A study on prethrombotic state and pregnancy outcomes in pregnant women with fetal growth restriction

doi:10.3877/cma.j.issn.2095-3259.2026.03.007

Abstract

Abstract:

Objective

To investigate the detection rate and risk factors of abnormal prethrombotic state and its association with pregnancy outcomes in pregnant women with fetal growth restriction.

Methods

A retrospective study was conducted on 182 pregnant women with FGR treated at our hospital from January to December 2024. Data collected included maternal age, pre-pregnancy body mass index (BMI), mode of conception, obstetric history, gestational age at first FGR diagnosis, gestational age at prethrombotic state testing, pregnancy complications and comorbidities, TORCH screening results, prenatal screening or diagnostic findings, medication during pregnancy, and pregnancy outcomes. Laboratory tests included antiphospholipid antibody profiles, antinuclear antibodies, protein C/S, antithrombin Ⅲ (AT-Ⅲ), and homocysteine levels. Patients were divided into an abnormal group (n=99) and a normal group (n=83) based on test results. Clinical characteristics and pregnancy outcomes were compared between the two groups.

Results

Prethrombotic state abnormalities were detected in 54.3% of FGR pregnant women. Compared with the normal group, the abnormal group had significantly higher levels of anticardiolipin antibody IgM, anti-β2-glycoprotein I antibody IgM, lupus anticoagulant screening/confirmatory ratio, anti-phosphatidylserine/prothrombin antibody IgM, and antinuclear antibodies, along with significantly lower levels of AT-Ⅲ activity and protein S, with all differences being statistically significant (all P<0.05). Multivariate logistic regression analysis identified maternal age (OR=1.10, 95%CI: 1.01-1.20) and high pre-pregnancy BMI (OR=1.10, 95%CI: 1.00-1.22) as independent risk factors for prethrombotic state abnormalities.

Conclusions

Advanced maternal age and high pre-pregnancy BMI are independent risk factors for prethrombotic state abnormalities in pregnant women with FGR, with a high detection rate. Screening for prethrombotic state is recommended in FGR patients with these risk factors to improve pregnancy outcomes.

Key words: Fetal growth restriction, Antibodies, antiphospholipid, Prethrombotic state, Pregnancy outcome, Risk factors

Lujing Chen, Feiyan Li, Zhuang Li, Yacong Cao, Xiaohui Ji, Hui Chen, Yihong Guo, Ping Zhou. A study on prethrombotic state and pregnancy outcomes in pregnant women with fetal growth restriction[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2026, 15(03): 167-174.

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References 33

[1]	段涛，杨慧霞，胡娅莉，等. 胎儿生长受限专家共识(2019版)[J/OL]. 中国产前诊断杂志(电子版)，2019，11(4)：78-98.
[2]	Lausman A, Kingdom J, Maternal Fetal Medicine Committee. Intrauterine growth restriction: screening, diagnosis, and management[J]. J Obstet Gynaecol Can，2013，35(8)：741-748.
[3]	American College of Obstetricians and Gynecologists′ Committee on Practice Bulletins—Obstetrics and the Society forMaternal-FetalMedicin. ACOG practice bulletin No. 204: fetal growth restriction[J]. Obstet Gynecol，2019，133(2)：e97-109.
[4]	Morris RK, Johnstone E, Lees C, et al. Investigation and care of a small-for-gestational-age fetus and a growth restricted fetus (green-top guideline No. 31)[J]. BJOG，2024，131(9)：e31-80.
[5]	中华医学会血液学分会血栓与止血学组. 易栓症诊断与防治中国指南(2021年版)[J]. 中华血液学杂志，2021，42(11)：881-888.
[6]	Committee on Practice Bulletins—Obstetrics, American College of Obstetricians and Gynecologists. Practice bulletin No. 132: antiphospholipid syndrome[J]. Obstet Gynecol，2012，120(6)：1514-1521.
[7]	Yasuda M, Takakuwa K, Tokunaga A, et al. Prospective studies of the association between anticardiolipin antibody and outcome of pregnancy[J]. Obstet Gynecol，1995，86(4 Pt 1)：555-559.
[8]	连岩，王谢桐. 遗传性易栓症的妊娠期筛查与抗凝治疗评价[J]. 中国实用妇科与产科杂志，2017，33(7)：678-684.
[9]	American College of Obstetricians and Gynecologists. Fetal growth restriction：ACOG practice bulletin, number 227[J].Obstet Gynecol，2021，137(2)：e16-28.
[10]	Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R, et al. The European registry on obstetric antiphospholipid syndrome (EUROAPS): a survey of 1000 consecutive cases[J]. Autoimmun Rev，2019，18(4)：406-414.
[11]	中华医学会围产医学分会. 产科抗磷脂综合征诊断与处理专家共识[J]. 中华围产医学杂志，2020，23(8)：517-522.
[12]	Rosina S, Chighizola CB, Ravelli A, et al. Pediatric antiphospholipid syndrome: from pathogenesis to clinical management[J]. Curr Rheumatol Rep，2021，23(2)：10.
[13]	Carroll TY, Mulla MJ, Han CS, et al. Modulation of trophoblast angiogenic factor secretion by antiphospholipid antibodies is not reversed by heparin[J]. Am J Reprod Immunol，2011，66(4)：286-296.
[14]	中华医学会风湿病学分会. 系统性红斑狼疮诊断及治疗指南[J]. 中华风湿病学杂志，2010，14(5)：342-346.
[15]	Labarrere CA. Acute atherosis. A histopathological hallmark of immune aggression？[J]. Placenta，1988，9(1)：95-108.
[16]	张慧萍. 同型半胱氨酸与妊娠相关疾病和胎儿出生缺陷基础与临床[M]. 北京：科学出版社，2017：152-159.
[17]	Sarig G, Younis JS, Hoffman R, et al. Thrombophilia is common in women with idiopathic pregnancy loss and is associated with late pregnancy wastage[J]. Fertil Steril，2002，77(2)：342-347.
[18]	Fujisaki M, Furuta K, Ohhashi M, et al. Antithrombin improves the maternal and neonatal outcomes but not the angiogenic factors in extremely growth-restricted fetuses at <28 weeks of gestation[J]. J Perinat Med，2017，45(7)：837-842.
[19]	Duarte-García A, Pham MM, Crowson CS, et al. The epidemiology of antiphospholipid syndrome: a population-based study[J]. Arthritis Rheumatol，2019，71(9)：1545-1552.
[20]	Dabit JY, Valenzuela-Almada MO, Vallejo-Ramos S, et al. Epidemiology of antiphospholipid syndrome in the general population[J]. Curr Rheumatol Rep，2022，23(12)：85.
[21]	朱锋，戈小虎，慈红波，等. 新疆哈萨克族人群遗传性易栓症流行病学调查[J]. 中华实用诊断与治疗杂志，2014，28(7)：638-640.
[22]	赵永强，朱铁楠，华宝来，等. 中国人群遗传性易栓症的多中心流行病学调查[C].第十一届全国血栓与止血学术会议暨血栓栓塞性疾病(血栓与止血)基础与临床研究进展学习班论文摘要汇编及学习班讲义，太原：中华医学会血液学分会血栓与止血学组，2007：173.
[23]	Morris MS, Jacques PF, Selhub J, et al. Total homocysteine and estrogen status indicators in the Third National Health and Nutrition Examination Survey[J]. Am J Epidemiol，2000，152(2)：140-148.
[24]	常广，陈永春，胡筱冉，等. 健康体检人群高同型半胱氨酸血症与血脂异常及肥胖关系[J]. 临床误诊误治，2017，30(11)：74-77.
[25]	徐祥凤，杨文东. 中青年超重和肥胖与高血压及高同型半胱氨酸血症的相关性研究[J]. 实用心脑肺血管病杂志，2014，22(5)：20-21.
[26]	王桂云，朱慧楠，林延明，等. 大学生肥胖与血脂、血清同型半胱氨酸的相关性分析[J]. 中国医药指南，2012，10(8)：322，324.
[27]	国家妇幼健康研究会生殖免疫学专业委员会专家共识编写组. 复发性流产合并血栓前状态诊治中国专家共识[J]. 中华生殖与避孕杂志，2021，41(10)：861-875.
[28]	Preston FE, Rosendaal FR, Walker ID, et al. Increased fetal loss in women with heritable thrombophilia[J]. Lancet，1996，348(9032)：913-916.
[29]	Kupferminc MJ, Eldor A, Steinman N, et al. Increased frequency of genetic thrombophilia in women with complications of pregnancy[J]. N Engl J Med，1999，340(1)：9-13.
[30]	Kupferminc MJ, Fait G, Many A, et al. Low-molecular-weight heparin for the prevention of obstetric complications in women with thrombophilias[J]. Hypertens Pregnancy，2001，20(1)：35-44.
[31]	中华医学会妇产科学分会妊娠期高血压疾病学组. 妊娠期高血压疾病诊治指南(2020)[J]. 中华妇产科杂志，2020，55(4)：227-238.
[32]	低分子肝素防治自然流产中国专家共识编写组. 低分子肝素防治自然流产中国专家共识[J]. 中华生殖与避孕杂志，2018，38(9)：701-708.
[33]	复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识编写组. 复发性流产合并风湿免疫病免疫抑制剂应用中国专家共识[J]. 中华生殖与避孕杂志，2020，40(7)：527-534.

项目	结果
年龄(岁，±s)	30.1±3.6
孕前BMI[kg/m²，M(P₂₅，P₇₅)]	20.8 (19.0, 22.9)
首次发现FGR孕周[周，M(P₂₅，P₇₅)]	26.0 (24.0, 31.0)
检测孕周[周，M(P₂₅，P₇₅)]	30.0 (25.0, 32.0)
孕次[次，M(P₂₅，P₇₅)]	2.00 (1.00, 2.00)
产次[次，M(P₂₅，P₇₅)]	0.00 (0.00, 1.00)
自然流产次数[次，M(P₂₅，P₇₅)]	0.00 (0.00, 0.00)
不良孕产史[例(%)]	12 (6.6%)
妊娠合并症或并发症[例(%)]	80 (44.0%)
胎盘或脐带因素[例(%)]	36 (19.9%)
分娩孕周[周，M(P₂₅，P₇₅)]	38.00 (37.00, 39.00)
顺产[例(%)]	97 (53.3%)
阴道助产[例(%)]	3 (1.6%)
剖宫产[例(%)]	82 (45.1%)
新生儿出生体重[kg，M(P₂₅，P₇₅)]	2.61 (2.29, 2.90)
Apgar评分1 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
Apgar评分5 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
Apgar评分10 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
新生儿转入NICU[例(%)]	46 (25.3%)

项目	结果
年龄(岁，±s)	30.1±3.6
孕前BMI[kg/m²，M(P₂₅，P₇₅)]	20.8 (19.0, 22.9)
首次发现FGR孕周[周，M(P₂₅，P₇₅)]	26.0 (24.0, 31.0)
检测孕周[周，M(P₂₅，P₇₅)]	30.0 (25.0, 32.0)
孕次[次，M(P₂₅，P₇₅)]	2.00 (1.00, 2.00)
产次[次，M(P₂₅，P₇₅)]	0.00 (0.00, 1.00)
自然流产次数[次，M(P₂₅，P₇₅)]	0.00 (0.00, 0.00)
不良孕产史[例(%)]	12 (6.6%)
妊娠合并症或并发症[例(%)]	80 (44.0%)
胎盘或脐带因素[例(%)]	36 (19.9%)
分娩孕周[周，M(P₂₅，P₇₅)]	38.00 (37.00, 39.00)
顺产[例(%)]	97 (53.3%)
阴道助产[例(%)]	3 (1.6%)
剖宫产[例(%)]	82 (45.1%)
新生儿出生体重[kg，M(P₂₅，P₇₅)]	2.61 (2.29, 2.90)
Apgar评分1 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
Apgar评分5 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
Apgar评分10 min[分，M(P₂₅，P₇₅)]	10.00 (10.00, 10.00)
新生儿转入NICU[例(%)]	46 (25.3%)

项目	检测结果
抗心磷脂抗体[AU/ml，M(P₂₅，P₇₅)]	4.10 (2.40, 5.00)
抗心磷脂抗体IgM[MPLU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.64)
抗心磷脂抗体IgG[GPLU/ml，M(P₂₅，P₇₅)]	1.48 (1.12, 1.92)
抗β2糖蛋白Ⅰ抗体IgM[AU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.00)
抗β2糖蛋白Ⅰ抗体IgG[AU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.00)
狼疮抗凝物初筛/确认比值[M(P₂₅，P₇₅)]	1.13 (1.08, 1.19)
aPS/PT IgM[U/ml，M(P₂₅，P₇₅)]	20 (13, 28)
aPS/PT IgG[U/ml，M(P₂₅，P₇₅)]	11.1 (6.0, 14.5)
类风湿因子[IU/ml，M(P₂₅，P₇₅)]	7.96 (7.04, 9.23)
抗核抗体及抗核抗体谱阳性[例(%)]	40 (22.6%)
蛋白C[%，M(P₂₅，P₇₅)]	113 (100, 128)
蛋白S[%，M(P₂₅，P₇₅)]	43 (37, 49)
抗凝血酶Ⅲ[%，M(P₂₅，P₇₅)]	87 (81, 98)
同型半胱氨酸[μmol/L，M(P₂₅，P₇₅)]	5.40 (4.70, 6.40)

项目	检测结果
抗心磷脂抗体[AU/ml，M(P₂₅，P₇₅)]	4.10 (2.40, 5.00)
抗心磷脂抗体IgM[MPLU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.64)
抗心磷脂抗体IgG[GPLU/ml，M(P₂₅，P₇₅)]	1.48 (1.12, 1.92)
抗β2糖蛋白Ⅰ抗体IgM[AU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.00)
抗β2糖蛋白Ⅰ抗体IgG[AU/ml，M(P₂₅，P₇₅)]	2.00 (2.00, 2.00)
狼疮抗凝物初筛/确认比值[M(P₂₅，P₇₅)]	1.13 (1.08, 1.19)
aPS/PT IgM[U/ml，M(P₂₅，P₇₅)]	20 (13, 28)
aPS/PT IgG[U/ml，M(P₂₅，P₇₅)]	11.1 (6.0, 14.5)
类风湿因子[IU/ml，M(P₂₅，P₇₅)]	7.96 (7.04, 9.23)
抗核抗体及抗核抗体谱阳性[例(%)]	40 (22.6%)
蛋白C[%，M(P₂₅，P₇₅)]	113 (100, 128)
蛋白S[%，M(P₂₅，P₇₅)]	43 (37, 49)
抗凝血酶Ⅲ[%，M(P₂₅，P₇₅)]	87 (81, 98)
同型半胱氨酸[μmol/L，M(P₂₅，P₇₅)]	5.40 (4.70, 6.40)

组别	例数	年龄(岁，±s)	孕前BMI[kg/m²，M(P₂₅，P₇₅)]	首次发现FGR孕周[周，M(P₂₅，P₇₅)]	检测孕周[周，M(P₂₅，P₇₅)]
异常组	99	30.6±3.8	21.4 (19.5, 23.3)	27.0 (24.0, 31.0)	30.0 (25.0, 32.0)
正常组	83	29.5±3.2	20.2 (18.4, 22.6)	25.0 (24.0, 31.0)	30.0 (24.0, 32.0)
统计值		t＝－2.12	W＝3 165.50	W＝4 048.50	W＝4 097.00
P值		0.035	0.037	0.866	0.933
组别	例数	孕次[次，M(P₂₅，P₇₅)]	产次[次，M(P₂₅，P₇₅)]	自然流产次数[次，M(P₂₅，P₇₅)]	不良孕产史[例(%)]
异常组	99	2.00 (1.00, 2.00)	0.00 (0.00, 1.00)	0.00 (0.00, 0.00)	8 (8.1%)
正常组	83	2.00 (1.00, 2.00)	0.00 (0.00, 1.00)	0.00 (0.00, 0.00)	4 (4.8%)
统计值		W＝3 987.50	W＝3 849.00	W＝4 351.00	χ²＝0.78
P值		0.713	0.403	0.282	0.377^a

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