A systematic review of the association between factor V Leiden or prothrombin gene variant and intrauterine growth restriction

OBJECTIVE: The purpose of this study was to conduct a systematic review of the literature of studies that examined the association between factor V Leiden and/or prothrombin gene variant and intrauterine growth restriction. STUDY DESIGN: This systematic review of studies assesses the association between factor V Leiden and/or prothrombin gene variant and intrauterine growth restriction. RESULTS: Ten case-control studies fulfilled the selection criteria for inclusion in the meta-analysis. There was a significant association between factor V Leiden and intrauterine growth restriction (odds ratio, 2.7; 95% CI, 1.3-5.5) and prothrombin gene variant and intrauterine growth restriction (odds ratio, 2.5; 95% CI, 1.3-5.0). Five cohort studies were identified in the systematic review; 3 studies were prospective (2 full publications), and 2 studies were retrospective (1 full publication). Combining the 2 full publication prospective studies yields a summary relative risk of 0.99 (95% CI, 0.5-1.9). CONCLUSION: This meta-analysis of case-control studies suggests that the factor V Leiden and prothrombin gene variant both confer an increased risk of giving birth to an intrauterine growth restricted infant, although this may be driven by small, poor-quality studies that demonstrated extreme associations. Large well-conducted prospective cohort studies are required to determine definitively whether an association between thrombophilia and intrauterine growth restriction is present.     

Homozygous factor V Leiden mutation in a woman with multiple adverse pregnancy outcomes

We report a case with one intrauterine fetal death (IUFD) at 32 weeks of gestation, one premature delivery at the same week, and one abortion of unknown etiology at 12 weeks of gestation. We discuss that the presence of homozygosity for Factor V Leiden may be associated with placental insufficiency in this woman. Application of anticoagulant therapy may have been beneficial in her current pregnancy. Received: 1 February 2000 / Accepted: 9 May 2000     

Evaluation of factor V Leiden, prothrombin and methylenetetrahydrofolate reductase gene mutations in patients with severe pregnancy complications in northern Finland

BACKGROUND: Thrombosis in placenta may lead to severe pregnancy complications. Most important inherited thrombophilias are factor V Leiden mutation, prothrombin mutation, and methylenetetrahydrofolate reductase mutation. The aim of our research was to evaluate the prevalence of inherited thrombophilias in severe pregnancy complications and in normal pregnancies. MATERIAL AND METHODS: The study subjects with severe preeclampsia, intrauterine growth restriction, placental abruption or fetal death were collected during the period 1999-2004 from Oulu University Hospital. We also collected during the same period voluntary parturients with normal pregnancy outcome as the control group. FVL, FII, and MTHFR gene mutations of the patients and controls were analyzed. RESULTS: We found a significant difference in the prevalence of FVL mutation between the groups. There were 9.5% FVL mutations in the study group compared to 1.8% in the control group; the observed difference between prevalences was 7.7% (95% CI 2.0-13.4). No statistical difference was found in the FII or MTHFR mutations between the groups. All FV and FII mutations were heterozygous and all the MTHFR mutations homozygous. CONCLUSION: Women with thrombophilia have a risk for severe pregnancy complications. Randomized controlled trials are needed to assess the influence of low-molecular-weight heparin in pregnant women with thrombophilia.     

B-Lynch suture after the failure of hypogastric artery ligation to control post-partum hemorrhage due to placenta increta in a patient with the factor V Leiden mutation

Post-partum hemorrhage may be a life-threatening condition. A case of a patient receiving antithrombotic therapy for the factor V Leiden mutation, in whom post-partum hemorrhage had occurred due to placenta increta, is described. In this case, the post-partum hemorrhage did not respond to bilateral hypogastric artery ligation, while the B-Lynch surgical technique was successful in obtaining hemostasis.     

Can we identify risk factors during pregnancy for thrombo-embolic events during the puerperium and later in life?

Objectives: To investigate parturients at risk to develop venous thrombo-embolic events (VTE) in the puerperium or later in life, during a follow-up of more than a decade and compare risk factors for VTE during the puerperium with VTE later in life.

Methods: A nested case–control study was conducted to profile parturients at risk for VTE and a secondary analysis to compare risk factors for VTE during or after puerperium. We used a cohort of 95?257 women who gave birth between the years 1988 and 1998.

Results: Independent risk factors to develop VTE were peripartum hysterectomy, stillbirth, cesarean delivery (CD), obesity, pregnancy-related hypertension, grandmultiparity and advanced maternal age. Women undergoing CD and those receiving blood transfusion were more likely to develop early versus late VTE (OR?=?2.0, 95% CI?=?1.15–3.5 and OR?=?11.0, 95% CI?=?2.25–55.5; respectively). Patients that encountered VTE during the puerperium had more pulmonary emboli and less deep vein thrombosis, compared with the late VTE group (p?Conclusions: Maternal age, grandmultiparity, pregnancy-related hypertension, CD, obesity, stillbirth and peripartum hysterectomy are independent risk factors for the development of VTE. CD and blood transfusion were predictive of early versus late VTE.     

Treatment with the long-acting insulin analogues detemir or glargine during pregnancy in women with type 1 diabetes: comparison of glycaemic control and pregnancy outcome

Objective: To compare glycaemic control and pregnancy outcome in women with type 1 diabetes treated with the long-acting insulin analogues detemir or glargine. Methods: Retrospective study of singleton pregnancies from 2007 to 2011 in women with type 1 diabetes with a single living fetus at 22 weeks using either insulin detemir (n = 67) or glargine (n = 46) from conception. Results: Baseline characteristics were similar in the detemir and glargine groups. Haemoglobin A_1c was comparable at 8 weeks (median 6.6% (range 5.6–9.8) vs. 6.8% (5.4–10.1), p = 0.15) and at 33 weeks (6.1% (5.1–7.6) vs. 6.2% (4.8–7.2), p = 0.38). The incidence of severe hypoglycaemia was comparable (15 (23%) vs. 10 (23%), p = 0.98). Pre-eclampsia occurred in 9 (14%) vs. 8 (18%), p = 0.52, pre-term delivery in 21 (31%) vs. 16 (35%), (p = 0.70) and 33 (49%) vs. 14 (30%) infants were large for gestational age (p = 0.046). No perinatal deaths were observed. One offspring in each group was born with a major congenital malformation. Conclusions: Glycaemic control and pregnancy outcome were comparable in women using insulin detemir or glargine, except for a lower prevalence of large for gestational age infants in women on glargine. The use of both long-acting insulin analogues during pregnancy seems safe.