Objective To determine whether there is an association between early recurrent miscarriage (before 10 weeks of pregnancy) and Factor V Leiden and G20210A prothrombin mutations. Design A prospective study.Setting Department of Gynaecology and Obstetrics, Saint Antoine Hospital, Paris, France.Population Two groups of women: those with early unexplained recurrent miscarriage before 10 weeks of pregnancy (n ¼ 260) and control healthy women without a previous history of thromboembolism (n ¼ 240). Methods Screening for defects in the protein C anticoagulant pathway was performed using the anticoagulant response to agkistrodon confortrix venom (ACV test). Protein C and Factor V Leiden mutation testing was performed for each low ACV level. Each sample was tested for the G20210A prothrombin mutation. Results Factor V Leiden and G20210A mutations were found to be associated with early recurrent spontaneous miscarriage before 10 weeks of pregnancy, the odds ratios being 2.4 (95% CI 1-5) and 2.7 (95% CI 1-7), respectively. Similar results were found whether or not women had had a previous live birth. Conclusions Early recurrent miscarriage before 10 weeks of pregnancy is significantly associated with Factor V or G20210A prothrombin mutations. These results indicate a possible role for anticoagulant prevention in these early miscarriages.

Cytokine expression is thus finely tuned in peripheral blood during pregnancy, in a previously unexpected complex pattern, related to gestational stage.

Objectives To investigate the association between iodine status and reproductive failure in a population of West African women. Design Epidemiological survey on iodine deficiency disorders carried out in 1996–1997. Setting The iodine deficient areas of Senegal (Casamance and Senegal Oriental). Population Four thousand nine hundred and eighty women, aged 10 to 50, of whom 1544 adolescent and 462 pregnant women were examined for thyroid size and urinary iodine excretion. Their iodine status was associated with their fertility rate and reproductive failures. Results Reproductive failure (defined as repeated miscarriages and stillbirth) was associated with low iodine status, with severe iodine deficiency increasing the risk. Poor nutritional status and illiteracy had a significant effect on the outcome of pregnancy: underweight women had a fourfold higher risk, and those who were illiterate an eightfold higher risk, of failed pregnancy, compared with nutritionally healthy, literature women. Conclusions These findings emphasise the need to implement an effective iodine supplementation programme targeted at young and pregnant women in this area of western Africa. They also emphasise the importance of improving the nutritional status of young girls and the crucial role played by education in the prevention of reproductive failure.

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