Detection of Immunoglobulin M Antibodies to P35 Antigen of Toxoplasma gondii for Serodiagnosis of Recently Acquired Infection in Pregnant Women

We examined the efficiency of detection of immunoglobulin M (IgM) antibodies to a 35-kDa antigen (P35) of Toxoplasma gondiifor serodiagnosis of acute infection in pregnant women. A double-sandwich enzyme-linked immunosorbent assay (ELISA) with recombinant P35 antigen (P35-IgM-ELISA) was used for this purpose. On the basis of the clinical history and the combination of results from the toxoplasma serological profile (Sabin-Feldman dye test, conventional IgM and IgA ELISAs, and the differential agglutination test), the patients were classified into three groups: group I, status suggestive of recently acquired infection; group II, status suggestive of infection acquired in the distant past; group III, status suggestive of persisting IgM antibodies. Eighteen (90.0%) of 20 serum samples from group I patients were positive by the P35-IgM-ELISA, whereas none of the 33 serum samples from group II patients were positive. Only 4 (25.0%) of 16 serum samples from group III patients were positive by the P35-IgM-ELISA, whereas all these serum samples were positive by the conventional IgM ELISA. These results indicate that demonstration of IgM antibodies against P35 by the P35-IgM-ELISA is more specific for the acute stage of the infection than demonstration of IgM antibodies by the ELISA that uses a whole-lysate antigen preparation. Studies with sera obtained from four pregnant women who seroconverted (IgG and IgM antibodies) during pregnancy revealed that two of them became negative by the P35-IgM-ELISA between 4 and 6 months after seroconversion, whereas the conventional IgM ELISA titers remained highly positive. The P35-IgM-ELISA appears to be useful for differentiating recently acquired infection from those acquired in the distant past in pregnant women.

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Anti-Toxoplasma gondii antibodies in pregnant women and their newborn infants in the region of São José do Rio Preto, São Paulo, Brazil

Sao Paulo Medical Journal ◽

10.1590/s1516-31802011000400010 ◽

2011 ◽

Vol 129 (4) ◽

pp. 261-266 ◽

Cited By ~ 7

Author(s):

Cinara de Cássia Brandão de Mattos ◽

Lígia Cosentino Junqueira Franco Spegiorin ◽

Cristina da Silva Meira ◽

Thaís da Costa Silva ◽

Ana Iara da Costa Ferreira ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Pregnant Women ◽

Newborn Infants ◽

Sao Paulo ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

São Paulo ◽

Serum Samples ◽

Igm Antibodies ◽

Igg Avidity

CONTEXT AND OBJECTIVE: Toxoplasmosis transmission during pregnancy can cause severe sequelae in fetuses and newborns. Maternal antibodies may be indicators of risk or immunity. The aim here was to evaluate seropositivity for anti-Toxoplasma gondii (anti-T. gondii) immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies and IgG avidity in pregnant women and their newborn infants. DESIGN AND SETTING: Cross-sectional study in a high-risk pregnancy outpatient clinic. METHODS: Serum samples from pregnant women (n = 87) and their respective newborns (n = 87) were evaluated for anti-T. gondii antibodies using indirect immunofluorescence (IIF) (IgM and IgG), enzyme-linked immunosorbent assay (ELISA) (IgG) and an avidity test. RESULTS: Anti-T. gondii antibodies were identified in 64.4% of the serum samples from the mothers and their infants (56/87). Except for two maternal serum samples (2.3%), all others were negative for anti-T. gondii IgM antibodies, using IIF. The results showed that 92.9% of the pregnant women had high IgG avidity indexes (> 30%) and four samples had avidity indexes between 16 and 30%. Two women in the third trimester of pregnancy were positive for anti-T. gondii IgM antibodies; their babies had avidity indexes between 16 and 30%. The avidity indexes of serum from the other 83 newborns were similar to the results from their mothers. CONCLUSIONS: The results showed that 2% of the pregnant women were at risk of T. gondii transmission during the gestational period. These data seem to reflect the real situation of gestational toxoplasmosis in the northwestern region of the state of São Paulo.

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High positive frequency of antibodies to metallothionein and heat shock protein 70 in sera of patients with metal allergy

10.31234/osf.io/vg9kt ◽

2020 ◽

Author(s):

Lungwani Muungo

Keyword(s):

Heat Shock ◽

Human Serum ◽

Enzyme Linked Immunosorbent Assay ◽

Strong Positive Correlation ◽

Metal Allergy ◽

Serum Samples ◽

Group Iii ◽

Group I ◽

Group Ii ◽

Positive Frequency

Two principal types of stress protein, heat shock proteins (hsps) and metallothionein (MT), are inducedin cells responding to a variety of stresses. They play an important role in protecting cells from thesestresses. However, many reports indicate that antibodies to hsps are present in human serum and areassociated with several autoimmunity diseases. Metals, which are commonly allergenic to humans,induce both MT and hsp70 (one of the hsps family). Until now, there has been no report of any antibodyto MT in human serum. In the present study, serum samples from healthy controls (Group I), andpatients suffering from atopic dermatitis without (Group II) or with (Group III) metal allergy, weremeasured for antibodies to MT and hsp70, using an enzyme-linked immunosorbent assay (ELISA).Metal allergy was confirmed by patch testing. We first found that antibody to MT exists in human serum.We also found a high positive frequency of antibody to MT (51·3%) and to hsp70 (43·6%) in the seraof Group III, compared to those of Group I (3·8% and 5·1%) or Group II (6·4% and 5·1%). Furthermore,there was a strong positive correlation between antibody to MT and antibody to hsp70 in GroupIII (P = 0·0013), but not in Group I and Group II. Our results indicate that antibody to MT exists inhuman serum, as do antibodies to hsps, and suggest

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Seroprevalence and Associated Risk Factors of Toxoplasma Gondii Among Pregnant Women in Southwest Iran

International Journal of Infection ◽

10.5812/iji.116379 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Shahrzad Soltani ◽

Ali Dalir Ghaffari ◽

Mehdi Sagha Kahvaz ◽

Mohamad Sabaghan ◽

Marzieh Pashmforosh ◽

...

Keyword(s):

Risk Factors ◽

Toxoplasma Gondii ◽

Pregnant Women ◽

Immunoglobulin M ◽

Screening Tests ◽

Enzyme Linked Immunosorbent Assay ◽

Seroprevalence Rate ◽

Igm Antibodies ◽

Associated Risk Factors ◽

Southwest Iran

Background: Acute Toxoplasma gondii infection during pregnancy period can cause congenital toxoplasmosis. The aim of this study was to assess the seroprevalence rate of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies against T. gondii infection during pregnancy and the associated risk factors in southwest Iran. Methods: This study was performed on 88 pregnant women from October to December 2019 in Khorramshahr County, Khuzestan province, Iran. Anti-T. gondii IgG and IgM antibodies were tested through enzyme-linked immunosorbent assay (ELISA) method. Results: Following serological assays, 38.63% (34/88) and 2.27% (2/88) serum samples were positive for IgG and IgM antibodies, respectively. Also, a statistically significant association was observed between IgG seroprevalence and drinking of unpurified water (P = 0.015). Conclusions: The serological evidence revealed that pregnant women of southwest Iran had moderate exposure to T. gondii parasite. Since the risk of acquiring acute toxoplasmosis in pregnant women is clinically important, we highly recommend regular screening tests for T. gondii infection during pregnancy period.

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Serodiagnosis of Recently Acquired Toxoplasma gondii Infection with a Recombinant Antigen

Journal of Clinical Microbiology ◽

10.1128/jcm.38.1.179-184.2000 ◽

2000 ◽

Vol 38 (1) ◽

pp. 179-184

Author(s):

Shuli Li ◽

Greg Maine ◽

Yasuhiro Suzuki ◽

Fausto G. Araujo ◽

Gina Galvan ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Acute Infection ◽

Chronic Phase ◽

Test Group ◽

Acute Stage ◽

Enzyme Linked Immunosorbent Assay ◽

Igg Antibodies ◽

Group I ◽

Igm Elisa ◽

Group Ii

ABSTRACT A portion of a cDNA encoding a 35-kDa antigen from Toxoplasma gondii was cloned into the CKS expression vector and expressed in Escherichia coli . By using the enzyme-linked immunosorbent assay (ELISA), the recombinant protein (rP35 antigen) was examined for reactivity with immunoglobulin G (IgG) antibodies in the sera of pregnant women. Of these women, 41 had a toxoplasma serologic profile suggestive of recently acquired T. gondii infection (Sabin-Feldman dye test [DT] titers from 1:256 to 1:32,000, positive IgM ELISA titers from 2.3 to 9.7, positive IgA ELISA from 1 to >28, and acute patterns in the differential agglutination [AC/HS] test) (group I), and 50 women had a toxoplasma serologic profile suggestive of infection acquired in the distant past (low DT titers from 1:16 to 1:512, negative IgM ELISA titers from 0 to 0.8, and chronic patterns in the AC/HS test) (group II). The classification of acute or chronic profile was based on the individual's clinical history as well as the combination of the results of the toxoplasma serological profile. An additional group (group III) was composed of sera from 50 women who were seronegative for T. gondii antibodies in the DT. The results revealed that whereas 85.3% of women in group I had IgG antibodies that reacted with the rP35 antigen, only 8% of women in group II had IgG antibodies that reacted with the same antigen. In immunoblots, the rP35 antigen was recognized by IgG antibodies in a pool of sera from individuals with a toxoplasma serologic profile compatible with acute infection but not in a pool of sera from individuals with a serologic profile characteristic of a chronic infection. These results reveal that IgG antibodies against the P35 antigen are produced during the acute stage of the infection but are uncommon in the latent or chronic phase of the infection. Thus, the rP35 antigen may be a useful serologic marker to differentiate between recently acquired infection and that acquired in the more distant past.

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Seroprevalence of Immunoglobulin G (IgG) and Immunoglobulin M (IgM) and Risk Factors of Toxoplasmosis for A sample of Pregnant Women in Baghdad

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v13i2.92 ◽

2019 ◽

Vol 13 (2) ◽

pp. 40-45

Author(s):

Huda Sahib Abdul Mohammed Al-Rawazq

Keyword(s):

Risk Factors ◽

Toxoplasma Gondii ◽

Pregnant Women ◽

Immunoglobulin G ◽

Clinical Manifestations ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Cross Sectional ◽

Igm Antibodies ◽

Wide Range

Background: Toxoplasmosis is a very common infection caused by the obligate intracellular protozoan parasite. This parasite is called Toxoplasma gondii widely distributed around the world . Toxoplasma gondii can be vertically transmitted to the fetus during pregnancy and may cause wide range of clinical manifestations in the offspring. Objective: To determine seroprevalence Immunoglobulin G (IgG) and Immunoglobulin M (IgM ) to toxoplasma gondii among pregnant women and to identify the risk factors. Type of the study: A cross-sectional study. Methods: A total of 110 blood samples of pregnant women were collected from private laboratory for Dr. luay Ibrahim to Pathogenesis Analyses in Baghdad Al-Mansour- 14 Ramadan street . Which obtained during the period from 1st March 2016 till the 30th June 2016. Data was collected by using direct interviewing questionnaire sheet concerning their ages of pregnant women between (less than 20 to more than 40 years old), place of residence ( urban, rural), level of education (illiteracy, literacy), number of pervious abortion (one, two, three or more), contact with ( cat and other domestic animal or no animal in house). The diagnosis is based on IgG and IgM antibodies of Toxoplasma gondii were measured using a commercial Kit ( Cobas Toxo IgG, Toxo IgM) according to the Roche Diagnostic manufacturer's instructions. Each blood was analyzed for the presence of Toxoplasma gondii by identifying serum IgG and IgM antibodies using Enzyme-linked Immunosorbent Assay (ELISA). Results: A total of 110 pregnant women were enrolled and screened for the presence of anti- toxoplasma IgG and IgM antibodies. The seroprevalence of Toxoplasma gondii IgG and IgM antibodies result revealed that 40 (63.4 %) of 110 pregnant women were positive for anti-toxoplasma-antibody IgG and 70 (63.6 %) of 110 were negative for anti-toxoplasma-antibody-IgG while revealed that 16 (13.6 %) of 110 pregnant women were positive for anti-toxoplasma-antibody IgM and 94 (86.4 %) of 110 were negative for anti-toxoplasma-antibody IgM. Conclusions: the present study shows that anti-Toxoplasma IgG Ab are higher than anti-Toxoplasma IgM Ab in pregnant women between the age group 20 to 30 years in literacy educational level and rural area also recorded the highest rates of seropositivity among women with only one previously abortion in contact with cats are more affected.

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Prevalence and clinical correlation of hepatitis E virus antibody in the patients’ serum samples from a tertiary care hospital in Thailand during 2015–2018

Virology Journal ◽

10.1186/s12985-021-01616-x ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Atiporn Boonyai ◽

Anchalee Thongput ◽

Thidarat Sisaeng ◽

Parisut Phumchan ◽

Navin Horthongkham ◽

...

Keyword(s):

Pregnant Women ◽

Tertiary Care ◽

Laboratory Data ◽

Organ Transplant ◽

Hospital Setting ◽

Antibody Detection ◽

Enzyme Linked Immunosorbent Assay ◽

Care Hospital ◽

Serum Samples ◽

Igm Antibodies

Abstract Background Prevalence and incidence of hepatitis caused by HEV infection are usually higher in developing countries. This study demonstrated the HEV seroprevalence and incidence of HEV infection in patients with clinical hepatitis in a tertiary hospital in Thailand. Methods A laboratory-based cross-sectional study was conducted using 1106 serum samples from patients suspected of HEV infection sent to the Serology laboratory, Siriraj Hospital, for detecting HEV antibodies during 2015–2018. Prevalence of anti-HEV IgG and IgM antibodies in general patients, including organ transplant recipients and pregnant women in a hospital setting, were determined using indirect enzyme-linked immunosorbent assay (ELISA) kits. Comparison of laboratory data between groups with different HEV serological statuses was performed. Results HEV IgG antibodies were detected in 40.82% of 904 serum samples, while HEV IgM antibodies were detected in 11.75% of 1081 serum samples. Similar IgG and IgM antibody detection rates were found in pregnant women. Interestingly, anti-HEV IgM antibodies were detected in 38.5% of patients who underwent organ transplantation. Patients who tested positive for anti-HEV IgM antibodies had higher alanine aminotransferase levels than those who had not. In contrast, patients who tested positive for anti-HEV IgG had more elevated levels of total bilirubin than those who tested negative. Conclusions HEV seroprevalence and incidence in patients with clinical hepatitis were relatively high in the Thai population, including the pregnancy and organ transplant subgroups. The results potentially benefit the clinicians in decision-making to investigate HEV antibodies and facilitating proper management for patients.

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Immunodiagnosis and molecular validation of Toxoplasma gondii infection among patients with end-stage renal disease undergoing haemodialysis

Parasitology ◽

10.1017/s0031182019001033 ◽

2019 ◽

Vol 146 (13) ◽

pp. 1683-1689 ◽

Cited By ~ 1

Author(s):

Zahra Arab-Mazar ◽

Shirzad Fallahi ◽

Davood Yadegarynia ◽

Amirreza Javadi Mamaghani ◽

Seyyed Javad Seyyed Tabaei ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Renal Disease ◽

End Stage Renal Disease ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Healthy Controls ◽

Blood Samples ◽

Igm Antibodies ◽

Stage Renal Disease ◽

End Stage

AbstractInfection is a significant cause of morbidity and mortality in patients with chronic kidney disease, especially who were under dialysis due to their depressed immunity. Toxoplasma gondii is a ubiquitous parasite that causes severe manifestations in immunocompromised patients. This case-control study was conducted to the immunodiagnosis and molecular validation of T. gondii infection among patients with end-stage renal disease undergoing haemodialysis. The study population consisted of 260 haemodialysis patients and 259 healthy controls referred to the main dialysis centres of Tehran, Iran during 2016. Anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies were assessed using enzyme-linked immunosorbent assay. As well, the T. gondii genomic DNA in whole blood samples of IgM-positive patients and healthy controls was evaluated using GRA6-polymerase chain reaction (PCR) and SAG1-loop-mediated isothermal amplification (LAMP) assays. The anti-T. gondii IgG and IgM antibodies were detected in 175 (67.3%) and 18 (7%) of haemodialysis patients and 122 (47%) and 4 (1.5%) of controls, respectively. Two of the 18 blood samples from IgM-positive patients and none of the IgM-positive control subjects were positive by GRA6-PCR. Whereas, nine and two blood samples of IgM-positive patients and controls were positive for Toxoplasma DNA by a SAG1-LAMP technique respectively. The seropositivity of the Toxoplasma IgM antibody was significantly different between haemodialysis patients and healthy controls which was confirmed by PCR and LAMP. The higher prevalence of T. gondii infection in haemodialysis patients compared with the controls proposes that these patients can be a group at risk for toxoplasmosis and screening for toxoplasmosis before dialysis is necessary for the patients.

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Toxoplasma gondii Infection in Dustmen in Northeastern China: A Case-Control Seroprevalence Study

BioMed Research International ◽

10.1155/2018/3207675 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Ruo-Lan Jiang ◽

Quan Zhao ◽

Jing Jiang ◽

Xue-Long Chen ◽

Xiao-Xuan Zhang ◽

...

Keyword(s):

Toxoplasma Gondii ◽

First Record ◽

Case Control ◽

Northeastern China ◽

Enzyme Linked Immunosorbent Assay ◽

Serum Samples ◽

Igm Antibodies ◽

Control Subjects ◽

The Government ◽

At Home

Background. Toxoplasmosis is caused by an intracellular parasite Toxoplasma gondii, which can infect many hosts including humans. Methods. In order to estimate whether dustmen are more susceptible to T. gondii, a case-control study was conducted containing 332 dustmen from Jilin and Heilongjiang in Northeastern China, as well as 332 general populations from the same regions as control subjects. Serum samples were tested IgG and IgM antibodies to T. gondii using the enzyme-linked immunosorbent assay (ELISA). Results. The overall anti-T. gondii IgG was 15.06% (50/332) in dustmen compared with 9.64% (32/332) in the controls (P = 0.0337). Also, 5 (1.51%) dustmen had anti-T. gondii IgM antibodies compared with 2 (0.60%) control individuals (P = 0.2543). A significant association was only found between dustmen and level of T. gondii IgG in comparison with the control subjects. Seroprevalence of T. gondii IgG antibodies in male dustmen was significant higher than male control subjects (P = 0.0399). Dustmen from Jilin had the significant higher T. gondii IgG rate (P = 0.0143), in comparison with the control subjects from Jilin. Moreover, dustmen raising cat at home had the significant higher T. gondii IgG rate (P = 0.0097), in comparison with the control subjects. Risk factor analysis suggested that raising cat at home and not having habits of washing hand before eating were mainly related to the T. gondii infection in dustmen. Conclusions. This is the first record of seroprevalence of T. gondii infection in dustmen in Jilin and Heilongjiang provinces in Northeastern China. These findings also suggest that the government departments should pay close attention to the toxoplasmosis in dustmen in Northeastern China.

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Evaluation of an Immunoglobulin M Capture Enzyme-Linked Immunosorbent Assay for Diagnosis of Orientia tsutsugamushi Infection

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.10.3.394-398.2003 ◽

2003 ◽

Vol 10 (3) ◽

pp. 394-398 ◽

Cited By ~ 19

Author(s):

Won-Jong Jang ◽

Myung-Suk Huh ◽

Kyung-Hee Park ◽

Myung-Sik Choi ◽

Ik-Sang Kim

Keyword(s):

Immunosorbent Assay ◽

Scrub Typhus ◽

Microtiter Plate ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Orientia Tsutsugamushi ◽

Serum Samples ◽

Capture Elisa ◽

Igm Antibodies ◽

Immunodominant Antigen

ABSTRACT To differentiate scrub typhus from other acute febrile diseases, a rapid and reliable serological diagnosis is important. We developed an immunoglobulin M (IgM) capture enzyme-linked immunosorbent assay (ELISA) for diagnosis of recent Orientia tsutsugamushi infections in humans. The 56-kDa major outer membrane protein of O. tsutsugamushi is well known as the most immunodominant antigen in scrub typhus. The test is based on the use of the biotinylated recombinant 56-kDa protein of O. tsutsugamushi Boryong, Bor56, which was expressed as a fusion protein with a maltose-binding protein in Escherichia coli. In the test, the serum IgM antibodies were captured by anti-human IgM antibodies coated onto a microtiter plate. The captured IgM antibodies were revealed through sequential addition of biotinylated Bor56 antigen and peroxidase-conjugated streptavidin to the plate. The IgM capture ELISA was compared with the immunofluorescence antibody assay (IFA) by testing 176 serum samples from patients with diagnosed cases of rickettsial disease and patients with other acute febrile diseases. Of the 81 IgG IFA-positive samples, 78 tested positive (sensitivity, 96.3%) and all 31 IgM IFA-positive samples tested positive (sensitivity, 100%) by the IgM capture ELISA. The specificity of the IgM capture ELISA was 99%, and 1 of the 95 IFA-negative samples was positive in the assay. These results strongly suggest that IgM capture ELISA using the recombinant Bor56 antigen is a reliable and detailed method for the detection of early O. tsutsugamushi infection.

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Safety and Efficacy of Low-Molecular-Weight Heparin in Pregnant Women at Increased Risk of Venous Thromboembolism: A Prospective Stratified Multicentre Trial.

Blood ◽

10.1182/blood.v108.11.715.715 ◽

2006 ◽

Vol 108 (11) ◽

pp. 715-715

Author(s):

Rupert M. Bauersachs ◽

Joachim Dudenhausen ◽

Andree Faridi ◽

Thorsten Fischer ◽

Samson Fung ◽

...

Keyword(s):

Venous Thromboembolism ◽

Pregnant Women ◽

Risk Group ◽

High Risk Group ◽

Group Iii ◽

Group I ◽

Increased Risk ◽

At Deficiency ◽

Group Ii ◽

Heparin Prophylaxis

Abstract Women with a history of VTE, thrombophilia or both are at increased risk for VTE during pregnancy, but the optimal management strategy, and the need for thromboprophylaxis is not well defined in clinical guidelines because of limited trial data. The EThIG (Efficacy of Thromboprophylaxis as an Intervention during Gravidity) is a multicenter trial that prospectively enrolled 810 pregnant women at risk of VTE. Women were assigned to one of 3 management strategies: Low risk group I (including women with prior secondary VTE, or asymptomatic thrombophilia) with “watchful waiting” management, and dalteparin prophylaxis postpartum (50–100 IU/kg), or earlier if additional risk factors occurred; high risk group II (e.g. idiopathic VTE or symptomatic thrombophilia) receiving 50–100 IU/kg dalteparin; and very high-risk group III (e.g. acute VTE, prior long-term OAC, symptomatic AT-deficiency or antiphospholipid syndrome), receiving 100–200 IU/kg dalteparin. Primary efficacy outcome measure was symptomatic VTE, main safety outcome measures were haemorrhages, osteoporosis, thromboctopenia and pregnancy outcome. Results (mean ± SD / 95% CI): 810 women (age 30.8±5.4 years, weight 73.6±16.1kg) were enrolled, 28 % in group I, 58 % in II and 14% in III, including 66 women with acute VTE. 60.1% had prior VTE, 75.4% had thrombophilia (42.1 % FV-Leiden, 2.1 % homozygous, 9.5 % FII G20210A, 4.1% PC-, 1 % AT-deficiency; 17.4 % APS). 35.8 % had previous miscarriage, still birth or physical malformation. Comorbid conditions included lupus erythematosus, liver transplantation, ventricular septum defect, paraplegia, hepatitis C, nephrotic syndrome, asthma, chronic haemolytic anaemia, thalassaemia, osteoporosis and thrombocytopaenia. Median treatment initiation was at 17.0 weeks, at 24.0 weeks in group I, 14.5 weeks in group II and 16.0 weeks for group III. Mean daily dose was 66.2 ± 22.5 IU per kg (group I), 76.8 ± 24.1 IU per kg (group II) and 120.0 ± 49.1 IU per kg (group III). Objectively confirmed, symptomatic VTE occurred in 5 of 810 women (0.6%;0.2–1.5%). The rate of serious bleeding was 3.0% (1.9–4.4%), 0.9% (0.3–1.8%) occurred in the antepartum period, 2.1% (1.3–3.4%) peri-partum;1.1% (0.5–2.2%) was possibly heparin-related. There was no evidence of heparin-induced thrombocytopenia, and one case of osteoporosis (fracture of the saccygous bone during delivery). There were 94.4% successful pregnancies, 40 foetuses (4.9%; 3.6–6.7%) were lost due to miscarriage, 7 due to elective termination. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic venous thromboembolism and few clinically important adverse events. Antepartum heparin prophylaxis is warranted in pregnant women with prior idiopathic thrombosis or symptomatic thrombophilia.

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