Racial Differences in Thrombotic Risk Factors Associated with Adverse Pregnancy Outcome Among Women Obtaining Care in US Thrombosis and Hemostasis Centers.

Abstract 2982

Poster Board II-958

Pregnancy complications such as recurrent miscarriage, intrauterine growth restriction (IUGR), and preeclampsia are common and have been associated with thrombophilia. However racial differences are poorly described for this population. The objective of this study was to determine racial differences in unexplained adverse pregnancy outcome among women obtaining care in the CDC Thrombosis and Hemostasis Centers Research and Prevention Network. Uniform data were prospectively collected from August 2003 to March 2009 in consenting women with a history of adverse pregnancy outcome obtaining care at Network Centers for pre-pregnancy, pregnancy, or postpartum consultation and/or management. Data from 407 women (mean age 38.5 ±12 yrs), including 326 white women (mean age 39.4 ± 12 yrs), and 60 black women (mean age 33.9 ± 11 yrs) were analyzed. Black women had significantly more second trimester pregnancy losses compared to white women (35% vs 22%, p=0.03) but the proportions of 1^st trimester losses, 3^rd trimester losses, IUGR, prematurity, abruption, and preeclampsia were not significantly different. The risk of thrombophilia differed by race, with Factor V Leiden mutation more common in white women compared to black women (19% vs 3%, p=0.002). Protein S deficiency was more common in black women compared to white women overall (15% vs 5%, p=0.006) and in the subgroup of non-pregnant women (14% vs 5%, p=0.04). There was no significant difference in the proportion of white and black women with antiphospholipid antibodies. Among 285 women evaluated when non-pregnant, body mass index (BMI) ≥ 25 was more frequent in black women (83%) compared to white women (63%) (p=0.04). Overall, black women had a significantly higher proportion with hypertension (27% vs 11%, p=0.002) and sickle cell disease (7% vs 0,%, p< 0.001). There was no significant racial difference in history of pregnancy associated, provoked, or idiopathic venous thromboembolism (VTE). A family history of thrombophilia (6% vs 0%, p=0.05), VTE (22% vs 7%, p=0.005), myocardial infarction (MI) or stroke (12% vs 0%, p=0.0042) was significantly more common in white women compared to black women (overall 32% vs 8%, p<0.0002). This study demonstrates that comorbidities including hypertension, sickle cell disease and BMI≥25 are more prevalent in black women with adverse pregnancy outcomes whereas white women have a higher prevalence of Factor V Leiden mutation, and positive family history of thrombophilia, VTE, MI, and stroke.