Intended for healthcare professionals

Rapid response to:

Primary Care

The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.576 (Published 10 March 2005) Cite this as: BMJ 2005;330:576

Rapid Response:

Thrombophilia and preeclampsia

Sir,

We would like to contribute a few comments on the pre-eclampsia community guideline (PRECOG).

The presence of antiphospholipid antibodies (aPLs) is associated with pre-eclampsia. However, aPLs have also been described in other clinical settings such as infections or drug administration. Only their persistent presence has a clinical significance and laboratory discrepancies may exist concerning the titer. A single positive result is therefore not necessarily associated with an adverse maternal outcome. In our view, such a situation would not justify specialist referral and furthermore would probably not be cost-effective, considering the high rate of false positive aPLs.

Genetic thrombophilia such as the factor V Leiden may also be a modest but usefull biological marker in improving early prediction of pre- eclampsia. Two meta-analysis provide support for an association of factor V Leiden and pre-eclampsia [1,2]. In the first study [1], factor V Leiden was associated with a 2.9 fold (95% CI 2.0-4.3) increased risk of severe pre-eclampsia. This association was confirmed recently [2] with an OR of 1,81 (95% CI 1,14-2,87). We recognize that PRECOG was based on studies published from 1996 to 2002 but guidelines are not meant to be static and we hope that a future update will analyse this issue.

Finally, since there is no single reliable screening test for predicting pre-eclampsia, the development of a risk calculator combining various risk factors (similar to the one used for screening Down’s syndrome) would certainly be a useful tool in today’s growing trend towards predictive medecine.

1. Dudding TE, Attia J. The association between adverse pregnancy outcomes and maternal factor V Leiden genotype : a meta-analysis. Thromb Haemost 2004 ;91 :700-11

2. Lin J, August P. Genetic thrombophilias and preeclampsia : a meta- analysis. Obstet Gynecol 2005 ;105 :182-92

Competing interests: None declared

Competing interests: No competing interests

15 March 2005
Raha Shojai
Specialist Registrar
Florence Bretelle, Claude d'Ercole
Pavillon Mère-Enfant, CHU Nord,13015 Marseille, France