Blood Clotting Disorders in Pregnancy: Role of Thrombophilia Screening

Pregnancy affects your body in many ways, from your heart to your circulatory system. One of the effects of pregnancy is the tendency of your blood to clot. Increased blood clotting is a natural phenomenon in pregnancy. This is a safeguard to ensure that the bleeding is not profuse during childbirth. But in some cases, women might experience a condition known as thrombophilia. This condition means that the blood of a pregnant woman clots readily, even before conception. 

Awareness of thrombophilia pregnancy in India will help you realize the importance of blood clot risk during pregnancy. Even though the condition might seem daunting, rest assured: it is curable, and you will be able to have a successful pregnancy.

Thrombophilia is a condition in which your blood is predisposed to the formation of blood clots. These conditions come in two forms: inherited and acquired conditions.

Inherited thrombophilias involve Factor V Leiden mutation, Prothrombin gene mutation, and deficiencies of Proteins C, S, and Antithrombin. Acquired thrombophilias, such as Antiphospholipid syndrome, result from changes in the immune system. Pregnancy inherently causes a hypercoagulable state because of hormonal changes to prepare your body to stop bleeding during childbirth. Further studies in India have found it to be prevalent in varying proportions in women who are pregnant, with over a third in Western India.

Now here's the good news: Studies suggest that most women with inherited thrombophilias go on to have normal pregnancies. Thrombophilia does not mean that pregnancy will be complicated; rather, it means that the pregnancy needs to be treated to prevent complications.

Blood clot risk during pregnancy can manifest in several ways. Some women experience multiple miscarriages that doctors can't otherwise explain. Miscarriages after 10 weeks and stillbirths sometimes connect to clotting issues.​

Other complications include intrauterine growth restriction, where reduced placental blood flow limits your baby's nutrition. Severe preeclampsia involving high blood pressure occurs more frequently in some women with clotting disorders. Thrombophilia is additionally found in placental abruption, which refers to early separation of the placenta from the uterus. Venous thromboembolism, or clotting within the legs and/or lungs, is considered the most severe complication of thrombophilia.

However, maintain perspective. Research presents inconsistent data about pregnancy outcomes with thrombophilia. Several studies reported no difference in miscarriage rates or stillbirth rates when comparing pregnant women with thrombophilia to those without thrombophilia. Large prospective studies suggest that the majority of women with inherited thrombophilias do not have adverse pregnancy outcomes.​

Not all pregnant women require thrombophilia testing. It is recommended that testing be done selectively, based on some risk factors.

Screening can be considered if you have had blood clots, particularly deep vein thrombosis or pulmonary embolism. Familial history is very important. You should have blood clot screening if your family members have thrombophilia or blood clots. Women with recurring pregnancy loss should be screened. Screening is needed if you have had pregnancy complications such as severe preeclampsia, growth restriction, placental abruption, or stillbirth. Screening should be done for unprovoked blood clots at a younger age.

Within the Indian context, health practitioners advocate for selective screening owing to resource constraints in hospitals. At the top of the priority list are women who have experienced clotting in their family or in their immediate relatives. This is in recognition of the fact that full screening is not feasible in all of these institutions. Screening is cheaper than conducting tests on everyone.

It is not advised to do universal screening because it is not supported by any literature. As long as you're in good health and do not have a personal or family history of clotting, you do not need screening.

Thrombophilia screening includes blood tests that evaluate various genetic mutations and protein levels that affect blood clotting. Among the specific markers tested are the following: Prothrombin gene mutation, Factor V Leiden mutation, and levels of Protein S, Protein C, and Antithrombin. Testing for acquired thrombophilia would involve testing for antiphospholipid antibodies. Laboratories use specialized molecular methods.​

Complete workup testing is available in very few centres, usually in large cities, and access is poor in smaller towns. All these tests are done in different panels, and the cost ranges from panel to panel. Timing is everything, and testing should not be performed during an acute clotting incident. Discuss which tests are appropriate for your specific situation.

Thrombophilia requires proper treatment, which can result in a significant reduction of risks if a patient is diagnosed with it. Primarily, treatment includes Anticoagulation therapy, which refers to a class of drugs used to thin an individual’s blood and thus prevent its clotting. 

Indian care providers practice by following a standardized protocol based on global guidelines. If you have a history of blood clots before, you will be treated with anticoagulation therapy from conception through to six weeks post-delivery. If you test positive for your family’s high-risk thrombophilia but haven't personally developed blood clots, your physicians may advise treatment before and after delivery.

During the periods of treatment, there would be regular checks such as blood tests, monitoring of the level of platelets, ultrasound scans carried out to monitor the baby’s growth, and blood pressure checks.

You might wonder why doctors don't test all pregnant women. No studies have examined universal thrombophilia screening. Selective screening based on risk factors appears more cost-effective.​

Women with inherited thrombophilias usually fare well. From the literature, there is no conclusive evidence of an effect on the outcome. Additionally, insufficient evidence proves that treating screen-detected thrombophilia in symptom-free women effectively prevents complications.​

The general agreement is now in favour of selective and targeted screening, based on clinical symptoms – primarily in women with a personal and family history. The approach would be relevant in India as well, due to the variability of availability of testing.​

Thrombophilia is highly treatable. With proper medical attention, women successfully carry healthy pregnancies to term. Research shows most women with thrombophilia have successful pregnancies. Current clinical trials are constantly refining treatment strategies.​.​

Timely intervention before complications arise is made possible by early detection. It can also be beneficial to have a thorough family history of health issues. The Indian healthcare system is successfully incorporating global guidelines into its environment.

Discuss your family history with your doctor before getting pregnant. If you have had blood clots or complicated pregnancies, ask for a screening evaluation. If you are found to be at risk, receive care at centers that can manage high-risk pregnancies. Major hospitals in metro cities have the necessary specialized experience.

Understand your specific risk level and treatment plan. Have proper access to blood thinners. Research support groups concerning women who are dealing with a high-risk pregnancy.

Understanding thrombophilia in pregnancy in India will help you make healthy choices. Blood clot risk during pregnancy is manageable with good medical support. Not everyone needs to be screened, but it's very important for people at risk. When treatment is needed, it significantly improves outcomes. Most importantly, the vast majority of women with thrombophilia have healthy pregnancies and babies.

Discuss your healthcare provider about your risk factors and family history. You can download the ParentZ app to monitor your pregnancy, reach out to professionals experienced in thrombophilia management, join our supportive community, or visit our website.

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