduction, 0.52; 95% CI, 0.32 to 0.86; P = .01; I2, 69%, indicating moderate heterogeneity). We identified similar relative risk reductions with LMWH for individual outcomes, including any PE, severe PE, SGA <10th percentile, SGA <5th percentile, preterm delivery <37 weeks, and preterm delivery <34 weeks with minimal heterogeneity. LMWH may be a promising therapy for recurrent, especially severe, placenta-mediated pregnancy complications, but further research is required.
: A 35 year old woman with recurrent severe placenta mediated pregnancy complications in her 2 pregnancies asks: Will low molecular weight heparin help prevent recurrent placenta mediated pregnancy complications in my next pregnancy? We performed a meta-analysis of randomised controlled trials (RCTs) comparing low molecular weight heparin (LMWH) versus no LMWH for the prevention of recurrent placenta-mediated pregnancy complications. We identified six RCTs, including a total of 848 pregnant women with prior placenta-mediated pregnancy complications. The primary outcome was a composite of PE, birth of a SGA newborn (<10th percentile), placental abruption, or pregnancy loss >20 weeks. Overall, 67/358 (18.7%) of women on prophylactic LMWH had recurrent severe placenta-mediated pregnancy complications, as compared with 127/296 (42.9%) women with no LMWH [relative risk reduction 0.52 (95% CI 0.32-0.86) (p=0.01) (I(2) 69% indicating moderate heterogeneity)]. We identified similar relative risk reductions with LMWH for individual outcomes including any PE, severe PE, SGA <10th, SGA <5th, preterm delivery <37 weeks and preterm delivery <34 weeks with minimal heterogeneity. Low molecular weight heparin may be a promising therapy for recurrent, especially severe, placenta mediated pregnancy complications but further research is required.
Author Carrier, Marc
Rey, Évelyne
Perna, Annalisa
de Vries, J.I.P.
Martinelli, Ida
Gris, Jean-Christophe
Rodger, Marc A.
Le Gal, Grégoire
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Copyright 2014 American Society of Hematology
Distributed under a Creative Commons Attribution 4.0 International License
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CorporateAuthor Low-Molecular-Weight Heparin for Placenta-Mediated Pregnancy Complications Study Group
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Snippet A 35-year-old woman with recurrent severe placenta-mediated pregnancy complications in her 2 pregnancies asks: Will low-molecular-weight heparin help prevent...
: A 35 year old woman with recurrent severe placenta mediated pregnancy complications in her 2 pregnancies asks: Will low molecular weight heparin help prevent...
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SubjectTerms Female
Heparin, Low-Molecular-Weight - administration & dosage
Humans
Infant, Newborn
Life Sciences
Placenta Diseases - prevention & control
Pre-Eclampsia - prevention & control
Pregnancy
Pregnancy Complications - prevention & control
Secondary Prevention
Title Meta-analysis of low-molecular-weight heparin to prevent recurrent placenta-mediated pregnancy complications
URI https://dx.doi.org/10.1182/blood-2013-01-478958
https://www.ncbi.nlm.nih.gov/pubmed/24357725
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