Effects of Thrombophilia and Antithrombotic Therapy on Embryonic Chromosomal Aberration Rates in Patients with Recurrent Pregnancy Loss

Abstract

Background: Miscarriage occurs in 10-15% of pregnancies and recurrent pregnancy loss (RPL) occurs in 1% of couples hoping for a child. Various risk factors, such as thrombophilia, uterine malformation, and embryonic chromosomal aberration cause RPL. We hypothesized that antithrombotic therapy for RPL patients with thrombophilia would reduce miscarriage due to thrombophilia, which would reduce the total miscarriages and result in a relative increase in miscarriage due to embryonic chromosomal aberrations. In this study, we investigated the incidence of chromosomal aberrations in products of conception in RPL patients with and without antithrombotic therapy. Methods:We performed a single-center, retrospective review of cases diagnosed as miscarriage with embryo chromosome analysis between July 1, 2000, and May 31, 2019. Rates of chromosomal aberration were compared between RPL patients with and without thrombophilia or antithrombotic therapy.Results: One hundred and-ninety RPL cases were analyzed. The average age was 37.4 ± 4.3 years, and the average number of previous pregnancy losses was 2.2 ± 1.1. The overall chromosomal aberration rate was 67.4% (128/190). There was no difference in the chromosomal aberration rate between the factors for RPL, with or without thrombophilia, and antithrombotic therapy. Only advancing maternal age had significant correlation to increased embryo chromosomal aberration rates. Conclusions:With or without antithrombotic therapy, miscarriage was caused by embryonic chromosome abnormalities at a certain rate. Antithrombotic therapy in RPL patients with thrombophilia may reduce abortions due to thrombophilia, which may also normalize the rate of embryonic chromosome aberrations in the subsequent miscarriages.

The postpartum uterine ultrasonographic scale in assessment of uterine involution after cesarean section in treated thrombophilia pregnant patients at term

“…There was also no difference in the chromosomal aberration rate between the factors for recurrent pregnancy loss, with or without thrombophilia, and antithrombotic therapy; only advancing maternal age was significantly correlated with increased embryo chromosomal aberration rates. 19 On the contrary, according to Kurodawa, 20 the live birth rate in thrombophilia patients treated with low‐dose aspirin increased in all patients, except for those older than 40 years old. Our patients were treated with low‐molecular‐weight heparin, not aspirin, but there was no difference regarding age.…”

Maternal cell contamination in embryonic chromosome analysis of missed abortions

“…About 25%-50% women experience miscarriage in their lives, and recurrent miscarriage occurs in 1% of couples hoping for a child. 10,15 Establishing the cause of miscarriage by chromosomal analysis of POC helps to choose the best treatment in the subsequent pregnancies. However, chromosome analysis by Gbanding method as well as other methods can contaminate maternal cells in some cases.…”

Anticoagulant therapy and psychological problem: Preparing for emerging problems associated with pregnancy and delivery

“…In order to improve the pregnancy rate, we are mainly conducting basic and clinical research on assisted reproductive technology and clinical research on preimplantation genetic diagnosis. [3,4] In our department, we are also performing research concerning recurrent pregnancy loss as pre-conception care which improves the health condition of children who will be born someday. Recurrent pregnancy loss is a disease in which pregnancy will be gotten but stillbirth and/or early neonatal mortality will be repeated.…”