Generality
High fibrinogen in pregnancy is a common finding: this factor, essential for coagulation, increases month after month in the bloodstream, as an effect of the changes that occur in the woman's body during gestation. Therefore, up to the maximum reference value of 700 mg / dl, this parameter is considered in the standard.
High fibrinogen in pregnancy is associated with a state of physiological hypercoagulability . In other words, the increase in this parameter in the blood is functional in reducing bleeding before, during and after childbirth .
Given its importance, high fibrinogen in pregnancy must be monitored very carefully. Too high values are associated with an increased risk of placental detachment and abortion, therefore they must be reported within the normal range.
Fibrinogen levels during pregnancy can far exceed those considered normal (reference range for pregnant women: 400-700 mg / dl) for several reasons. These include: severe healing, burns, tumors and nephropathies.
In the case in which the high fibrinogen in pregnancy depended on particular conditions, it will be the gynecologist or the general practitioner to establish the causes of the excessive increase of the parameter in the blood, to then direct the pregnant woman towards appropriate therapies for the case.
Fibrinogen: key points
- Fibrinogen, or coagulation factor I, is a plasma glycoprotein synthesized by the liver and, to a small extent, by endothelial tissue, with the aim of promoting haemostasis (blood coagulation) .
- Fibrinogen is released into the circulation when needed: when there is a wound and bleeding begins, this factor is activated to help form a clot . In particular, the glycoprotein constitutes the substrate on which thrombin acts, a proteolytic enzyme that determines the conversion of fibrinogen to fibrin . In one of the last steps of the coagulation cascade, a protein weave is formed (given by the polymerization of fibrin) that incorporates platelets and red blood cells between its meshes. Once stabilized, this mass adheres to the damaged site, until it heals.
- The plasma concentration of fibrinogen increases, in parallel to its speed of synthesis, in the acute phase of inflammatory stimuli of any origin, in the recovery from a surgical intervention and during pregnancy . The chronic increase in the plasma of this parameter is associated with a greater cardiovascular risk (increased susceptibility to diseases such as thrombosis, stroke, angina pectoris, heart attack and coronary heart disease). Indeed, more fibrinogen in the circulation means a greater tendency for the blood to coagulate, and vice versa.
What's this
During pregnancy, fibrinogen gradually increases, month after month, until reaching very high values in the blood. The state that is thus created has the function of protecting the future mother from bleeding associated with childbirth .
Normally, in men and in non-pregnant women, the levels of this parameter should be between 200 and 400 mg / dl. This interval of reference does not take into consideration, obviously, the changes that take place in the organism during gestation.
During pregnancy, fibrinogen concentrations up to 700 mg / dl are considered normal, with the minimum value also moving upwards and around 400 mg / dl.
Why do you measure
Fibrinogen is a parameter that must be carefully monitored by gynecologists and doctors during pregnancy, through blood tests . In fact, as anticipated, fibrinogen is the precursor of fibrin, a fundamental substance for coagulation.
Too high values of fibrinogen in pregnancy must be immediately reported within the acceptable ranges: with values exceeding 700 mg / dl, the risk of detachment of the placenta and abortion increases significantly.
High fibrinogen in pregnancy: qualitative and quantitative test
There are two types of laboratory tests to evaluate fibrinogen:
- Quantitative test : it allows to measure the concentration of fibrinogen in the blood;
- Activity test : examines the function of fibrinogen during the formation of the clot, ie its ability to be converted into fibrin. The time that the clot takes to form is directly proportional to the activity of the glycoprotein present. A prolonged duration may be due to a decreased concentration of normal fibrinogen or to a malfunction of the same.
Possible alterations of this parameter with respect to the norm allow to highlight a possible coagulation defect . It is therefore a value that is monitored very carefully even during pregnancy.
When to take the test in pregnancy?
Fibrinogen is a parameter that is kept under control, through regular blood tests, as it represents one of the indexes of the state of health of pregnancy .
Any criticality in fibrinogen levels, whether they are too high or too low, must be corrected with appropriate treatment. The risk is to incur various complications, such as post-partum bleeding and placental problems.
The doctor may indicate the fibrinogen test in pregnancy even in the following cases:
- To monitor the health of the maternal placenta (useful, for example, in the presence of other known risk factors for eventualities such as the detachment of the same);
- After episodes of bleeding or abnormal thrombotic events in the pregnant woman;
- If the pregnant woman is suffering from an abnormality or an inherited deficiency of fibrinogen (thus increasing the risk of bleeding during and after delivery).
To remember
Fibrinogen is one of the parameters to be considered to monitor the health of the maternal placenta.
Normal values
Depending on the methods used, normal fibrinogen levels are between 150 and 400 mg / dl, taking into account that, generally, the average stable value is about 225 mg / dl.
During pregnancy, an increase over this reference interval is considered physiological (not pathological). Between 28 and 40 weeks of gestation, in particular, fibrinogen can range from 400 to 600 mg / dl, sometimes reaching up to 700 mg / dl.
- Fibrinogen in pregnancy - normal values : 400-700 mg / dl.
Note : the examination reference interval may change depending on the instrumentation used in the analysis laboratory. For this reason, it is preferable to consult the ranges listed directly on the report. It should also be remembered that the results of the analyzes must be assessed as a whole by the primary care physician who knows the patient's medical history.
Fibrinogen High in Pregnancy - Causes
High fibrinogen in pregnancy should not be a cause for concern, as this parameter tends to increase physiologically after conception and is reduced in the puerperium.
During gestation, high fibrinogen is due to a state of physiological hypercoagulability (note: in pregnancy also the variation of other coagulation factors is significant). The condition that is thus created has the function of protecting the future mother from bleeding associated with childbirth.
When are the values considered too high?
In the event that the level of fibrinogen is to be even higher than normal (ie above 700 mg / dl), your doctor should be consulted, who will prescribe specific analyzes to identify the causes of the excessive increase and to indicate the most suitable treatments to restore values to normal.
One of the most common causes of increased fibrinogen in pregnancy is undoubtedly weight gain . In fact, there is a positive correlation between the level of fibrinogen in the blood and the body mass index. This means that the higher the body weight, the more fibrinogen levels will tend to increase.
During pregnancy, an excessive increase in fibrinogen may be due to:
- Severe burns, trauma and / or injuries;
- Acute infections;
- Use of first-generation oral contraceptives, despite the onset of gestation.
Fibrinogen in pregnancy can increase beyond the reference interval in the presence of previous and concomitant diseases, such as:
- Obesity;
- Inflammatory diseases (such as rheumatoid arthritis and glomerulonephritis);
- tumors;
- Cardiovascular diseases, myocardial infarction and peripheral artery diseases;
- Stroke;
- Hepatitis;
- Nicotine addiction;
- Nephrosis.
What risks with fibrinogen too high in pregnancy?
Too high values of fibrinogen in pregnancy must be immediately reported within the acceptable ranges. If the parameter in the blood exceeds the concentration of 700 mg / dl, the risk of placental detachment and, unfortunately, also of abortion increases significantly.
Low Fibrinogen in Pregnancy - Causes
When fibrinogen values become too low and fall below the threshold of 250–300 mg / dl during gestation, it is important to contact the reference gynecologist or the attending physician.
The most common causes of the reduction in fibrinogen values during pregnancy include problems in the liver; the pathologies that affect the liver tend, in fact, to reduce the synthesis of fibrinogen, hence its presence in the blood.
Low fibrinogen in pregnancy may also depend on disseminated intravascular coagulation; this situation may suggest the excessive consumption of glycoprotein due to the presence of numerous thrombi in the cardiovascular system.
There are also hereditary deficits that cause decreased production of fibrinogen and, at the same time, predispose to the possibility of even serious bleeding. These conditions include afibrinogemia, dysfibrinogemia or hypofibrinogemia .
Other conditions that may predispose to low fibrinogen in pregnancy include:
- Severe malnutrition;
- Eclampsia;
- Anemia;
- Embolism;
- fibrinolysis;
- Very serious infections;
- Some tumors (eg leukemia);
- Rapid transfusions of large amounts of blood.
What risks with fibrinogen too low in pregnancy?
Too low fibrinogen values during pregnancy increase the risk of:
- Umbilical cord bleeding;
- Serious bleeding before, during and after childbirth;
- Miscarriage within the seventh week of pregnancy.
How to measure it
To evaluate high fibrinogen in pregnancy, it is sufficient that the future mother undergoes a simple blood test.
Preparation
In the case of blood tests for high fibrinogen in pregnancy, no special preparation is required, except for fasting.
Furthermore, it should be noted that the values cannot be considered as reliable in the case in which the woman has been subjected to a blood transfusion in the four weeks preceding the withdrawal.
Interpretation of Results
Normal values
High fibrinogen in pregnancy is a normal report, at least until it remains within the indicated reference range (400-700 mg / ml). For this reason, the finding of high values relative to the parameter in question must not be absolutely cause for concern.
High fibrinogen in pregnancy usually reflects a good ability to coagulate and to cope with any post-partum bleeding.
High Fibrinogen Values in Pregnancy
High fibrinogen in pregnancy beyond the reference interval (700 mg / ml) could indicate that the woman's body is trying to regain normalcy after a wound, a burn or a severe trauma . It should be remembered, in fact, that fibrinogen is an acute phase protein, therefore protein quantities can rapidly increase in all conditions that cause inflammation or tissue damage . The value of fibrinogen can be excessively high in pregnancy also due to the presence of diseases that affect the kidneys and certain tumors, such as lymphomas.
Warning! High concentrations of fibrinogen in pregnancy are non-specific, therefore they do not indicate the cause of the temporary increase in the parameter or the site of the possible underlying disorder. Usually, these increments are temporary and return to normal after the underlying diseases are resolved. In this regard, it should be remembered that in the case in which the high fibrinogen in pregnancy depended on particular conditions, it will be the gynecologist or the general practitioner to identify the causes, to then direct the pregnant woman towards the most appropriate therapeutic strategies.
Low Fibrinogen Values in Pregnancy
A significant decrease in fibrinogen in pregnancy is not a common finding, but may be related to decreased concentrations or reduced glycoprotein activity.
Low fibrinogen values in pregnancy may be related to decreased production due to an inherited disease (such as aphibrinogemia or hypofibrinogemia) or to an acquired disease, such as end-stage liver disease or severe malnutrition .
Low acute results are often related to the consumption of fibrinogen that can be observed in disseminated intravascular coagulation (CID) .
Low levels of fibrinogen in pregnancy, especially when accompanied by other coagulation problems, are a risk factor for placental abruption.
Some advice
During pregnancy, it is possible to adopt small measures and lifestyle adjustments that can more easily maintain fibrinogen levels in normal conditions. First, it is good to remember that if the high fibrinogen is determined by an underlying disease, this condition must be treated to restore the congruous levels of this parameter.
Furthermore, to control high fibrinogen in pregnancy can be useful:
- Avoid taking too much weight during pregnancy;
- Practicing a light and constant aerobic activity;
- Adjust your diet by adding foods rich in omega-3 and omega-6 fatty acids (such as oily fish, salmon, nuts and oilseeds).
