DOI: 10.1097/01.aoa.0000393168.08651.f1
,
Issn Print: 0275-665X
Publication Date: 2011/03/01
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
Between December 2005 and February 2007, the pregnancies of 95 consecutive, unrelated, white French women who were homozygous for factor V Leiden, and who had been pregnant at least once, were identified. This group was compared with 195 women who were heterozygous for factor V Leiden and 73 noncarriers. In both the groups, all women had been pregnant at least once and had never used thromboprophylaxis during pregnancy. Comprehensive clinical data on each pregnancy were collected using standardized forms. Early and late pregnancy loss was defined as losses occurring within 12 weeks of gestation or after 12 weeks, respectively. All patients were screened for inherited or acquired thrombophilic abnormalities. Maternal factor V Leiden results were analyzed in relation to timing of fetal loss.
The median age and numbers of pregnancies were similar in the 3 groups. Early fetal loss occurred in 23.1%, 20.0%, and 21.9% of women who were homozygous, heterozygous, and noncarriers, respectively (P=0.81). Four homozygous women, 12 heterozygous women, and 7 noncarriers had ≥2 early fetal losses, and the numbers of early losses for all pregnancies were similar in the 3 groups. The rate of late fetal loss was higher in homozygous women (13.7%) compared to noncarriers (1.4%) [odds ratio (OR), 11.41; 95% confidence interval (CI), 1.46-89.46; P=0.002] and heterozygous women (OR, 4.99; CI, 1.83-13.6; P<0.002). The percentage of pregnancies ending in late fetal loss was not significantly higher in heterozygous women compared with noncarriers (3.1% vs. 1.4%, respectively, P=0.68). The frequency of preeclampsia, placental abruption, and intrauterine growth restriction did not differ among groups. The age of the women at the time of late fetal loss did not differ among the 3 groups (27, 26, and 27 y, respectively). Parity and a history of thromboembolism had no effect on fetal loss. The frequency of non-O blood group was not statistically different between women with late fetal loss and those without. Among the 21 women who had late fetal loss, 10 homozygous women, 5 heterozygous women, and 1 noncarrier had at least 1 successful pregnancy without thromboprophylaxis. Live birth rates were 80%, 84%, and 85%, respectively, for the homozygous, heterozygous, and noncarrier groups (P=0.88). A history of pregnancy-associated venous thromboembolism was more frequent in homozygous women compared with heterozygous women or noncarriers (37% vs 15% and 1% respectively, P<0.001).
This study did not find any association between early fetal loss in women either heterozygous or homozygous for factor V Leiden mutation. Homozygous women had an 11-fold greater risk of late fetal loss compared with noncarriers. However, the overall likelihood of a positive outcome for these women is high, with a live birth rate of 80%. Whether thromboprophylaxis is necessary in women with this mutation is unclear.
