Sex hormones, hemostasis and early pregnancy loss

Abstract Aims: This study was designed to determine the association between coagulation factors and spontaneous abortion adjusting for sex steroids and to examine the influence of sex hormones on coagulation factors early in pregnancy. Methods: Pregnant women presenting to the emergency department at the Hospital of the University of Pennsylvania were recruited and followed through 22 weeks gestation. Cases were women who experienced a spontaneous abortion (n=29) and controls were women who maintained their pregnancy to 22 weeks gestation (n=89). Participants completed a baseline questionnaire to assess demographic, reproductive, and drug use information. Blood samples measured estradiol, progesterone, fibrinogen, and factor VII antigen. Results: Cases of spontaneous abortion had significantly lower levels of estradiol, progesterone, fibrinogen and factor VII antigen compared to controls. The relationship between low levels of fibrinogen and factor VII antigen was diminished adjusting for the sex steroids. Regression analyses found low progesterone was the primary prospective marker for early pregnancy loss among our study population. Conclusions: The relationship between coagulation factors and spontaneous abortion was reduced after adjustment for progesterone suggesting that progesterone mediates the relationship between low levels of coagulation factors and spontaneous abortion. Progesterone seems to be the primary marker for a spontaneous abortion among women seeking emergent care.

摘要目的：本研究旨在确定凝血因子与自然流产之间的关联，并根据性类固醇进行调整，同时检验性激素在妊娠早期对凝血因子的影响。方法：招募宾夕法尼亚大学医院急诊科的孕妇，并对其随访至妊娠22周。病例为发生自然流产的女性（n = 29），对照为妊娠维持至22周的女性（n = 89）。参与者完成一份基线调查问卷，以评估人口统计学、生殖和药物使用信息。血液样本用于检测雌二醇、孕酮、纤维蛋白原和因子VII抗原。结果：与对照组相比，自然流产病例的雌二醇、孕酮、纤维蛋白原和因子VII抗原水平显著较低。在根据性类固醇进行调整后，纤维蛋白原和因子VII抗原水平低之间的关系减弱。回归分析发现，在我们的研究人群中，孕酮水平低是早期妊娠丢失的主要前瞻性标志物。结论：在根据孕酮进行调整后，凝血因子与自然流产之间的关系减弱，这表明孕酮介导了凝血因子水平低与自然流产之间的关系。在寻求急诊护理的女性中，孕酮似乎是自然流产的主要标志物。