Summary of Recommendations
The following recommendations are based on limited or inconsistent scientific evidence (Level B):
• Screening for inherited thrombophilias is not recommended for women with a history of fetal loss or adverse pregnancy outcomes including abruption, preeclampsia, or fetal growth restriction because there is insufficient clinical evidence that antepartum prophylaxis with unfractionated heparin or low-molecular-weight heparin prevents recurrence in these patients.
• Because of the lack of association between either heterozygosity or homozygosity for the MTHFR C677T polymorphism and any negative pregnancy outcomes, including any increased risk of VTE, screening with either MTHFR mutation analyses or fasting homocysteine levels is not recommended.
• Warfarin, low-molecular-weight heparin, and unfractionated heparin do not accumulate in breast milk and do not induce an anticoagulant effect in the infant; therefore, these anticoagulants may be used in women who breastfeed.
The following recommendations are based primarily on consensus and expert opinion (Level C):
• Among women with personal histories of VTE, recommended screening tests for inherited thrombophilias should include factor V Leiden mutation; prothrombin G20210A mutation; and antithrombin, protein S, and protein C deficiencies.
• All patients with inherited thrombophilias should undergo individualized risk assessment, which may modify management decisions regarding VTE prevention.
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ACOG Practice Bulletin No. 197
Summary: Inherited Thrombophilias in Pregnancy.
Obstet Gynecol. 2018 Jul;132(1):249-251
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