There is a history of 2 stillbirths, what should I prepare for the next pregnancy?

Question
Hi doctor,
I had 2 stillbirths, after the 2nd time I had a chromosomal test, the result was that I was heterozygous for PAI1, MTHFR, MTRR. I want to ask if there is a history of 2 stillbirths, what should I prepare for the next pregnancy? With heterozygous PAI1, MTHFR, MTRR, can I continue to get pregnant?
Anonymous client
Answer
Answered by Resident Doctor, MSc Nguyen Thi Tam - Clinician - Women's Health Center - Vinmec Times City International General Hospital.
Hello,
With the question "Having a history of 2 stillbirths, what should I prepare for the next pregnancy?", the doctor would like to answer as follows:
Thrombophilia (or hypercoagulable syndrome) is defined as group of inherited or acquired disorders, characterized by a higher-than-normal tendency to form blood clots. Women during pregnancy is inherently a process of physiological hypercoagulability, resonance with Thrombophilia syndrome increases thrombosis, leading to many complications including miscarriage and stillbirth.
Mutations in the gene that produce the enzyme methylenetetrahydrofolate reductase (MTHFR), 5-methyltetrahydrofolate-homocysteine ​​methyltransferase reductase (MTRR) will lead to stasis and increased homocysteine ​​in the blood, increasing the risk of blood clots, increasing the risk of miscarriage. The PAI-1/Serpin 1 gene mutation also increases the risk of blood clots in the blood vessels. In addition, patients with heterozygous or homozygous MTHFR mutations, folic acid have difficulty converting to folate - the active form in the body. Leads to an excess of folic acid but a deficiency of folate. This is an essential substance during pregnancy to reduce the risk of neural tube defects for the fetus.
Not all cases with the above mutations also cause miscarriage, stillbirth. These two mutations can still be found in normal fertile people, it only increases the risk of miscarriage and stillbirth compared to normal people.
Your case has a history of 2 stillbirths, so with subsequent pregnancies, there are often indications to use drugs to prevent the formation of blood clots in the blood vessels before pregnancy such as: Aspirin, Lovenox, .. The response to treatment depends on certain clinical cases. In addition, you should supplement with bioactive Folate, also known with the scientific name 5-MTHF (5-methyltetrahydrofolate) which the body can use directly without metabolizing the enzyme MTHFR 3 months ago. during pregnancy.
If you still have questions about having a history of 2 stillbirths, what to prepare for the next pregnancy, you can go to a hospital of Vinmec Health System for further examination and advice. Thank you for trusting and sending questions to Vinmec. Wishing you lots of health.
Best regards!