In the present study, the questionnaire on thrombophilia in pregnancy was validated with the examined population to ensure that the questionnaire was used correctly and accurately measured the desired outcomes with few errors or biases. The validation procedure must be carried out using a representative number of samples. In this study, 900 recruited patients correctly completed the questionnaire. This large number of completed questions ensured a decent validation procedure and showed that surveys on thrombophilia during pregnancy are powerful objective tools for monitoring expected outcomes. Thrombophilia accounts for approximately 50% of gestational VTEs ( 14 ). Recent research has suggested a relationship between thrombophilia and pregnancy loss, among other gestational vascular issues ( 14 ). However, there was insufficient evidence to recommend screening and treatment for these conditions during pregnancy ( 16 ). Our study has shown that a high percentage of women in Lebanon (42%) were not aware of thrombophilia. This percentage was associated with women who have a higher level of education. (Bachelor, Master, and Ph.D.). Moreover, 51% of women somewhat familiar with thrombophilia due to family cases correctly answered questions related to these diseases. Our results confirmed our hypothesis that women don’t have strong information about thrombophilia and the source is a family case. From here, it must be interesting to do more formation. The main participants showed that the disease of thrombophilia is either hereditary or acquired. However, thrombophilia disorders are either acquired, as in antiphospholipid syndrome, or hereditary, as in factor V Leiden ( 15 ). A high percentage of participants believe that the main conditions causing miscarriages in women were hereditary, confirming the lack of knowledge about thrombophilia. Moreover, the participants defined the disease of thrombophilia as a symptomatic disease. Tsikouras et al have shown that thrombophilia in pregnant women can be an asymptomatic disease. Another question in our study also examines the participants' information regarding the different symptoms present in pregnant women with thrombophilia. The main ones were choosing the swollen veins, heart palpitations, anxiety, and chest pain. However, the typical symptoms are unilateral leg pain and swelling, chest pain, anxiety, dizziness, and heart palpitations ( 15 ). This lack of information related to this disease is justified by the few studies on thrombophilia in Lebanon, as of now, we have few publications related to thrombophilia in patients who have studied the different factors introducing thrombophilia ( 17 ). As we know, there is little research related to thrombophilia in pregnant women in Lebanon ( 12 ). This may be due to a lack of funding and also to the disconnection between the gynecologist and the research laboratory. Limited studies showed a high recurrence risk (66-83%) in successive pregnancies among multiparous women with thrombophilia and severe pregnancy issues, with varying types of complications between pregnancies ( 20 ). In Lebanon, 2 of 100 healthy Lebanese women with no history of pregnancy loss and with at least 2 successful pregnancies ( 12 ). Early detection of pregnant women with risk factors for thrombosis, even without clinical symptoms, was crucial to reduce the incidence of this condition ( 19 ). The best treatment for asymptomatic pregnant women with hereditary thrombophilia was unknown and was only detected in cases of difficulties during pregnancy, such as recurrent miscarriages or hypertension ( 10 ). The questionnaire discussed this point by asking the participants if the gynecologist had requested the thrombophilia test and the importance of incorporating this test into various pregnancy examinations. The result showed that a high percentage of women confirmed that few gynecologists requested the test related to this condition and that they generally asked for it after the loss of a baby during the second pregnancy. However, potential indications include screening the general population, screening populations potentially enriched for thrombophilia, populations at increased risk of thrombosis, and testing symptomatic patients with incidental or recurrent thrombosis ( 21 ). These indications were controversial and should be considered in the context of the clinical presentation, except for general population screening ( 21 ). The clinical approach to thromboembolism was the same for pregnant women with and without thrombophilia. Based on the family history, clinical symptoms should be evaluated using simple, reliable, and affordable laboratory tests, such as prothrombin time and activated partial thromboplastin time. Early diagnosis and adequate prophylaxis against thrombosis lead to better maternal and perinatal outcomes ( 21 ). From this study, we can suggest that adding some sample tests can help gynecologists detect the presence of thrombophilia in pregnant women especially in women with no family case or asymptomatic. In Lebanon, numerous complications can limit gynecologists from requesting this type of test, such as the education of doctors on the indications and limitations of genetic tests, with the main developed laboratory located in the capital, and the most significant reason being the cost of these tests. Finally, our study shows a considerable lack of knowledge in Lebanon about thrombophilia; this is an important issue that needs to be addressed through extensive training and cooperation with the Ministry of Health.
Limitations: The current study relies on self-reported habits and beliefs, which have not been objectively reviewed and may be subject to memory biases and social desirability. Moreover, the current study's design prevented the use of other methodologies to validate health tools, such as concurrent and predictive validity.
